Depression Flashcards
(33 cards)
Core symptoms of depression (2)
Persistent low mood
Anhedonia
DSM classification of depression?
Presence of at least 5/9 symptoms present for at least 2 weeks causing significant distress or impairment in function
Other defining symptoms of depression (7)
Fatigue/anergia Excessive or inappropriate guilt Recurrent thoughts of death/suicidality Loss of concentration Psychomotor agitation/retardation Insomnia/hypersomnia Changes in appetite/weight loss
What is the two-question approach recommended by NICE in at-risk groups?
During the past month, have you a) felt low, depressed or hopless b) had little interest or pleasure in doing things?
Self-report symptom scales which may be used to assist in diagnosis?
Patient Health Questionnaire
Hospital Anxiety and Depression Scale (needs to be purchased)
Beck’s Depression Inventory
Suicide risk factors?
Previous suicidality/self harm Male gender Unemployment Living alone Being unmarried Alcohol/drug dependence Physical health problems
Management of persisting subthreshold symptoms or mild-moderate depression (2)
Consider watchful waiting, assessing again normally within two weeks
Low intensity psychosocial interventions such as individual guided self-help, computerized CBT
In what circumstances would you consider antidepressants in mild to moderate depression? (3)
People with a history of depression
Persistent refractory subthreshold symptoms
Concomitant chronic physical health problem
Management of moderate-severe depression (2)
Antidepressant + high intensity psychological intervention
Why are SSRIs recommended as first-line antidepressant? (3)
They are as effective as TCAs , safer in overdose and less likely to be discontinued as a result of side effects
Examples of SNRIs (2)
Venlafaxine
Duloxetine
Why is sertraline preferred in chronic physical health problems?
Lower risk of drug interactions
Why consider gastroprotection with SSRIs?
Increased risk of upper GI bleeding particularly in patients on aspirin/NSAIDs
How long does it take for symptoms to improve?
At least 2-4 weeks
How long should antidepressants continue to be taken after remission?
6 months (at least)
How often should young people/people at risk of suicide be reviewed initially?
Within one week, then every two-four weeks for the first three months
Side effects of antidepressants to monitor/be aware of
Suicidal thoughts and suicide attempts Anxiety, agitation or insomnia Hyponatraemia Sexual dysfunction Nausea/GI upset- usually transient
Which class of drugs is most likely to cause sexual dysfunction?
SSRIs
If response is absent/minimal by three to four weeks…?
Increase dose
Switch to different SSRI
Switch to a different class
How long should antidepressants be discontinued over?
Four weeks
In what situation might an SSRI such as sertraline be particularly useful?
Concurrent anxiety disorders e.g. GAD, panic disorders, OCD
SSRIs are contraindicated in..?
Poorly controlled epilepsy
SSRIs should be used with caution in…(3)
Patients with conditions/other meds causing hyponatraemia, QTc prolongation, GI bleeding risk
In what situation might mirtazapine be useful? (3)
Poor sleep
Poor appetite
Where SSRIs are contraindicated
