Depression

Question 0

How long do depression symptoms need to be present for to make it depression?

Answer 0

2 weeks

Question 1

What are the three core symptoms of depression?

Answer 1

Persistent low mood
Anhedonia
Fatigue

Question 2

What are the common side effects of antidepressants?

Answer 2

GI upset 
Sleep effects 
Agitation 
Sexual dysfunction
Hyponataemia
GI bleed (antiplatelet activity)
Suidical risk

Question 3

With MAOI inhibitors what foods can you eat and why?

Answer 3

Tyramine rich foods so cheese, red wine, bovril

Can cause a hypertensive crisis

Question 4

What factors might suggest that CBT should be used over pharmacological methods?

Answer 4

Pt has mild/moderate depression
Pt is willing to think about psych issues
Willing to engage and carry out homework (motivated)
Pt would prefer psych treatment over pharma

Question 5

All the standard antidepressants used in psych are
monoamine reuptake inhibitors
or
monoamineoxidase inhibitors?

Answer 5

Mono amine reputake inhibitors

Question 6

Name some mono amines

Answer 6

Histamine 
Dopamine 
Noradrenaline 
Adrenaline 
Melatonin

Question 7

Name some catecholamines?

Answer 7

Noradrenaline
Adrenaline
Dopamine

Question 8

How long should someone stay on antidepressant treatment after they have recovered from their first episode?

Answer 8

6-9 months

Question 9

If someone has multiple episodes how long should they stay on antidepressant therapy for?

Answer 9

2 years

Question 10

Why does someone need antidepressant therapy after they have recovered?
How effective is this?

Answer 10

To reduce the rate if relapse

Cuts relapse rates by 50%

Question 11

If the therapy isn’t working what are the first things you should do?

Answer 11

Compliance
Increase to max dose
Review the case for correct diagnosis and ask about perpetuating factors eg social issues/ alcohol / drugs etc

Question 12

If he antidepressant therapy still doesn’t work what are your options?

Answer 12

Switch drug to SSRI or mirtrazapine then
Add lithium in severe depression
Add mirtrazapine
Add antipsychotic ( (psychotic symptoms/ agitated/ insomnia)
Add CBT

Question 13

If the depression is multi drug resistant what treatment options are there?

Answer 13

ECT

Question 14

When else might ECT be the best form of treatment?

Answer 14

When you need a quick response to treatment

Question 15

If someone has had one depressive episode what is the likelyhood that they will have another?

Answer 15

50%

Question 16

Is the management of depression in bipolar disorder the same a unipolar depression?

Answer 16

No

Question 17

What are the features of serotonin syndrome?

Answer 17

1)Autonomic dysfunction, 2)neuromuscular hyperactivity,
3) altered mental state
So
Tachycardia
Sweating
Shivering
Hyperthermia
Hyperreflexia

Question 18

Name some seretonergic drugs?

Answer 18

MAOI
Ltryptophan
Lithium
St johns wort

Question 19

What do SSRIs do?

Answer 19

Block the reputake transporters in the pre synapse to leave more seretonin in the cleft

Question 20

Name some SSRIs

Answer 20

Citolopram
Escitalopram
Fluoxetine 
Fluvoxamine malfeate
Paroxetine
Sertraline

Question 21

What are SNRIs?

Answer 21

Seretonin and noradrenaline reputake inhibitors

Question 22

Name an SNRI?

Answer 22

Venlefaxine

Question 23

What are SSRIs better that TCAs

Answer 23

Less side effects and less toxic in an overdose

Question 24

What is the antidepressant most likely to cause hyponatraemia? And in which patient group?

Answer 24

SSRI | Elderly

Question 25

Which of the SSRIs is most likely to give withdrawal effects?

Answer 25

Paroxcitine

Question 26

What is the medical name of at johns wort?

Answer 26

Hypericum

Question 27

Why do doctors advice against at johns wort?

Answer 27

Less well researched Various strengths for sale Interferes with other medications eg COCP

Question 28

What is the trade name of fluoxetine?

Answer 28

Prozac

Question 29

How do tricyclic antidepressants work?

Answer 29

Inhibit presynaptic noradrenaline and and seretonin transporters

Question 30

What other conditions are tricyclics used to treat?

Answer 30

Neuropathic pain Bladder instability Migraine prophylaxis

Question 31

TCAs can have an antimuscurinic effect. Name some antimuscurinic side effects?

Answer 31

Dry mouth Blurrd vision Constipation Urinary retention

Question 32

TCAs may interact with alpha 1 adrenergic receptors, what sideeffects can this cause?

Answer 32

Postural hypotension Drowsiness Sexual dysfunction

Question 33

What is the benefit about lofetramine (a TCA)?

Answer 33

Less side effects than the other | Relatively nonsedating

Question 34

Name three other receptors that tricyclics block

Answer 34

Muscurinic Alpha 1adrenergic Histamine

Question 35

Two main side effects of mirtrazapine (can be useful)

Answer 35

Weight gain | Sedative

Question 36

What is the therapeutic window for lithiumv

Answer 36

0.5-1mmol/L

Question 37

How often should lithium levels be measured?

Answer 37

At first weekly then every three months

Question 38

How soon after taking a lithium dose should levels be measured?

Answer 38

12 hours

Question 39

What are the side effects of lithium?

Answer 39

``` Tremor Dry mouth Polydipsia/polyuria Weight gain Hypothyroid ```

Question 40

What are the indications for lithium?

Answer 40

Bipolar Mania Recurrent depression Agressive self harming behaviour

Question 41

In tricyclic overdose will the pupils dilate or constrict?

Answer 41

Constrict

Question 42

What are the main two organs that lithium affects?

Answer 42

Kidneys and thyroid

Question 43

What are the signs of lithium toxicity?

Answer 43

Vomiting/ diarrhoea "Being drunk" ataxia in coordination slurred speech Course tremor

Question 44

If someone suspects lithium toxicity what should they do?

Answer 44

Drink lots of water Stop the lithium See GP/A&E

Question 45

If someone is taking lithium and it is working really well for their mood but they have a tremor, what drug can be added?

Answer 45

Beta blocker

Question 46

What common drug should you advise people taking lithium to avoid?

Answer 46

Ibruprofen

Question 47

What is the best SSRI in breast feeding?

Answer 47

Paroxitine- very small amounts in breast milk

Question 48

What is the risk of using SSRIs in pregnanacy?

Answer 48

In first tried ester chance of congenital heart defects | In third risk of withdrawal symptoms in baby