Depression

Question 1

What can cause depression?

Answer 1

• Stress
• Bereavement
• Divorce
• Illness
• Redundancy
• Financial concerns
• Postnatal
• Physical disorders
  
  • Thyroid dyfunction
  • Vitamin B12 deficiency
  • Heart and lung disease
  • Kidney disease
  • Liver disease

Question 2

Outline the pathophysiology of depression

Answer 2

• Not clearly defined
• Disturbance in CNS serotonin (5-HT) activity and noradrenaline

Question 3

What are the signs and symptoms of depression?

Answer 3

• Continual for >2 weeks
• Anhedonia
• Decreased concentration
• Low mood
• Lack of appetite
• Decreased sleep
• Decreased libido
• Weight loss
• Suicidal thoughts
• Self-harm
• Worthlessness/hopelessness
• Psychomotor retardation

Question 4

How should depression be investigated?

Answer 4

1. Patient health questionnaire 9 (PHQ-9)
   
   1. 9 item depression scale
2. Beck depression Inventory (BDI) for primary care
   
   1. 7 question scale
3. Zung self rating depression scale
4. Centre for epidemiology studies - depression scale (CES-D)
   
   1. 20 items

Question 5

How is depression best managed?

Answer 5

• Conservative
  
  • Sick note
  • Counselling, CBT
  • Famiy and friend support
  • Hobbies/enjoyments
• Medication
  
  • SSRI - Sertraline, Citalopram
  • SNRI - Duloxetine
  • Mirtazepine
  • TCAs - amitryptiline
  • Monoamine oxidase inhibitors (MAOIs)

Question 6

What are the complications of depression?

Answer 6

• Suicide
• Self-harm
• Risky behaviour - drug/alcohol abuse

Question 7

What is the role fo serotonin in the brain and where is it produced?

Answer 7

• Produced in the brain stem - raphe nuclei
• Sleep
• Impulse control
• Appetite
• Mood