Depression Flashcards
(25 cards)
What is depression?
A disorder that causes persistent feelings of low mood, low energy, and reduced enjoyment of activities.
What is the pathophysiology of depression?
Not fully understood but likely involves a combination of complex mechanisms, particularly a disturbance in neurotransmitter activity in the CNS, especially serotonin (5-HT).
What are the causes of depression?
Can be triggered by life events, can occur without any apparent trigger, and can be caused by genetic, psychological, biological, and environmental factors. An affected relative is a significant risk factor. Physical health conditions can trigger or exacerbate depression, commonly with conditions such as stroke, MI, MS, and Parkinson’s.
What are the core symptoms of depression?
Low mood and anhedonia (a lack of pleasure or interest in activities).
What are the emotional symptoms of depression?
Anxiety, irritability, low self-esteem, guilt, and hopelessness about the future.
What are the cognitive symptoms of depression?
Poor concentration, slow thoughts, and poor memory.
What are the physical symptoms of depression?
Low energy, abnormal sleep (especially early morning waking), poor appetite or overeating, and slow movements.
What are some environmental factors that can contribute to depression?
Potential triggers (e.g., stress, grief), home environment (e.g., housing situation), relationships with family, friends, colleagues, work-related stress, unemployment, financial difficulties (e.g., poverty and debt), and safeguarding issues (e.g., abuse).
What are some key factors to explore when taking a history for depression?
Caring responsibilities (e.g., children or vulnerable adults), social support, drug use, alcohol use, and forensic history (e.g., violence or abuse).
What should be looked for in a risk assessment for depression?
Self-neglect, self-harm, harm to others (including neglect), and suicide.
What is used to assess the severity of depression?
PHQ-9 questionnaires, which consist of 9 questions asking how often the patient is experiencing symptoms in the past 2 weeks. Scores: 5-9 = mild depression, 10-14 = moderate depression, 15-19 = moderately severe depression, 20-27 = severe depression.
How can depression be managed?
Active monitoring and self-help, addressing lifestyle factors (e.g., exercise, diet, stress, alcohol), therapy (e.g., CBT, counselling or psychotherapy), and antidepressants (e.g., SSRIs).
When may admission for depression be required?
Self-harm risk, suicide, self-neglect, or immediate safeguarding issues.
What are some additional specialist treatments for unresponsive or severe depression?
Antipsychotic medications (e.g., olanzapine or quetiapine), lithium, and ECT.
What is ECT?
Treatment for severe, medication-resistant, and psychotic depression, administered twice weekly for four weeks. Under GA, electrodes are placed on the patient’s head, and a brief electrical current is administered, triggering a short generalized seizure lasting around 30 seconds.
What are some potential side effects of ECT?
Headache, muscle aches, and short-term memory loss.
What is psychotic depression?
This depression involves symptoms of psychosis: delusions (strongly held and clearly untrue beliefs), hallucinations (hearing or seeing things that are not real), and thought disorder (disorganized thoughts causing abnormal communication and behavior).
How is psychotic depression treated?
Combination of antipsychotics (e.g., olanzapine or quetiapine) and antidepressants. ECT is also an option.
What are some postnatal mental health issues?
Baby blues (majority of women experience this in the first week after birth), postnatal depression (1 in 10 women, peaking around 3 months after birth), and puerperal psychosis (starts a few weeks after birth).
What are baby blues and their treatment?
Symptoms include mood swings, low mood, anxiety, irritability, and tearfulness. Usually mild and resolve within 2 weeks of delivery; no treatment needed.
What is postnatal depression?
Characterized by low mood, anhedonia, and low energy, usually occurring after 3 months post-birth. Symptoms must last for 2 weeks for diagnosis. Treatment is similar to depression.
What is puerperal psychosis?
Severe illness with onset between 2-3 weeks after delivery, characterized by symptoms of psychosis (e.g., hallucinations, delusions, mania, confusion, thought disorder). Urgent assessment and specialist mental health input are needed.
What is the management of puerperal psychosis?
May require admission to a mother and baby unit, medications, and potentially ECT.
