Depression Flashcards
Definition
Abnormalities in dopamine signalling result in poor concentration and motivation, whereas noradrenaline may play a role in fatigue, and together with serotonin contribute to physical symptoms.
Epidemiology
- Age > 65 years
- Female
- Postpartum: 20% of women have a depressive episode in the first 3 months after delivery
- Family history: having a first-degree relative increases the lifetime risk by two-fold
- Co-morbidities: long term health conditions e.g. chronic pain, heart failure
- Medications: e.g. corticosteroids, COCP
- Abuse: childhood, physical, sexual, psychological, or drug abuse
Core Symptoms
Low mood
Anhedonia: diminished interest or pleasure activities
Associated symptoms
- Functional impairment: in social and/or occupational function
- Weight change: weight loss or gain, with decreased or increased appetite
- Sleep disturbance: insomnia or hypersomnia
- Psychomotor agitation or retardation
- Feeling of worthlessness or guilt
- Suicidal ideation
- Poor concentration
- Low energy or fatigue
Screening questions
During the last month have you often been bothered by feeling down, depressed, or hopeless?
Do you have little interest or pleasure in doing things?
Diagnostic criteria
DSM-IV
ICD-10
Validated questionairres
- Patient Health Questionnaire (PHQ-9) : a 9 item questionnaire reflecting the DSM criteria
- Beck depression inventory-II (BDI-II): a 21 item questionnaire reflecting the DSM criteria
- Hospital Anxiety and Depression (HAD) scale : a 14 item questionnaire consisting of questions on anxiety and depression
-Edinburgh Postnatal Depression Scale: If postpartum depression is suspected, the may be used 4-6 weeks after delivery
Diagnosis
Clinical diagnosis
Consider:
- Bloods
- Validated questionnaire
Treatment
Mild to moderate:
- Low-intensity psychosocial interventions : computerised CBT
- Antidepressants: usually an SSRI e.g. citalopram, or
High-intensity psychological interventions : offered over 3 to 4 months, e.g. CBT
Moderate to severe:
- Anti-depressant: usually SSRI e.g. citalopram
- High-intensity psychological interventions: CBT or interpersonal therapy
Severe:
- Electroconvulsive therapy
What medication is preferred in Children
First line SSRI - Fluoxetine
In which patients should SSSRI’s be avoided
Patients on warfarin
- Mirtazapine = alternative
Mirtazapine side ffects
Drowsiness and increased appetite; it is good in elderly patients with insomnia and reduced appetite; to be taken in the evening
SSRI side effects
Increased risk of upper GI bleed
Co-prescribe omeprazole
Which SSRI is preferred for post MI
Sertraline