Depression Flashcards
(131 cards)
1
Q
Lifetime prevalence of depression
A
13%
2
Q
One year prevalence of depression
A
5.3%
3
Q
Mean age of onset of depression
A
30 years
4
Q
Mean number of episodes of depression in patients with lifetime major depressive disorder
A
5
5
Q
Percentage of patients with major depressive disorder who attempt suicide
A
9%
6
Q
Most common change of diagnosis from an initial diagnosis of depressive disorder
A
Schizophrenia and related disorders
7
Q
Percentage of patients who have had a depressive episode who have an episode of mania within 10 years
A
10%
8
Q
Percentage of seriously depressed hospitalised patients who develop an episode of mania within 10 years
A
Nearly 50%
9
Q
Factors associated with an increased chance of change from unipolar depression to bipolar disorder
A
Younger age
Family history of bipolar disorder
Anti-depressant induced hypomania
Hypersomnia
Psychotic depression
Postpartum depression
10
Q
Average length of time of an untreated depressive episode
A
6-13 months
11
Q
Average length of time of a treated depressive episode
A
3 months
12
Q
Percentage chance of recurrence after a depressive episode
A
50%
13
Q
Percentage chance of recurrence after two depressive episodes
A
70%
14
Q
Percentage chance of recurrence after three depressive episodes
A
80-95%
15
Q
Percentage reduction in symptoms of depression for someone to have a treatment response
A
50%
16
Q
Percentage reduction in symptoms of depression for someone to have a partial treatment response
A
26-49%
17
Q
Criteria required to be in remission from depression
A
No scales can detect meaningful measure of depression
No symptoms after the natural period of a treated episode is over (3 months)
18
Q
Criteria for a relapse of depression
A
Further depressive episode after remission has been achieved but before recovery has been achieved
19
Q
Criteria for a recurrence of depression
A
Further depressive episode after recovery has been achieved
20
Q
Treatment options for mild depression
A
Watch and wait
CBT or other talking therapies
21
Q
Time frame for review if adopting watch and wait strategy for mild depression
A
Within 2 weeks
22
Q
First line of antidepressants
A
SSRIs
23
Q
First line treatment for an initial presentation of severe depression
A
Antidepressants along with CBT
24
Q
Length of time to continue antidepressants for patients with a moderate or severe episode
A
At least 6 months after remission
25
Length of time to continue antidepressants for patients with an episode of depression who have residual symptoms
At least two years
26
Length of time to continue antidepressants for patients with an episode of depression who have had >2 episodes in the recent past
At least two years
27
Criteria for using ECT in depression
After an adequate trial of other treatments has been ineffective
OR
If the condition is potentially life threatening
28
Number needed to treat for an antidepressant response in adults
4-5
28
Three phases of depression treatment as per Hirschfield
Acute
Continuation
Maintenance
29
Time frame and aim of the acute phase of depression treatment
Stabilisation of acute symptoms
For up to three months
30
Time frame of the continuation phase of depression treatment
6-12 months, to cover the natural (if untreated) course of a depressive episode
31
Time frame of the maintenance phase of depression treatment
From 12 months onwards, aiming to prevent recurrences
32
Percentage rate of relapse of depression on placebo vs. on active treatment, once the initial episode had finished
41% on placebo
18% on active treatment
33
Largest antidepressant study carried out
STAR*D
34
Year in which the STAR*D trial was completed
2006
35
Level 1 treatment in the STAR*D study
Patients given citalopram for up to 12 weeks
36
Level 2 treatment in the STAR*D study
Four different options:
1. Citalopram was switched to an alternative antidepressant (bupriopion, sertraline, or venlafaxine XL)
2. Citalopram was augmented with another antidepressant (bupropion or buspirone)
3. Citalopram was switched to cognitive therapy
4. Cognitive therapy was added to citalopram
37
Level 3 treatment in the STAR*D study
Four different options:
1. Patients were switched to mirtazapine
2. Patients were switched to nortriptyline
3. Treatment was augmented with lithium
4. Treatment was augmented with thyroid medication
38
Level 4 treatment in the STAR*D study
Two options:
1. Patients were switched to tranylcypromine
2. Patients were switched to a combination of venlafaxine XL and mirtazapine
39
Criteria for moving patients up a level on the STAR*D study
If they had not achieved remission by 12 weeks of the previous level's treatment
40
Method to decide which treatment option each patient received within each level of the STAR*D study
Patient choice
41
Percentage of patients on level 1 of the STAR*D study who achieved remission from their depression symptoms
37%
42
Cumulative remission rate of all patients in the STAR*D study
67%
43
Factors associated with immediate drop out of the STAR*D study
Younger age
Lower education level
Higher perceived mental health functioning
44
Class of antidepressants that carry a black box warning for suicidality in under 18s
SSRIs
45
Risk of suicidal behaviour associated with antidepressants in patients aged <25
Increased
46
Risk of suicidal behaviour associated with antidepressants in patients aged 25-64
Neutral
47
Risk of suicidal behaviour associated with antidepressants in patients aged >64
Decreased
48
Class of antidepressant which shows the highest toxicity in overdose
TCAs
49
Class of antidepressant which shows the lowest toxicity in overdose
SSRIs
50
'5 As' which can lead to an apparent resistance to antidepressant treatment
Alcoholism
Adequate dosage (lack of)
Adherence (lack of)
Axis 2 disorders (personality disorders)
Alternate diagnosis
51
Two classes of antidepressant which combined have the highest risk for serotonin syndrome
SSRIs and MAOIs
52
Combination of antidepressants which is known as Californian rocket fuel due to its perceived efficacy in treatment resistant depression
Venlafaxine and mirtazapine
53
Pharmacokinetic method by which SSRI and TCA combination can improve treatment efficacy
SSRIs inhibit TCA metabolism
54
Two most common comorbidities of depression
Anxiety
Alcohol use disorder
55
Percentage of patients with depression who receive antidepressants in a year
21%
56
Increased risk of suicide among patients with mood disorder compared to the general population
14x higher
57
Number of episodes experienced by patients with bipolar compared to unipolar depression
2x higher in patients with bipolar
58
SSRI with the highest toxicity in overdose
Citalopram
59
Mechanism of action of agomelatine
5HT2c antagonist
60
Options for treatment of sexual side effects from antidepressants
Add sildenafil or tadafinil
Add bupropion
Switch of antidepressant
Reduce dose of antidepressant
61
Plant which St John's Wort is derived from
Hypericum perforatum
62
Mechanism of action of ketamine as an antidepressant
Blocks glutamatergic NMDA receptors
Upregulates AMPA receptors
63
Speed of action of ketamine as an antidepressant
Rapid - better than placebo at 24 hours
64
Mechanism of action of SSRI related sexual dysfunction
5HT2 stimulation
65
Factors associated with treatment discontinuation in depression
Younger age
Ethnic minority status
Male sex
Unemployment
Lower educational level
Lower income
Greater depressive symptom burden
Higher anxiety levels
66
Effect of previous depressive episodes on treatment drop out rates
Lowers likelihood of treatment drop out
67
In comorbid anxiety and depression, illness which should usually be treated first
Depression
68
Number needed to treat for antidepressants
5-7
69
Treatment status of most patients with depression who attempt suicide
Unmedicated
70
Length of time over which treatment emergent suicidal ideation associated with antidepressants disappears in adults
4-6 weeks
71
Herbal remedy with evidence for its use to treat depression
St John's Wort (Hypericum perforatum)
72
Most common psychiatric diagnosis in patients with chronic fatigue syndrome
Depression
73
Time required after stopping phenelzine and before starting fluoxetine
2 weeks
74
Symptoms of the first stage of bereavement
Disbelief
Numbness
Searching behaviour
75
Symptoms of the second stage of bereavemenet
Withdrawal
Somatic symptoms
Preoccupation
Guilt
Anger
76
Symptoms of the third stage of bereavement
Resuming old roles
Returning to work
Acquiring new roles
Experiencing pleasure again
Seeking companionship in others
77
Class of antidepressants which can cause peripheral neuropathy
MAOIs
78
Most common neurological side effect of SSRIs
Headache
79
SSRI most likely to cause headaches
Fluoxetine
80
Male:female ratio for major depression
1:2
81
Antidepressant most likely to cause priapism
Trazodone
82
Antidepressant most likely to cause vaginismus
Paroxetine
83
Symptom inventory which measures symptoms of both anxiety and depression
Hopkins symptoms checklist
84
Antidepressant most likely to cause urinary hesitancy
Reboxetine
85
UK licensed dose for treatment of depression with mirtazapine
15-45mg daily
86
UK licensed dose for treatment of depression with venlafaxine
75-375mg daily
87
UK licensed dose for treatment of depression with duloxetine
60-120mg daily
88
UK licensed dose for treatment of depression with citalopram
20-60mg daily
89
UK licensed dose for treatment of depression with sertraline
50-200mg daily
90
UK licensed dose for treatment of depression with escitalopram
10-20mg daily
91
Best way to switch antidepressants from fluoxetine to moclobemide
Stop fluoxetine
Wait five weeks before starting moclobemide
92
Best way to switch antidepressants from a MAOI to an SSRI
Stop MAOI
Wait two weeks before starting SSRI
93
Best way to switch antidepressants between SSRIs
Cross taper cautiously
94
Best way to switch antidepressants from an SSRI/SNRI to mirtazapine
Cross taper cautiously
95
Treatment options for antidepressant induced hyponatraemia
Change class of antidepressant from SSRI e.g. to reboxetine, lofepramine or a MAOI
Demeclocycline
96
First line antidepressant in hepatic impairment
Imipramine
97
Likely safest antidepressants in renal impairment
Sertraline
Citalopram
98
Safest antidepressants for patients with epilepsy
SSRIs
Moclobemide
99
Antidepressants which should be avoided in patients with epilepsy
Amitryptyline
Dothiepin
100
Phase one in a normal grief reaction
Shock and protest
Disbelief
101
Phase two in a normal grief reaction
Preoccupation
Yearning and searching
102
Phase three in a normal grief reaction
Disorganisation
Despair and then acceptance of loss
103
Phase four in a normal grief reaction
Resolution
104
Features of inhibited grief
Absence of expected grief symptoms at any time
105
Features of delayed grief
Avoidance of painful symptoms within two weeks of the loss
106
Features of chronic grief
Ongoing significant grief symptoms more than six months after the loss
107
Nutritional causes of depression
Pellagra (niacin deficiency)
Vitamin B12 deficiency
108
Alternative name for pathological crying
Pseudobulbar affect
109
Features of pathological crying
Frequent, sudden loss of emotional control
Occurs in response to small or inappropriate stimuli
Not associated with the patient's background mood
110
Medical conditions most often associated with pathological crying
Stroke
MS
111
Medication options for pathological crying
Citalopram
Sertraline
Sodium valproate
Combination of dextromethorphan and low dose quinidine
Amitryptyline
Fluoxetine
112
Medication advised if an antidepressant switch is required due to antidepressant induced prolactinaemia
Mirtazapine
113
Length of time after starting an antidepressant that a patient should be reviewed in clinic
2 weeks
1 week if <30 or suicide risk identified
114
Medication licensed for self mutilating behaviour
Lithium
115
Medication shown to improve confusion after ECT
Donepezil
116
Length of time an antidepressant should be trialled before considering a switch if there is no benefit seen
4 weeks
117
First choice treatments for refractory depression
Lithium + AD
Olanzapine + fluoxetine
Quetiapine + SSRI/SNRI
Aripiprazole + AD
Bupropion + SSRI
SSRI/venlafaxine + mirtazapine/mianserin
ECT only if specific risk factors
118
General accepted definition of refractory depression
Depression which has not responded to two attempts at treatment adequate dose/length of time
119
Medications advised for pathological crying post stroke
Citalopram
Sertraline
120
Antidepressants which should be avoided in combination with tamoxifen
Fluoxetine
Paroxetine
121
Least effective antidepressant class for atypical depression
TCAs
122
Most effective antidepressant class for atypical depresson
MAOIs
123
First line treatment for psychotic depression
TCA plus antipsychotic - either olanzapine or quetiapine
124
Antipsychotic said to have an antidepressant effect when used at low doses
Flupentixol
125
Condition for which phototherapy has the most evidence for efficacy
SAD
126
Number of times an SSRI should usually be tried for depression before another class of drug is considered
Twice
127
Type of epilepsy where depression is most often comorbid
Complex partial seizures
128
Class of antidepressant which can cause HTN
SNRI
129
TCA safest in overdose
Lofepramine
130
Antidepressant recommended for a woman also taking tamoxifen
Venlafaxine
