Depression

Question 1

DSM IV criteria for Dx of depression

Answer 1

1. Depressed mood most of the day, nearly every day
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
3. Significant weight loss or weight gain when not dieting or decrease or increase in appetite nearly every day
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day
8. Diminished ability to think or concentrate, or indecisiveness nearly every day
9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Question 2

What is the diagnosis in < 5 symptoms

Answer 2

Mild depression

Question 3

Symptoms or functional impairment are between ‘mild’ and ‘severe - WHAT IS THE DIAGNOSIS

Answer 3

Moderate depression

Question 4

Most symptoms, and the symptoms markedly interfere with functioning. Can occur with or without psychotic symptoms. WHAT IS THE DIAGNOSIS

Answer 4

Severe depression

Question 5

Mx of mild depression

Answer 5

1. CBT

2. General measures - exercise, sleep hygiene

Question 6

What are the biological (somatic) symptoms associated with depression?

Answer 6

Problems with sleep - especially early morning wakening
Depression worse in the morning
Marked loss of appetite - might have weight loss as a result
Psychomotor retardation or agitation
Loss of libido

Question 7

What are the cognitive symptoms associated with depression?

Answer 7

Reduced concentration and memory
Low self esteem
Guilt
Hopelessness
Thoughts of suicide or self harm

Question 8

What are the first line antidepressant medications?

Answer 8

SSRI’s

Question 9

If SSRI’s are not found to be helping a depressed patient after 4-8 weeks, what should the clinician do now/

Answer 9

Either choose another SSRI or more commonly start them on mirtazapine.

Question 10

What is severe depression characterised by?

Answer 10

Psychotic symptoms

Question 11

What is the mechanism of action of Mirtazapine?

Answer 11

It is a presynaptic alpha-2 blocker which results in increased release of noradrenaline and serotonin from pre-synaptic membrane.

Question 12

What are the side effects of Mirtazapine?

Answer 12

Drowsiness
Weight gain
Rare cases of neutropenia