Depression

Question 1

F:M depression

Answer 1

2:1

Question 2

Screening questions for depression

Answer 2

• Over last mo, have you been bothered by feeling down, depressed or hopeless?
• over the last mo, have you been bothered by having little interest or pleasure in doing things?

Question 3

Core sx of depression

Answer 3

• persistent low mood
• loss of interest/pleasure
• fatigue

Question 4

Other sx of depression

Answer 4

disturbed sleep
poor concentration
low self esteem
change in appetite
suicidal thoughts
feeling of worthlessness/guilt

Question 5

DSM IV use

Answer 5

assesses number of core and general sx of depression present

Question 6

What is sub threshold depression

Answer 6

4 or fewer of DSM IV depression sx is sub threshold depression

Question 7

What is Dysthymia

Answer 7

Sub threshold depression persisting for 2 yrs

aka chronic subthreshold depression

Question 8

What is the questionnaire for depression

Answer 8

PHQ-9

Question 9

Stepped care model of depression mx

Answer 9

Step 1: known or suspected presentations of depression
Step 2: persistent sub threshold or mild to moderate depression
Step 3: persistent sub threshold or mild to moderate depression with inadequate response to step 2 and Moderate to severe depression
Step 4: Severe and complex depression; severe self-neglect

Question 10

Step 1 mx of depression

Answer 10

Support,
Psychoeducation
Active monitoring

Question 11

Step 2

Answer 11

low intensity psychological interventions (eg Cognitive behavioural therapy, CBT or structured group physical activity programme)
Consider meds/referral if sx persist

Question 12

Step 3

Answer 12

• Meds

- high intensity psychological interventions (one to one psychotherapy)

Question 13

Step 4

Answer 13

• meds
• high intensity psychological interventions (one to one psychotherapy)
• electroconvulsive therapy
• crisis services
• in patient care

Question 14

Problem solving therapy

Answer 14

step 2 mx

• write a list of problems,
• rank them in order of importance
• suggest solutions

Question 15

Cognitive behavioural therapy (CBT)

Answer 15

• changing the way pt think/react
• may involve systemic desensitisation (behavioural method)
• or focussing on peoples thoughts and reasoning to challenge assumptions

Question 16

Mindfullness based cognitive therapy

Answer 16

for people who are well currently but have a hx of 3 prvs depressions

Question 17

How long do most antidepressants take to work

Answer 17

1-2 wks

Question 18

How long for antidepressants to reach their peak effect

Answer 18

4-6 wks

Question 19

When most SEs of antidepressants start to ease

Answer 19

2 wks post start

Question 20

Main SEs of most antidepressants

Answer 20

GI problems:
- nause
- dry mouth
Increased anxiety

Question 21

Monitoring after starting on antidepressants

Answer 21

Every 2 peaks until stable

Unless <30 or increased risk of suicide (every 1 wk)

Question 22

How long should a course of antidepressants be

Answer 22

6 mo, but can be longer if they opt for it

- if 2 or more episodes of major depression, then 2 yrs

Question 23

Discontinuation reaction to antidepressants

Answer 23

• if used more than 2mo, then suddenly stopped

- sx include headache, nausea, paraesthesia, dizziness, anxiety

Question 24

How to avoid discontinuation reaction to antidepressants

Answer 24

weaning off over a period of about 1 mo

Question 25

Meds used for depressin

Answer 25

``` SSRI SNRI TCA MAOi Mirtazapine ```

Question 26

SSRI examples

Answer 26

citalopram, fluoxetine, paroxetine sertraline (fewest interactions)

Question 27

SNRI examples

Answer 27

Duloxetine or venlafaxine

Question 28

TCA example

Answer 28

Lofepramine

Question 29

MAOi example

Answer 29

phenelzine

Question 30

Mirtazapine mech of action

Answer 30

presynaptic alpha2 antagonist