Depression

Question 1

DEPRESSION symptoms

Answer 1

• Depressed mood.
• Energy loss.
• Pleasure loss.
• Retardation.
• Eating changed.
• Sleep changed.
• Suicidal thoughts.
• ‘I’m a failure’.
• ‘Only me to blame’.
• No concentration.

Question 2

Early morning wakening definition

Answer 2

waking 2 hours early and not being able to get back to sleep every day for weeks

Question 3

Psychotic symptoms

Answer 3

• Delusions.
• Hallucinations (defamatory auditory and offensive olfactory).
• Retardation.
• Lack of insight.

Question 4

Mild depression criteria

Answer 4

2 core symptoms plus 2 others. Minor functional impairment.

Question 5

Depression core symptoms

Answer 5

2 LATE.
2 weeks duration.
Loss of interest.
Anhedonic.
TATT.
Energy loss.

Question 6

Moderate depression criteria

Answer 6

2 core symptoms plus 3 or 4 others.

Question 7

Severe depression criteria

Answer 7

Most symptoms. Core ones are severe. May be with or without psychotic symptoms. Symptoms MARKEDLY INTERFERE with functioning.

Question 8

Obsessive compulsive symptoms

Answer 8

Intrusive thoughts (unwanted e.g. ejaculating on own mother).
Repeat checking (e.g. is that the door is locked).

Question 9

Step 1 focus.

Answer 9

SCREENING.
During the last month, have you often been bothered by feeling down, depressed or hopeless?
During the last month, have you often been bothered by having little interest or pleasure in doing things?
IF YES, MOVE TO A FORMAL SCREENING TOOL/HISTORY.

Question 10

Step 1 intervention

Answer 10

self help
?antidepressants - ASSESS RISK OF SUICIDE.
?referral

Question 11

Step 2 focus

Answer 11

Recognised depression, mild/moderate - HOW SEVERE?

Question 12

Step 2 interventions

Answer 12

1st line - CBT (Computer/group)
Sleep hygiene.
Antidepressants

Question 13

Step 3 focus

Answer 13

Moderate and severe depression.

inadequate response to initial interventions.

Question 14

Step 3 interventions

Answer 14

Combined medication.
Collaborative care.
Referral.

Question 15

Step 4 focus

Answer 15

Severe, with risk to life/self neglect

Question 16

Step 4 interventions

Answer 16

Crisis service, multi professional input, admission, ECT.

Question 17

Name 2 tricyclics

Answer 17

Amitriptyline

Nortriptyline

Question 18

MoA of tricyclics

Answer 18

Inhibit reuptake of serotonin and noradrenalin

Question 19

Adverse effects of tricyclics

Answer 19

Sedation, confusion, tachycardia, postural hypotension, arrhythmias, antimuscarinic.
VERY DANGEROUS OD

Question 20

Name 2 SSRIs

Answer 20

Citalopram, Fluoxetine

Question 21

MoA of SSRIs

Answer 21

Inhibits reuptake of serotonin

Question 22

Adverse effects os SSRIs

Answer 22

Nausea, vomiting, anorgasmia, QT prolongation, serotonin syndrome.

Question 23

What is serotonin syndrome?

Answer 23

caused by too much serotonin (from OD, or combination of drugs). Agitation, diarrhoea, tachycardia, hypertension, hyperthermia.

VERY SIMILAR TO TCA OD, BUT WET SWEATING, NOT DRY AS A BONE.

Question 24

Name 2 MAOIs

Answer 24

Phenelzine (irreversible)

Maclobemide (reversible)

Question 25

MoA of MAOIs

Answer 25

inhibit the metabolism of neurotransmitter (by MAO)

Question 26

Adverse effect of MAOIs

Answer 26

postural hypotension, Dizziness, drowsiness. Cheese effect.

Question 27

What is the Cheese effect?

Answer 27

Cheese (and other foods) contains TYRAMINE. Usually this is metabolised, but MAOIs prevent its metabolism, and tyramine causes hypertension.

Question 28

Mirtazapine MoA

Answer 28

antagonises presynaptic adrenoreceptors - reducing negative feedback, so noradrenalin and serotonin remain in synapse for longer.

Question 29

first line choice of antidepressant

Answer 29

SSRI (routinely citalopram)

Question 30

How long will treatment take before benefits observed? (except MAOIs)

Answer 30

2-4 weeks, during which the Pt may feel worse due to adverse effects.

Question 31

How long should a course of antidepressant be taken for following the resolution of symptoms?

Answer 31

4 weeks

Question 32

If there have been 2 or more previous treatments for depression, how long should a new course be considered for?

Answer 32

2 years

Question 33

What options are there if a drug does not work?

Answer 33

Switch or augment.

Question 34

With what would an antidepressant be augmented?

Answer 34

Lithium, Antipsychotics, benzodiazepine.

Question 35

Benzodiazepine MoA

Answer 35

GABA agonist - causing increased inhibition of neurotransmission.

Question 36

What is a common side effect of antidepressants, especially SSRIs?

Answer 36

Hyponatraemia Thought to be as a result of it causing SIADH.