Depression

Question 1

list some risk factors for developing depression

Answer 1

unemployment
chronic illnesses
post-natal period
substance misuse

Question 2

what neurotransmitters are involved in depression

Answer 2

serotonin
noradrenaline
dopamine

Question 3

what are the 3 core symptoms seen in depression

Answer 3

low mood
low energy levels
loss of interest (adhenonia)
think MEE - mood, energy and enjoyment

Question 4

for a diagnosis of depression, how many core symptoms must be present

Answer 4

2 out of 3

Question 5

list some of the associated symptoms of depression

Answer 5

lack of appetite/weight loss 
poor sleep
poor concentration 
suicidal thoughts 
psychmotor retardation 
anxiety 
irritability

Question 6

how do symptoms of depression fluctuate as the day goes on

Answer 6

shows diurnal variability, symptoms are worse first thing in the morning

Question 7

what is Beck’s triad

Answer 7

hopelessness
worthlessness
excessive guilt

Question 8

for a diagnosis of depression how long do symptoms have to be present for

Answer 8

at least 2 weeks

also no manic episodes

Question 9

describe a diagnosis of mild depression

Answer 9

2 core symptoms + 2 additional symptoms

Question 10

describe a diagnosis of moderate depression

Answer 10

2 core symptoms + 4 additional symptoms

Question 11

describe a diagnosis of severe depression

Answer 11

2 core symptoms + at least 4 additional symptoms but also cannot carry out activities of daily living

Question 12

what are the additional features present in psychotic depression

Answer 12

delusion and hallucination observed
delusions centred around guilt and failure
hallucinations are second person auditory

Question 13

what is Cotards syndrome

Answer 13

extreme form of nihilistic delusion where individuals believe part of them has already died

Question 14

what is dysthymia

Answer 14

continuous chronic form of depression that is present for at least 2 years and does not respond to most antidepressants

Question 15

how does atypical depression present

Answer 15

biological symptoms are reversed such as increase in appetite, weight gain and excessive sleeping
presents with reactive mood changes

Question 16

what other tests may be useful in ruling out an organic cause for dementia

Answer 16

FBC - anaemia
TFTs
LFTs

Question 17

how is mild depression managed

Answer 17

no medication required
low intensity interventions such as sleep hygiene, mindfulness
arrange follow up in 2 weeks, if persistent consider CBT

Question 18

how is moderate to severe depression managed

Answer 18

antidepressants and CBT

Question 19

when is ECT indicated for depression

Answer 19

extreme/life threatening depression

when a rapid response is required

Question 20

what is the first line antidepressant for depression

Answer 20

SSRIs

Question 21

what is the mechanism of SSRIs

Answer 21

inhibit reuptake of serotonin from synapse into presynaptic cleft

Question 22

list some examples of SSRIs

Answer 22

fluoextine
sertraline
citalopram

Question 23

what are the other indications for SSRIs

Answer 23

generalised anxiety disorder
panic disorder
OCD
phobia

Question 24

are SSRIs safe in overdose

Answer 24

yes however issues with withdrawal and have to slowly reduce dose

Question 25

what are the main side effects of SSRIs

Answer 25

``` headache nausea anxiety insomnia agitation decreased sexual function ```

Question 26

what is the main risk of prescribing SSRIs in young people

Answer 26

initially increases risk of suicidal ideation

Question 27

what is the main risk of prescribing SSRIs in older people

Answer 27

increased risk of hyponatraemia and therefore falls

Question 28

what is the mechanism of action of tricyclics

Answer 28

block the reuptake of serotonin and noradrenaline from the synapse

Question 29

what are some examples of tricyclics

Answer 29

amitriptyline imipramine clomipramine lofepramine

Question 30

what are the indications for TCAs

Answer 30

usually second line for depression | chronic neurological pain

Question 31

what are the side effects of TCAs

Answer 31

weight gain, sedation | anti-cholinergic s/e urinary retention, constipation, blurred vision, sexual dysfunction

Question 32

what are the cardiac side effects associated with TCAs

Answer 32

QT prolongation | postural hypotension

Question 33

what are some examples of SNRIs

Answer 33

duloxetine | venlafaxine

Question 34

what are the side effects of SNRIs

Answer 34

GI upset hypertension palpitations dizziness

Question 35

what are the main indications for prescribing mirtazapine in depression

Answer 35

if someone has low weight and insomnia as side effects are weight gain and sedation

Question 36

what type of drugs are monoamine oxidase inhibitors

Answer 36

moclobemide | phenlzine

Question 37

what must be restricted with use of MAO inhibitors

Answer 37

certain foods such as red wine and cheese as can cause a hypertensive crisis/cheese reaction

Question 38

how long should a trial of antidepressants last before a review of them

Answer 38

4-6 weeks

Question 39

if initially starting on SSRI and symptoms do not improve within 6 weeks what is the next step

Answer 39

``` try an alternative SSRI if unsuccessful try another class of antidepressants ```

Question 40

once a patient is in remission from their depression, how long must they continue on their antidepressant to prevent relapse

Answer 40

at least 1 year

Question 41

outline the process of ECT

Answer 41

procedure under general anaesthetic that triggers a therapeutic seizure where electrodes are placed on patients anterior temporal areas

Question 42

what are the side effects of ECT

Answer 42

confusion headache autobiographical memory loss