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5 - PSYCH > Mood disorders - Depression > Flashcards

Mood disorders - Depression Flashcards

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1
Q

What is the definition of depression?

A

Depression is a mood disorder characterised by persistent feelings of sadness, loss of interest, or pleasure in nearly all activities, along with a range of emotional, cognitive, physical, and behavioral symptoms.

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2
Q

List common emotional symptoms of depression.

A

Persistent sadness or low mood

Feelings of hopelessness

Guilt or worthlessness

Irritability or frustration

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3
Q

What are the cognitive symptoms of depression?

A

Difficulty concentrating or making decisions

Negative or self-critical thoughts

Suicidal ideation

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4
Q

Name physical symptoms commonly associated with depression.

A

Fatigue or loss of energy

Changes in appetite or weight (increase or decrease)

Sleep disturbances (insomnia or hypersomnia)

Psychomotor agitation or retardation

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5
Q

What behavioral symptoms are indicative of depression?

A

Social withdrawal

Reduced engagement in activities previously enjoyed

Neglect of responsibilities or personal care

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6
Q

How is major depressive disorder (MDD) diagnosed according to DSM-5 criteria?

A

The diagnosis requires at least 5 of the following symptoms, including either depressed mood or anhedonia, present for at least 2 weeks:

Depressed mood

Anhedonia

Significant weight/appetite change

Sleep disturbances

Psychomotor changes

Fatigue

Feelings of worthlessness/guilt

Difficulty concentrating

Recurrent thoughts of death/suicide

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7
Q

What are the subtypes of depression?

A

Melancholic features

Atypical features

Psychotic features

Seasonal pattern

Peripartum onset

Persistent depressive disorder (dysthymia)

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8
Q

Describe the features of melancholic depression.

A

Severe anhedonia

Lack of mood reactivity

Early morning awakening

Significant weight loss

Guilt or psychomotor agitation/retardation

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9
Q

What characterizes atypical depression?

A

Mood reactivity (improved mood with positive events)

Increased appetite or weight gain

Hypersomnia

Leaden paralysis

Sensitivity to rejection

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10
Q

What treatment options are available for depression?

A

Psychological therapies (CBT, interpersonal therapy, psychodynamic therapy)

Pharmacotherapy (SSRIs, SNRIs, TCAs, MAOIs)

Lifestyle modifications (exercise, sleep hygiene, social engagement)

Electroconvulsive therapy (ECT) for severe or treatment-resistant cases

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11
Q

What is the first-line pharmacological treatment for depression?

A

SSRIs (Selective Serotonin Reuptake Inhibitors), such as sertraline, fluoxetine, or citalopram.

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12
Q

Name common side effects of SSRIs.

A

Nausea

Headache

Sexual dysfunction

Insomnia or drowsiness / vivid dreams

Increased anxiety initially

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13
Q

What is the role of electroconvulsive therapy (ECT) in depression?

A

ECT is used for severe depression, especially when it is treatment-resistant, involves psychotic features, or is life-threatening due to suicidal ideation or refusal to eat.

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14
Q

What is persistent depressive disorder (dysthymia)?

A

A chronic form of depression characterized by a depressed mood lasting for at least 2 years, with fewer symptoms than major depressive disorder but still impairing.

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15
Q

What are risk factors for depression?

A

Family history of mood disorders

Personal history of trauma or abuse

Chronic medical conditions

Substance abuse

Stressful life events

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16
Q

How is depression assessed in a clinical setting?

A

Clinical interview using diagnostic criteria (e.g., DSM-5)

Use of standardised screening tools (e.g., PHQ-9, Beck Depression Inventory)

Rule out medical causes (e.g., thyroid dysfunction, anemia)

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17
Q

What is the biopsychosocial model of depression?

A

Depression arises from an interplay of biological, psychological, and social factors, including genetics, brain chemistry, personality traits, and environmental stressors.

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18
Q

What lifestyle changes can help manage depression?

A

Regular physical activity

Balanced diet

Adequate sleep

Social connections

Stress management techniques (e.g., mindfulness, relaxation exercises)

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19
Q

What class of drug is meclobemide

A

RIMA

reversible inhibitors of MAO-A

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20
Q

Symptoms of serotonin syndrome + acid balance?

A

what causes:
think HYPER:

Neuromuscular abnormalities (hyperreflexia, clonus, tremors)
altered consciousness (deliriums)
autonomic dysfunction (hyperthermia, sweating, increased HR)

Increased CK, WCC, LFTs, Metabolic acidosis

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21
Q

What class of drug is Citalopram?

A

SSRI

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22
Q

What class of drug is mirtazapine?

A

NASSA: Noraadrenergic and specific serotonin antidepressant

’ Zap zap to Nasa ‘

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23
Q

How does NICE define less severe depression using the PHQ-9 scoring?

A

PHQ-9 score of <16

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24
Q

Paroxetine dosing?

A

20mg only

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25
What are discontinuation symptoms? (for antidepressants)
Drugs with shorter half lives, if stoppesd suddenly: Dizziness, nausea, numbness, anxiety, flu like symptoms
26
Contraindications for SSRIs include:
Mania GI bleed risk so keep caution with NSAIDs prolonged Qt interval especially with citalopram
27
What are the contraindications for tricyclics? (5)
After myocardial infarction (MI): TCAs can increase heart rate and cause hypotension. Arrhythmias: TCAs can exacerbate cardiac issues. Manic phase of bipolar disorder: TCAs may induce mania. Acute porphyria: TCAs can trigger symptoms. Epilepsy: TCAs lower the seizure threshold, increasing the risk of seizures.
28
What is serotonin?
5 - hydroxytryptamine / 5-HT
29
What does serotonin do?
Affects mood, sleep, appetitie, memory
30
When can you not give a SSRI - based on someones drug history? What to give instead
If patient takes warfarin or heparin due to increased risk of bleeding give mirtazapine
31
When to give mirtazapine for depression?
If patient takes warfarin or heparin due to increased risk of bleeding, give mirtazapine not SSRI
32
What is dysthymia?
Chronic low mood for more days than not lasting years but not continous enough to be diagnosed as depression
33
What class of medicine used to treat HTN can exacerbate depressive symptoms?
Beta blockers
34
When is SSRIs given for mild depression?
If they have had it for 2 years or persists after other interventions
35
Which neurotransmitters can TCAs block?
Serotonin (5-HT) Noradrenaline (NA)
36
High risk of depression, screen for? (6)
- Suicide attempt - Any abuse - Signicant physical illness - Other mental health problems - History of depression - Frequent visits to doctor
37
How to manage mild-moderate depression / less severe (2nd line)
Inadequate response to initial intervention -> higher intensity psychosocial intervention (CBT, IPT) SSRI + CBT
38
What psychosocial causes can lead to depression? (3)
Childhood - adverse events (abuse, criticism etc) Vulnerability - reduce resilience (unemployment, isolation) Substance abuse
39
The diagnosis of Recurrent depressive disorder?
Atleast 1 previous episode of depression, 2 weeks and seperated from current episode by atleast 2 months. Never met criteria for mania or hypomania
40
What does Noradrenaline do biologically
Affects mood and energy
41
Small increased risk of x in 1-2 weeks of starting SSRI so must monitor
suicide
42
What are some serotonin and noradrenaline reuptake inhibitors?
Venlaflaxine Duloxetine
43
The starting dose of Fluoxetine is ? Max dose?
20mg max dose is 60mg
44
TCAs can cause anticholinergic side effects such as?
Dry mouth
45
Beck’s Cognitive Triad of Depression
Worthlessness, Helplessness, Hopelessness
46
How does ECT work? What side effects might there be?
Attaching electrodes to the scalp and passing an electric current through them to induce a seizure. Under general anaesthesia and thought to act as a Neutrotransmitter release which improves symptoms - 12 sessions needed Memory impairment (Retrograde [memories before ECT]] > anterograde]), headache, confusion, cardiac arrhythmia
47
What class of drug is Fluoxetine?
SSRI
48
What SSRI is preferred for a patient with a chronic health problem?
Sertraline (less drug interactions)
49
Co-prescription of SSRI with which medications? can cause serotonin syndrome
Treat a stop offending drug, manage hydration, consider ITU for ventilation tramadol or triptans
50
What is Agitated depression?
Psychomotor agitation instead of retardation
51
What class of drug is Sertraline?
SSRI
52
What SNRIs are available for depression?
Duloxetine Venlafaxine (this one can exacerbate arrythmia and HTN)
53
Symptoms of serotonin syndrome + acid balance?
what causes: think HYPER: Neuromuscular abnormalities (hyperreflexia, clonus, tremors) altered consciousness (deliriums) autonomic dysfunction (hyperthermia, sweating, increased HR) Increased CK, WCC, LFTs, Metabolic acidosis
54
What class of drug is Escitalopram
SSRI
55
which specific 2 drugs can discontinuation symptoms occur for ? (for antidepressants)
paroxetine (SSRI), venlafaxine (SNRI)
56
Diagnosis using ICD-10 with following criteria: 2 of the 3 core symptoms 2+ max additional symptoms
Mild depressive episode
57
low mood in winter, reversed biological symptoms (increased sleep, appetite), recur annually each year with remission in between
Seasonal affective disorder
58
Which medications can cause depression?
Steroids Methyldopa OCP Isotretinoin Beta Blockers
59
How does NICE define more severe depression using PHQ score?
PHQ-9 score of >16 * think 16 yr olds are depression
60
How to manage severe resistent depression?
Electroconvulsive therapy Need to assess cognitive function before and after 4 treatments and end of treatment:;
61
What class of drug is venlafaxine?
SNRI
62
What happens if you take st johns wart with antidepressants?
Do NOT do it, can increase levels of serotonin too much
63
Which category does the following depressive symptoms fit into? mood congruent
psychosis
64
How to manage mild-moderate depression / less severe (1st line)
Watch and wait, give advice on sleep hygiene Actively monitor and repeat assessments in 2 weeks Consider low intensity psycho-social interventions if not well after 2 weeks (group CBT, self referral IAPT)
65
What scale is used to screen for postnatal depression?
Edinburgh postnatal depression scale
66
What class of drug is Paroxetine?
SSRI
67
Diagnosis using ICD-10 with following criteria: 2 of the 3 core symptoms + 2+ max additional symptoms PLUS Psychotic symptoms with criteria unmet for diagnosis of psychosis
Severe depressive episode
68
What is pseudodementia?
Memory loss that can occur in severe depression and may mimic dementia, it often has a quicker onset It is global memory loss compared to short term memory loss in Alzheimers
69
If a 12-18 year old needed medication intervention for depression, what would be offered?
Fluoxetine
70
Which category does the following depressive symptoms fit into? constipation, dysmenorrhoea, loss of libido
Biological
71
Diagnosis using ICD-10 with following criteria: 2 of the 3 core symptoms 3-4 additional symptoms
Moderate depressive episode
72
severe psychomotor retardation, patient grinds to halt, becomes mute, stops eating, drinking, moving
Depressive stupor
73
Take caution with prescribing some one SSRI if they take x due to risk of bleeding
NSAIDs
74
severe psychomotor retardation, patient grinds to halt, becomes mute, stops eating, drinking, moving
Depressive stupor
75
How to go about doing a PHQ-2
Ask for low mood and anhedonia, if yes ask: - Have any of the core symptoms been present on most days, most of the time for at least 2 weeks - Other typical symptoms of depression
76
Diagnosis using ICD-10 with following criteria: 2 of the 3 core symptoms 2+ max additional symptoms
Mild depressive episode
77
What are the additional symptoms in the ICD-10 depression criteria? (7)
Reduced concentration Reduced self esteem Disturbed sleep Reduced appetitie Ideas of guilt / worthlessness Pessimistic views Ideas of self harm / suicide
78
When can discontinuation symptoms occur ? (for antidepressants)
If stopped suddenly: gradually wean off 4 weeks (not needed for fluoxetine)
79
Which category does the following depressive symptoms fit into? Poor concentration and suicide?
Cognitive
80
What does dopamine do?
affects psychomotor activity and motivation
81
How can Severe depressive episodes be further classified?
Mood congruent (More common in depression) - Delusions (often revolving aroung guilt and inadequecy) - Hallucinations (can be auditory, olfactory, visual) Incongruent: - Hallucinations / delusions not consistent with typical depression themes, includes more first rank symptoms (e.g. thought insertions), more common in schizophrenia
82
Diagnosis using ICD-10 with following criteria: 2 of the 3 core symptoms + 2+ max additional symptoms PLUS Psychotic symptoms with criteria unmet for diagnosis of psychosis
Severe depressive episode
83
What is the monoamine hypothesis?
A neurochemical theory - cause of depression: A deficiency in brain monoamine neurotransmitters: - Serotonin - Noradrenaline - Dopamine
84
Core symptoms of Depression include?
Low mood Anhedonia Anergia
85
Diagnosis using ICD-10 with following criteria: 2 of the 3 core symptoms 3-4 additional symptoms
Moderate Depressive episode
86
Epidemiology of Depression? - Gender - Rate - Age
- 1/20 have depression 1/4 are women 1st degree relative increases risk 3x 2 peaks in age: 12-24 & 65+ years
87
When can sedation occur with antidepressants?
When taken with alcohol
88
Selective serotonin reuptake inhibitors - examples
Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline
89
low mood in winter, reversed biological symptoms (increased sleep, appetite), recur annually each year with remission in between
Seasonal affective disorder
90
ASEPTIC?
A: Appearance/ behaviour S: Speech E: Effect P: Perception T: Thought I: Insight C: Cognition
91
What 'perceptions' might come up for A: Appearance/ behaviour S: Speech E: Effect P: Perception T: Thought I: Insight C: Cognition
hallucinations (evil images, derogatory voices) delusions (guilt, nihilistic, persecutory)
92
How long is depression treated for after remission? If it is a second episode of depression how long is it treated after remission?
6 months after remission 2nd episode should be treated for 2 years following remission
93
What is an absolute contradiction to using ECT?
Raised intracranial pressure
94
The complication of hyponatraemia can occur within x days of antidepressant use, stop the drug and treat accordingly
30
95
What is the primary mechanism of TCAs?
Inhibition of the reuptake of neurotransmitters
96
When to do a PHQ-2
In primary care/ 1st line
97
The diagnosis of Recurrent depressive disorder?
Atleast 1 previous episode of depression, 2 weeks and seperated from current episode by atleast 2 months. Never met criteria for mania or hypomania
98
How to treat a suicidal patient with psychotic depression and is unresponsive to antidepressants?
Electroconvulsive therapy
99
Which SNRIs can exacerbate arrythmia and HTN?
Venlafaxine (this one can exacerbate arrythmia and HTN)
100
What class of drug is Duloxetine?
SNRI
101
What is the single biggest risk factor for suicide?
Previous attempt
102
What type of urinary incontinence is the most associated with amitriptyline? (tricyclic)
Overflow incontinence due to anticholinergic effect
103
Side effects of mirtazapine?
Increased appetite + weight gain drowsiness
104
Tricyclic / TCA side effects?
Dry mouth (anticholinergic antagonism) and weight gain (histamine antagonism) Blurred vision Urinary retention + overflow incontinence
105
What drug is clomipramine?
TCA
106
What drug is Imipramine
TCA/Tricylic
107

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