Depression Flashcards
(26 cards)
What are the 3 core symptoms of depression?
Low mood
Loss of interest and enjoyment in things (anhedonia)
Lack of energy or easy fatiguability
What are some other common symptoms of depression?
Reduced concentration and attention
Changes in appetite (can be increased or decreased) –> weight changes
Changes in sleep (increased or decreased)
Early morning waking (classed as being two hours before they would normally have to wake up)
Ideas or acts of self-harm or suicide
Feelings of guilt or worthlessness
Reduced self-esteem and self-confidence
Psychomotor retardation (particularly common in elderly)
Psychotic tendencies can occur (hallucinations)
How long do symptoms have to have persisted before it is classed as depression
> 2 weeks without resolution
If someone presents with low mood what is it important to ascertain?
Whether there are any triggers: if it a response to organic illness, bereavement/traumatic life event or due to the effects of drugs or alcohol then it probably isn’t classed as depression
What are some of the biological symptoms of depression?
Poor sleep (early waking >2h)
Reduced libido
Appetite changes
Reduced attention and concentration
DIURNAL VARIATION IN MOOD (important feature)
- mood is worse in early morning and gets better throughout day
How do we rank the severity of depression?
MILD = 2 core + 1 other symptom MODERATE = 2 core + 3 other symptoms SEVERE = 3 core + 4 other symptoms
What are some of the biological aetiologies of depression?
SEROTONIN DEPLETION
Familial mutation in serotonin transporter gene
Hypothyroid
Post natal
Dysregulation of the hypothalamic-pituitary axis (levels of cortisol)
Chronic pain
Medications (? beta-blockers)
What could be some psychological aetiologies of depression?
Childhood trauma Low self-esteem Lack of coping mechanisms - reactions to stressors Attitudes and beliefs Anxiety and guilt
What could some social aetiologies of depression?
Low SES Isolation Bereavement Poor housing Abuse Relationships Education
What are some of the biological managements of depression?
SSRIs: Sertraline, citalopram, fluoxetine TCAs: Amitriptyline, nortriptyline NASSAs: Mirtazapine SNRIs: Duloextine, venlafaxine MAOIs: Hydracarbazine
AUGMENTATION TREATMENTS: Li, Antipsychotics, Thyroxine
ECT
What are some of the psychological managements for depression?
Talking therapies:
- CBT
- IPT (interpersonal therapies) - looks at forming relationships and managing current ones
- Psychotherapy
- Group therapy
- Meditation and mindfulness
What are some social managements for depression?
Helping with housing
Job centre - employment aid
Education in community
Citizen advice bureau
What is the first line biological management for depression?
SSRIs - sertaline 50mg OD
What are some common side effects of SSRIs and what is it important to tell the patient?
GI problems, agitation, loss of appetite, loss of libido, dizziness, dry mouth, blurred vision
HYPONATRAEMIA is a common problem with SSRIs
-ALSO motivation recovers before mood so might increase suicide risk particularly in young men
Can take up to 4-6 weeks before there mood improves so important to keep up with therapy even when it doesn’t seem to be doing anything
How long do you have to stay on anti-depressants for?
Can stay on for a very long time
Usually 6-9 months AFTER the recovery of mood (to prevent relapse of symptoms)
if it is the second round of treatment then consider being on it for 2 years
What if the anti-depressant therapy doesn’t work?
Consider AUGMENTATION with Li, second antidepressant or anti-psychotic
OR consider an antidepressant switch
Also consider the persons alcohol consumption - can effect the drug
What are the indications for lithium?
Recurrent depression not controlled with antidepressants alone
Mania
BAD
Aggressive or self-mutilating behaviour
How is Lithium cleared?
Cleared by the kidneys so important to monitor kidney function - water and Na balance are also very important?
What baseline investigations do you need BEFORE starting Li?
ECG
FBC, U&E, TFT, Ca
Weight
Pregnancy test
What is the monitoring regime for Li?
Check Li levels 5 days after first dose
And then check every week until the levels have been stable and within range for 4 weeks
Then check every 3/12
Check U&E, Ca, TFTs every 6/12
What are some of the side effects of Li?
EARLY:
- Metallic taste
- GI (nausea)
- Fatigue
LATE:
- Diabetes insipidus (dry mouth, polyuria, polydipsia, but NORMAL glucose)
- HypOthyroid
- Arrhythmias
- Weight gain
- Ataxia, dysarthria (walk/talk)
- Confusion, seizures
L-ethargic I-nsides (GI) T-remor (fine) H-hypOthyroidim I-nsipidus (dry mouth, polyuria, polydipsia but normal glucose) Up your calcium M-etallic taste
Li becomes toxic when its levels in the blood increase - how high is too high and what are some causes of this?
What are some symptoms of Li toxicity?
Li >1.5
More likely if:
-dehydrated (hot day, fever, D+V)
- taking other nephrotoxic drugs e.g. NSAIDs
- COURSE tremor
- blurred vision
- anorexia
- N+V
- dysarthria or ataxia
- confusion>siezure>coma >death
How does ECT work?
Send electrical signals through the brain to induce seizures - it is very effective
What are the indications for ECT?
Catatonia (not eating, not responsive)
Prolonged or severe manic episode
