Disease - Depression

From CambridgeNotes

  • Prevalance 5-10%; Aged usually 30-40 years; Women affected more than men

History and Examination: Depressed SIG E CAPS (DSM IV)

  • Depressed, altered Sleep, reduced Interest, Guilt, reduced Energy, reduced Concentration, altered Appetite, altered Psychomotor, Suicidal
  • 5/8 of these symptoms with depressed mood or anhedonia for 2 weeks or more

Differential Diagnosis

  • Depression subtypes: 1 month or less post-partum, seasonal
  • Psychiatric: adjustment disorder (milder, within 3 months of stressor, lasts 6 months or less), dysthymia (milder, chronic depression for 2 years or more), bipolar, dementia, schizophrenia
  • Organic (hypothyroidism, Parkinson’s); drugs (B-blockers)
  • Normal bereavement shares many symptoms but not suicidal thoughts, psychotic symptoms and profound guilt

Investigations

  • Only if ?organic cause e.g. TFTs

Treatment

  • Assess immediate suicide risk
  • Non-drugs: exercise, guided self-help; Cognitive Behaviour Therapy (CBT)
  • Drugs: always give risk of side effects (akathisia or agitation, suicidal ideas), and delay in onset of effect; continue 6 months or more after remission and reduce dose over 4 weeks
    • SSRIs e.g. fluoxetine, citalopram: usually first line; main side effects include nausea, drowsiness, sexual dysfunction
    • TCAs e.g. amitriptyline: consider ?initial ECG; toxic in overdose; many anticholinergic side effects; may cause prostatism, glaucoma
    • Heterocyclics e.g. trazodone: side effects include priapism
    • MAOi e.g. phenelzine: useful if resistant to other therapy; watch for interactions!
    • Newer drugs: SNRI (venlafaxine), NaSSA (mirtazapine)
    • Note: St Johns wort may also be effective!
  • Electroconvulsive therapy (ECT) for resistant cases; Deep Brain Stimulation (DBS)?

References

  1. NICE guidelines 2004
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