Depression / Antidepressants Flashcards
What is the Mono-amine theory
Monoamines = Nor (Noradrenaline) & 5HT - Serotonin
Low levels of both these neurotransmitters found in patients with depression
10 ICD criteria symptoms for depression
CORE - low mood CORE - anhedonia CORE - reduced energy sleep disturbance change in appetite Reduced concentration reduced libido loss of confidence Guilt suicidal thoughts
Criteria for diagnosis of depression according to ICD 10`
Presence of CORE/associated symptoms
For at least 2 weeks, present most of the time
In the absence of any organic cause, drugs, bereavement
What constitutes mild, moderate and severe depression according to ICD 10
Mild = 2 core + 2 other
Moderate = 2 core + 3 others
Severe = 3 core + 4 others (with/without psychosis)
Investigations when diagnosing depression
Exclusion of organic causes
metabolic panel, FBC, TFTs, drug screen
PHQ - 9
consider also Edinburgh post-natal depression
Management of mild depression
Low intensity psychological therapies - NOT medication
Advice - sleep hygiene, regular exercise
CBT self help, group CBT
Structured group physical activity programme
Management of moderate depression
High intensity psychological therapy OR start antidepressant
CBT - 16-20 session over 3-4 months Interpersonal therapy (IPT) - 16-20 sessions over 3-4 months Behavioural activation therapy Behavioural couples therapy OR Start an SSRI - sertraline/citalopram
4 tiers of care in depression + MDT involved
Tier 1 - GP
Tier 2 - Primary care mental health worker (PCMHW)
Tier 3 - Community mental health team (CMHT)
Tier 4 - home therapy or in-patient
Principles of ECT
~12 weekly doses per year
Short induced seizure under GA
70-80% effective in severe depression
S/E - headache, nausea, muscle pain, memory loss
Commonly used SSRIs
Sertraline, citalopram, fluoxetine (Prozac), escitalopram
Common S/E of SSRIs
GI upset, nausea, headaches, agitation Dizziness, dry mouth, blurry vision, sweaty confusion - hyponatraemia citalopram prolongs QT loss of sex drive, ED
Advice to give when counselling on SSRIs
Takes 4-6 weeks to have effect may get worse before it gets better Take with food to lessen GI upset Don't stop suddenly - flu like withdrawal symptoms Warn about serotonin syndrome
SSRIs in pregnancy - small chance of CHD in 1st and 3rd trimester - discontinue/stop
Presentation of serotonin syndrome + management
“Head, red, dead”
restless, feverish, hot, tremor, myoclonus, confusion
Mx - discontinuation of the drug + supportive measures
- mostly mild and will resolve in 24 hrs
commonly used SNRIs
Venlafaxine, duloxetine
S/E of SNRIs
Same serotonin S/E of SSRIs
+ Nor+ effects - so increase blood pressure, heart rate
Check ECG and BP before and after prescribing
Do not prescribe in existing heart disease
