Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
32 Cards in this Set
- Front
- Back
|
DSM IV criteria for depression (unipolar)
Duration of symptoms required? |
Pervasive low mood/loss of interest or pleasure (or irritability in children) and 4 or more of:
1. hopelessnes 2. feelings of guilt or worthlessness 3. insomnia / hypersomnia 4. weight gain / loss 5. Psychomotor retardation or agitation 6. Fatigue 7. decreased concentration or indecisiveness 8. suicidal ideation DSM IV: 2 months Others: 2 weeks |
|
|
In treatment of depression, what is the greatest contributer to positive outcome?
|
It is not the choice of drug. It is
1. Patient compliance 2. Maintainenance of treatment for as full course 3. Address risk factors for relapse |
|
|
What general advice should all depressed people be given?
|
1. Signs of depression, to enable recognition of relapse
2. Recognise negative thoughts to be a product of the disease and not true (e.g. self worth, guilt) 3. Put off important decisions 4. Moderate exercise helps 5. Using social supports helps |
|
|
For people with mild depression for <2/12, what is the treatment?
|
There is no evidence for CBT/IPT/drugs (Up-to-date)
Use 1. genreal advice 2. address comorbities, such as substance abuse, physical disorders, anxiety, personality disorders |
|
|
For moderate depression, what is the treatment
|
1. drugs, or
2. CBT/IPT for 8-12 sessions, if a qualified psychiatrist is available; other techniques may be useful 3. or both Also: ~weekly monitoring And if melancholic: give drugs first then psychotherapy |
|
|
All AD have equal effectivenss. What proportion will respond?
|
50%, even to different drugs in same class
30% placebo effect |
|
|
What is the brand name of duloxetine
|
Cymbalta
|
|
|
If a patient is severely depressed or has melancholy, what drugs may be better?
|
TCA, MAOIs vs SSRIs
|
|
|
If a patient has atypical depression, what drug may be better?
|
Mirtazapine
|
|
|
Which antidepressants cause O.H.
|
TCA
mianserin (also vertigo) |
|
|
When is psychotherapy alone inadequate
|
major depression
|
|
|
When can ECT not be used
|
1. raised intracranial pressure (hmm.. a hypertensive crisis then)
2. a CI to GA (e.g. AMI, unstable ANGINA, ALCOHOL, sepsis, MI in last 6/12, poor cardiac output, poor lung function, DVT/PE) ** after use give drug treatment to maintain remission |
|
|
St John's Wort - place as an antidepressant
|
Discourage use
- more effective than placebo for mild to mod depression & MAY be as effective as standard ADs. - Less AEs than other ADs - AEs are rare - lack of standardisation - seritonin syndrome - Drug interactions |
|
|
St john's Wort -
dosing |
Standardised hydroalcoholic extracts at daily dose of up to 900 mg providing 0.2–2.7 mg total hypericins
2–4 g of herb as an infusion per day |
|
|
St John's wort
- DIs. |
1. SS: MAOIs, other antidepressants, etc
2. Induces CYP450 enxymes: 2C9 AND 3A4 (a)Warfarin: reduced INR - AVOID (b) Calcineurin inhibitors: AVOID - 1 case of heart tx rejection (c) COCs - avoid; monitor for breakthrough bleeding 3. Induces P-glycoprotein, reducing GI absorption of digoxin - AVOID Use with caution with alprazolam, midazolam, omeprazole, fexofenadine, statins, verapamil and theophylline |
|
|
St John's wort
- A/Es |
Mild: gastrointestinal symptoms, anxiety, hypomania, dizziness, dry mouth, restlessness and sleep disturbances
|
|
|
What adjuncts may be used in depression? (3)
|
A carefully planned course of benzodiazepines, zolpidem or zopiclone may help insomnia and/or anxiety in the early phase of antidepressant treatment.
If antidepressant therapy (at appropriate maximum doses) produces only a partial response, augmentation, eg with lithium, may improve outcome. Psychotic depression requires antipsychotic treatment in addition to antidepressants. |
|
|
Considerations for use of ADs in the elderly?
|
May respond more slowly. Consider a lower starting dose with a more gradual increase. Claims that the newer antidepressants are better tolerated in the elderly are not well supported by evidence.
|
|
|
What odd discontinuation syndrome may be associated with paroxetine?
|
a flu like syndrome
|
|
|
What percentage of mothers have post-natal depresssion?
|
10-20%
|
|
|
Besides depression, when can ECT be used?
|
psychosis
|
|
|
Side effects of ECT
|
1. muscle aches and pains
2. headaches 3. transient confusion for an hour or so after treatment 4. some memory loss |
|
|
How many times is ECT done per course?
|
3 times per week (2 times if there is severe confusion)
About 6-24 times, usually 9 |
|
|
What is done pharmacologically before and after an ECT treatment?
|
1. withdraw BZDs (increase seizure threshold)- Can use zopiclone or zolpidem
2. anaesthesia and short acting muscle relaxant Follow with an antidepressant, mood stabiliser or both |
|
|
What alternative treatments are available for depression?
|
Good evidence for
- SJW - Exercise - Self help books with CBT Some evidence for - SAM-E - Folate - Relaxation therapy - Yoga - Accupuncture |
|
|
What other treatments are available for anxiety?
|
Good
- Relaxation - Exercise - Bibliotherapy: using written materials, audiotapes or computer materials to gain understanding of and solving problems relevant to personal development Some evidence - alcohol avoidance - music, dance - meditation |
|
|
Suicide - what % of depressed patients?
|
15%
|
|
|
Which agents are recommended in the elderly
|
the PROSPECT study recommended SSRIs started at half the recommended adult dose and titrated every 6 weeks
|
|
|
What is the remission rate with ECT for severe depression?
|
80-90%
|
|
|
Which neurological disorders are most commonly associated with depression?
|
PD (50%)
Alzheimers (15-30%) Stroke (25%) |
|
|
With PD, what AD?
|
TCA - anticholinergic effect may improve PD
SSRIs - infrequently cause EPSE Selegeline - avoid SSRIs and venlafaxine! |
|
|
a good website for patients?
|
Beyond blue
|
