Mood Disorders Flashcards
(44 cards)
What is Depression?
Depression is a disorder that causes persistent feelings of low mood, low energy and reduced enjoyment of activities.
Explain the pathophysiology of Depression
The pathophysiology is not fully understood and likely involves a combination of complex mechanisms. At least partially, it appears to involve a disturbance in neurotransmitter activity in the central nervous system, particularly serotonin, also called 5-hydroxytryptamine (5-HT). This makes sense, considering that medications that boost serotonin are effective treatments.
The cause is often described as “a chemical imbalance” or “low levels of serotonin”, which may be helpful as a simple explanation but is probably overly simplistic.
Causes of Depression
Depression may be triggered by life events (e.g., the loss of a loved one). However, it can occur without any apparent triggers. It is thought to be caused by genetic, psychological, biological and environmental factors. Having an affected relative is a significant risk factor.
What can exacerbate depression?
Physical health conditions can trigger or exacerbate depression, and it commonly occurs with conditions such as stroke, myocardial infarction, multiple sclerosis and Parkinson’s disease.
Core symptoms of Depression
Low mood
Anhedonia (a lack of pleasure or interest in activities)
Emotional Sx of Depression
Anxiety
Irritability
Low self-esteem
Guilt
Hopelessness about the future
Cognitive Sx of Depression
Poor concentration
Slow thoughts
Poor memory
Physical Sx of Depression
Low energy (tired all the time)
Abnormal sleep (particularly early morning waking)
Poor appetite or overeating
Slow movements
Environmental contributors to Depression
Potential triggers (e.g. stress, grief or relationship breakdown)
Home environment (e.g., housing situation, who they live with and their neighbourhood)
Relationships with family, friends, partners, colleagues and others
Work (e.g., work-related stress or unemployment)
Financial difficulties (e.g., poverty and debt)
Safeguarding issues (e.g., abuse)
Hx taking tips (things to remember) for a patient with Depression
Essential factors to explore when taking a history include:
Caring responsibilities (e.g., children or vulnerable adults)
Social support
Drug use
Alcohol use
Forensic history (e.g., violence or abuse)
Every encounter should include a risk assessment for:
Self-neglect
Self-harm
Harm to others (including neglect)
Suicide
What is used to assess the severity of Depression?
Patient Health Questionnaire (PHQ-9).
PHQ-9 questionnaire is used to assess the severity of depression
What is the PHQ-9 Questionnaire / what does it include?
There are nine questions about how often the patient is experiencing symptoms in the past two weeks. asks patients ‘over the last 2 weeks, how often have you been bothered by any of the following problems?’
9 items which can then be scored 0-3
includes items asking about thoughts of self-harm
How to interpret the scores in a PHQ-9 Questionaire for Depression
The higher the score, the more severe the depression:
5-9 indicates mild depression
10-14 indicates moderate depression
15-19 indicates moderately severe depression
20-27 indicates severe depression
What is the HAD scale?
Hospital Anxiety and Depression (HAD) scale
consists of 14 questions, 7 for anxiety and 7 for depression
each item is scored from 0-3
produces a score out of 21 for both anxiety and depression
severity: 0-7 normal, 8-10 borderline, 11+ case
patients should be encouraged to answer the questions quickly
Management options for Depression
Active monitoring and self-help
Address lifestyle factors (exercise, diet, stress and alcohol)
Therapy (e.g., cognitive behavioural therapy, counselling or psychotherapy)
Antidepressants (selective serotonin reuptake inhibitors are first-line)
How effective is exercise in terms of management of Depression?
A recent meta-analysis found good evidence supporting that exercise is comparable to antidepressants or therapy as a treatment for depression. The more vigorous the exercise, the greater the effect size. Some forms of exercise were found to have a stronger effect than using SSRIs alone, and that exercise enhanced the effects of SSRIs.
Should people with “less severe depression” be given antidepressants first line ?
NICE (2022) recommends not offering antidepressants first-line to patients with less severe depression (defined as less than 16 on the PHQ-9) unless they have a preference for taking antidepressants.
Management for severe or psychotic depression?
Patients with severe or psychotic depression require urgent specialist input and management.
What is the role of the crisis resolution and home treatment team for Depression?
The crisis resolution and home treatment team offer intensive support and treatment for patients having a mental health crisis without them being admitted to hospital (usually for a short period only).
When is admission needed for Depression?
Admission may be required where there is a high risk of self-harm, suicide or self-neglect or where there may be an immediate safeguarding issue.
Additional specialist treatments for unresponsive or severe depression include:
Antipsychotic medications (e.g., olanzapine or quetiapine)
Lithium
Electroconvulsive therapy
What is Electroconvulsive Therapy?
Electroconvulsive therapy (ECT) is a very safe and effective treatment for severe, medication-resistant and psychotic depression. It involves a course of treatments, for example, twice weekly for four weeks.
Under general anaesthesia, electrodes are placed on the patient’s head, and a brief electrical current is administered, which triggers a short generalised seizure lasting around 30 seconds.
Side effects of Electroconvulsive therapy
headache, muscle aches and short-term memory loss.
What are the symptoms of psychosis (psychotic depression)?
Delusions (beliefs that are strongly held and clearly untrue)
Hallucinations (hearing or seeing things that are not real)
Thought disorder (disorganised thoughts causing abnormal communication and behaviour)
