Depression 1

Question 1

What is depression?

Answer 1

Persistantly low mood and/or loss of enjoyment in most activities and the associated emotional, physical, cognitive and behavioural symptoms

Question 2

What are the core symptoms of depression?

Answer 2

• prolonged low mood
• frequently feeling fatigued/ lack of energy
• withdrawl from social activities
• insomina/ hypersomnia
• suicidal thoughts
• loss of enjoyment/ interest in pleasurable activities
• Reduced libido
• Weight gain/ loss
• Feeling worthless/ guilty
  *

Question 3

How is depression diagnosed?

Answer 3

• Core symptoms present for 2 weeks
• Not due to drug/ alcohol missue, brevement, medicine or medical disorder
• Causes significant distress and/or imparement to social, occupational or general function

Question 4

Describe the different severities of depression

Answer 4

• Mild: 4-5 core symptoms and minor social/ work impairment
• moderate: 5+ core symptoms and variable social/ work impairment
• severe: 5+ core symptoms and significatn social/ work impairment
• Sub threshold - less than 5 core symptoms required to make diagnosis. May have been going on for long time tho

Question 5

What are the problems with diagnosing depression?

Answer 5

• Anxiety can obscure depressive symptoms
• Can be difficult to diagnose from normal saddness especially during breavement

Question 6

What are complications associated with depression?

Answer 6

• Increases likelyhood of substance misuse
• Exacerbates pain, disability and distress with a range of physical diseases
• Increases mortality (death rate)

Question 7

What are 2 examples of subtypes of depression?

Answer 7

• postnatal
• seasonal affective disorder

Question 8

1. What is seasonal affective disorder?
2. What symptoms are there?
3. What are the treatment methods?

Answer 8

1. Depression associated with certain seasons
2. Recurrent with generally mild to moderate symptoms: hypersomnia, low self-esteem, increased appetitie
3. Light therapy (2 hours when waking and 30 maintance in winter) and fluoxetine

Question 9

What is cyclothymia?

Answer 9

persistent mood instability

Question 10

What is the relationship between number of depressive episodes and chance of recurrance?

Answer 10

Increase number of episodes, more likely to have another

Question 11

What treatments are available for patients with depression?

Answer 11

• Psycotherapies (talking therapies)
• Electroconvulsive therapies
• Antidepressants
• placebo effect

Question 12

Give examples of psychotherapy treatments

Answer 12

CBT and interpersonal pyschotherapy (IPT)

psychotherapies can have prophylactic effects

Question 13

What causes depression?

Answer 13

The monoamine hypothesis: Lower levels of monoamines (mainly 5-HT and seretonin)

Question 14

Describe electroconvulsive therapy

Answer 14

• Involves inducing a modified epileptic seizure
• Increases amount of NT released from the brain
• Increases BBB permeability
• Increased secretion of hypothalamic and pitiary hormones

Question 15

Discuss reponse to antidepression drugs and placebo

Answer 15

AD drugs - 70% respond. P - 30% respond.

Takes around 8 weeks for tablet to work. Need to inform patient of this

Question 16

Examples of classes of Antidepressants

Answer 16

• Tricyclic antidepressants (TCA)
• selective serotonin reuptake inhibitors (SSRI)
• Serotonin and NA reuptake inhibitors (SNRI)
• NA reuptake inhibitor
• NA and dopaminergic reupake inhibitor
• tryptophan
• Monoamine oxidase inhibitor

Question 17

How is serotonin/ 5-HT synthesised?

Answer 17

tyrptophan –(tyrptophan hydroxylase)–> 5-hydroxytyrptophan – (aromatic acid carboxylase)–> 5-HT/ serotonin

Question 18

How are monoamines degraded?

Answer 18

MAO

Question 19

How do TCA, SSRI, MAOIs work>

Answer 19

• TCA: block reuptake of 5-HT, DA, NA
• SSRI: Blocks reuptake of 5-HT
• MAOIs: inhibits MAO degrading 5-HT, DA, NA to inactive metabolites

Question 20

Explain how AD work

Answer 20

AD rapidly increase MA transmitters but clinical effects take longer. AD treatment and change in transmitter levels also decreases receptor sensitivity and expression. Both of these lead to the clinical effect.