Depression Flashcards

Front 1

Aetiology of Depression: biological & genetic factors

Back 1

Monoamine theory: depression caused by a shortage of NA, DA, and 5-HT, which is why AD drugs are affective (e.g. TCAs, SSRIs, MAOIs). Increasing the amount of NT in the synaptic cleft, acts on the post-synaptic neuro and stimulates second messenger systems. Overtime, this may correct the intracellular abnormalities and lead to a remission of symptoms.

However, this is likely to be an over simplification. There are NTs and peptides involved. Also, AD drugs take several weeks to have an effect, although in vitro, the drugs have been shown to work instant.

Genetic factors: there is a genetic component that has been found in twin/family studies. People with a first degree relative affected by depression are at increased risk.

Front 2

Aetiology of Depression: psychological and social factors

Back 2

Psychological factors predispose to the development of depression. Families with high expressed emotion, especially negative remarks, has been shown to increase the risk of relax. There is an increased with associated with OCD and borderline PD.

For social, there is an increased risk with significant life events, such as marital separation or job loss. Some specific risk factors in women include:
- >3 children at home under the age of 14
- no job outside of the home
- lack of confiding relationships
- loss of own mother before age of 11

Front 3

Lifetime risk of recurrent depressive disorder, average age of onset, and sex ratio

Back 3

F: 10-25%
M:5-12%
Avg age of onset: late 20s
Sex ratio: 2:1

Front 4

Key Symptoms and Associated Symptoms for Diagnosis of Depression (ICD-10) (3 + 7)

Back 4

Key symptoms:
1. Persistent sadness of low mood
2. loss of interest or pleasure
3. fatigue or low energy
At least one of these, most days, for most of the time for at least 2 weeks. If any of the above present, ask about:
- disturbed sleep
- poor concentration
- low self-confidence
- poor/increased appetite or weight
- suicidal thoughts or acts
- agitation or slowing of movements
- guilt or self-blame

Front 5

Cognitive Symptoms of Depression (4)

Back 5

- reduced concentration and attention
- poor self-esteem
- guilt
- hopelessness

Front 6

Biological (somatic) symptoms (8)

Back 6

1. Anhedonia
2. Reduced emotional reactivity
3. Early morning waking (2h before normally do)
4. Depression worse in the morning
5. Psychomotor retardation (slow, monotonous speech, long pauses before answering a question, limited facial expressions) or agitation
6. Loss of appetite
7. Weight loss (>5% body weight in 1 month)
8. Loss of libido

Front 7

Pharmacological Treatment of depression
- first line
- prognosis
- strategies if treatment doesn't work

Back 7

First line: SSRIs (maybe venlafaxine or mirtazapine)
Prognosis: 60-70% remission of AD prescribed at correct dose for sufficient period (4-6 weeks)
After remission of symptoms, should continue to take full dose for 6 months to prevent relapse

Strategies if treatment hasn't worked:
1. Increase dose of current AD
2. Change to another AD in same class
3. Change to another AD in different class
4. Consider other treatment modalities e.g. CBT or ECT

Front 8

Psychological Treatment of depression

Back 8

CBT:
Cognitive therapy: IDs distorted or illogical thoughts (cognitions) and assumptions and then traied to replace them with more 'reality-based' thinking and behaviours
Behaviour therapy: involves behavioural experiments (testing irrational thoughts against reality), target setting, activity scheduling. Requires between 6-20 sessions.

IPT: IDs interpersonal problems resulting from grief, role disputes, role transitions, or interpersonal deficits and attempts to modify these.

Psychodynamic therapy

Family and marital interventions

Mindfulness-based cognitive therapy: helps patients disengage or become mindful of their depressive ruminations instead of trying to solive them - decreases the risk of recurrence if used in recovered pts.

Front 9

Electroconvulsive Therapy (ECT) - Indications in depression

Back 9

- poor response to adequate trials of AD
- intolerance of ADs due to side effects
- depression with severe suicidal ideation
- Depression with psychotic features, severe psychomotor retardation or stupor
- Depression with severe self-neglect (food/fluid)
- previous good response to ECT