psych > Depression > Flashcards

Depression Flashcards

(52 cards)

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1
Q

What system in the brain is involved in depression?

A

Aversive system
-it promotes survival in event of stress

loss event- depression
threat event- anxiety

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2
Q

what mediates the aversive system?

A

serotonin

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3
Q

what system in the brian is involved in mania?

A

Appetitive system
-promotes seeking behaviours

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4
Q

what mediates the appetitive system?

A

dopamine

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5
Q

what structure in brain is reduced in depression?

A

hippocampal volume reduced

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6
Q

how is depression diagnosed?

A

Depressive episodes should last at least 2 weeks (with no hypomanic or manic symptoms)

At least 2 of the following must be present:
-Depressed mood (to a degree that is abnormal for the individual, present for most of day and almost every day, uninfluenced by circumstances, and for at least 2 weeks)
-Loss of interest or pleasure in activities that are normally pleasurable
-Decreased energy or increased fatigue

PLUS at least 4 of:
-loss of confidence or self esteem
-unreasonable guilt
-suicidal behaviours
-complaints of diminished ability to concentrate
-agitation or retardation
-sleep disturbance of any type
-change in appetite

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7
Q

classifications used for depression?

A

ICD10/11
DSM5

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8
Q

what can be used to assess severity of depression?

A

-HRSD
-MADRS
-PHQ 9
-

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9
Q

Subtypes of depression?

A

-psychotic depression
-Cotard’s syndrome
-Somatic syndrome
-Atypical depression
-Late onset depression

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10
Q

‘I cant eat because my bowels have turned to durst’
-what subtype

A

Cotard’s

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11
Q

-weight loss, lack of appetite
-depression worse in morning
-waking in morning 2 hours before usual time
-loss of libido
-loss of interest of pleasure in activities that normally enjoy
-lack of emotional reaction to things they would normally react to

what subtype?

A

Somatic syndrome

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12
Q
  • Mood reactivity (that is, mood brightens in response to actual or potential positive events)
    • Significant weight gain or increase in appetite
    • Hypersomnia
    • Leaden paralysis (heavy, leaden feelings in arms or legs)
    • Long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment

what subtype?

A

Atypical depression

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13
Q

Depression occuring for first time in later life
-what subtype?

A

late onset depression

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14
Q

Occasionally paranoid, typically ‘mood-congrent’ or hypochondiacal
what subtype?

A

Psychotic depression

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15
Q

what is considered mild depression?

A

key symptoms most of the time for atleast 2 weeks
5 symptoms of depression (<5 subthreshold depressive symptoms)

Key symptoms= low mood, fatigue + anhedonia

other:
-disturbed sleep
-reduced appetitie and/or weight
-fatigue or loss of energy
-agitation or slowing of movements
-poor concentration or indicisive
-feeling worthless, excessive guilt
-suicidal thoughts or acts

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16
Q

what is considered moderate depression?

A

key symptoms
5-7 symptoms

key symptoms= low mood, fatigue + anhedonia

other:
-disturbed sleep
-reduced appetitie and/or weight
-fatigue or loss of energy
-agitation or slowing of movements
-poor concentration or indicisive
-feeling worthless, excessive guilt
-suicidal thoughts or acts

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17
Q

what is considered severe depression?

A

3 key symptoms (fatigue, low mood + anhedonia)
>7 symptoms
can occur with or without psychotic symptoms

interfere with functioning

or PHQ >16

other:
-disturbed sleep
-reduced appetitie and/or weight
-fatigue or loss of energy
-agitation or slowing of movements
-poor concentration or indicisive
-feeling worthless, excessive guilt
-suicidal thoughts or acts

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18
Q

spontaneously resolving brief depressive episode following childbirth (50% of women)
-what subtype

A

post partum depression

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19
Q

recurrent depression in winter months
-what is this + what is treatment?

A

seasonal depression
-treat with bright light therapy

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20
Q

what is the monoamine hypothesis?

A

Depression is thought to be related to monoamine deficiency
-so medications which increase monoamine activity reduce depressive symptoms

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21
Q

what are examples of monoamines?

Study These Flashcards
A

-Serotonin (5-HT)
-Dopamine
-Noradrenaline

22
Q

what role does stress play in depression?

Study These Flashcards
A

Stress releases cortisol
-Chronic stress can cause cortisol dysregulation

Excess cortisol may cause depression through:
-neuronal damage (low hippocampal volume)
-release of proinflammatory cytokines

23
Q

what are the mofa of antidepressants?

Study These Flashcards
A

Increase monoamine activity by two main mechanisms:
Reuptake inhibition- Keep monoamine in synaptic cleft

Monoamine oxidase inhibitors- Prevent removal of monoamine from presynaptic neuron

24
Q

examples of tricyclic antidepressants?

Study These Flashcards
A

-amitriptyline
-Imipramine

25
MofA tricyclic antidepressants?
inhibit the reuptake of serotonin + noradrenaline (keeping monoamines in synaptic cleft) Monoamines= serotonin, dopamine and noradrenaline
26
SE of tricyclic antidepressants?
-QT prolongations -seizures -anticholinergic
27
examples of SSRIs?
-sertraline -citalopram
28
mechanism of action SSRIs?
Inhibit reuptake of serotonin in the monoamine synaptic cleft examples of monoamines= serotonin, dopamine and noradrenaline
29
SE of SSRIs?
-Self harm risk -GI upset -sexual dysfunction -nausea/ tremor/ headache citalopram= long QT
30
examples of SNRIs?
-venlafaxine -Duloxetine
31
mechanism of action of SNRI?
Seretoning and noradrenaline reuptake inhibitors (keeping monoamines in synaptic cleft) Monoamine= noradrenaline, serotonin and dopamine
32
mofa- monoamine oxidase inhibitors?
Prevent removal of monoamine from presynaptic neurone + also break down tyramine
33
examples of reversible + irreversible monoamine oxidase inhibitors?
irreversible= phenylzine reversible= moblecamide
34
why can people on monoamine oxidase inhibitors not eat cheese, beer or wine?
-because monoamine oxidase inhibitors break down tyramine cheese, wine + beer contain tyramine If someone on monoamine oxidase inhibitor eats something with tyrosine in it they can have a hypertensive crisis
35
more likely to have a hypertensive crisis with phenylzine or moblecamide?
more likely with phenylzine because it is irreversible Moblecamide= reversible monoamine oxidase inhibitor
36
example of atypical antidepressant?
Mirtazapine
37
mofa atypical antidepressants (mirtazapine)?
Mixed receptor effects: Alpha-2 5-HT2 AND 5-HT3
38
when would an atypical antidepressant be used?
after a trial of SSRIs -especially useful if patient has had trouble sleeping
39
what is the diagnosis?
serotonin syndrome
40
what causes serotonin syndrome?
Caused by excess of serotonin in synaptic cleft Most often caused by combination of SSRI and MAOI -St Johns wort and SSRI may cause this
41
How does serotonin syndrome present?
Neuromuscular excitation- hyperreflexia, clonus, myoclonus Altered mental status- delirium, agitation, insomnia Autonomic dysregulation- tachycardia, high temperature, shivering, sweating and diarrhoea
42
what can a prolonged fever for serotonin syndrome lead to?
-rhabdomyolysis -metabolic acidosis -renal failure -DIC
43
treatment of serotonin syndrome?
-benzodiazepines for agitation -if severe ventilation and sedation May use cyproheptadine (seretonin receptor antagonist) however little evidence
44
treatment mild depression?
no treatment, watchful waiting and assessing again in 2 weeks 2 key symptoms (fatigue, low mood + anhedonia) 4 other symptoms
45
treatment of moderate/ severe depression?
CBT 1st= SSRI (if no benefit in 6 weeks change) e.g. sertraline, escitalopram, fluoxetine 2nd= switch SSRI 3rd= consider another class of antidepressant e.g. SNRI venlafazine, tricyclic antidepressant (amytriptyline) or an MAOI (phenyzine/ meblocamide) Moderate= 2 key symptoms (fatigue, low mood + anhedonia) + 5/6 other symptoms Severe= 3 key symptoms + >7 symptoms
46
is sertraline or fluoxetine preferred in children/ young people?
fluoxetine
47
treatment is psychotic depression?
+ antipsychotic
48
treatment if life threatening or rapid response needed?
ECT
49
what antidepressant when used with an NSAID risks GI bleed?
SSRI + NSAID risk GI bleed -and so warrant a PPI
50
how should SSRIs be stopped?
-gradually over 4 weeks
51
what type of antidepressant can cause hyponotraemia?
SSRI
52
can you take triptans and SSRIs together?
No- avoid triptans when on SSRI as they can lead to serotonin syndrome
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