Depression - SAD

Question 1

Depression
-etiology
-predisposing factors

Answer 1

Majority of cases secondary to environmental factors

Young females

Past psych history
-past episodes and how were they managed

Past medical history
-chronic/terminal illness
- DM
- hypothyroidism
- CVD (MI, stroke)

Family history
-depression/bipolar affective disorder

Social history
- relationship status, no of children
- employment, finances
- social/familial support
- accommodation

Substance use
-alcohol, illicit substances => exacerbates symptoms, reduces treatment efficacy

Question 2

Depression
-screening for core features and timeframe
-associated features

Answer 2

Either core symptom for most days in 2wks
- persistent low mood
- anhedonia

PHQ-9

Disturbed sleep
Appetite, weight change
Anergia
Psychomotor activity
Poor concentration, indecisive
Worthless, guilt
Suicidal thought/acts
Psychosis

Question 3

Severity of depression classification

Answer 3

Less severe
-PHQ9 U16

More severe
-PHQ9 16+

Question 4

Differentiating between dementia and depression

Answer 4

Depression more likely if
-short, rapid onset
-physical symptoms
-global memory loss (dementia affects short term memory)

Question 5

Depression management of
-less severe
-more severe

Answer 5

Both involve shared decision making

Less severe
Antidepressants not offered 1st unless patient’s preference

Options in order of preference
-self guided help
-group CBT => BA
-solo CBT => BA
-SSRI

More severe
Options in order of preference
-CBT + antidepressant
-solo CBT => BA
-SSRI => SNRI => other if indicated based on past Hx

Question 6

Antidepressant choice (SSRI)
-contraindications
-key interactions
-side effects

Answer 6

1st line - citalopram, fluoxetine

Post MI - sertraline
Children - fluoxetine

Avoid citalopram/escitalopram with meds/conditions that prolong QT

NSAIDs/aspirin - avoid SSRI but if given, add PPI
Warfarin/heparin - mirtazapine instead of SSRI
Triptan/MAOIs - risk of seretonin syndrome if SSRI given

GI symptoms
Increased GI bleed risk
SIADH => hypo Na

Question 7

SSRI
-monitoring
-reducing dose
-discontinuation symptoms

Answer 7

After starting SSRI, review in
-1wk if U25/increased suicide risk
-2wks for everyone else

Good response => continue for min 6 months after remission to reduce relapse risk
Gradually reduce dose over 4wks

Discontinuation symptoms - within 5 days of stopping, last 1-2wks
-increased mood change
-restlessness
-difficulty sleeping
-unsteady
-sweating
-GI symptoms (pain, cramps, diarrhoea, vomiting)
-paraesthesia
-electric shock-like feelings in head

Question 8

Seasonal affective disorder
-how to identify it
-management

Answer 8

Depression occuring in winter

1st line - psychological therapy
Follow up in 2wks
-add SSRI if needed

Question 9

ECT
-indications
-contraindications

Answer 9

Severe depression
-refractory to meds
-psychosis

CI in raised ICP

Short term SE
-headache
-nausea
-short term memory impairment
-memory loss prior to ECT
-cardiac arrythmia

Long term SE
-impaired memory