DEPRESSION

Group C Jairan Nourbakhsh

Saba SheikhMinyi Teo

Naim Uzzaman

Depression?

A mood disorder What is it?

How common is it?

1 in 20 adults will experience a depression episode every year.

Visit GP

Question time!

Blood Tests

Diagnosis

Severity of depression?

1) Persistent sadness

2) Loss of interest in activites

3) Disturbed sleep

4) Change in appetite

5) Tiredness

6) Agitation

7) Poor concentration

8) Feelings of worthlessness

9) Recurrent thoughts of death

Symptoms of depression:

The Core Symptoms

Treating clinical depressionTreatment for depression usually involves a combination of medicines, talking therapies and self-helpType of treatment depends on type of depressionTreatment options:1. Mild depression - Wait and see - Exercise - Self-help groups2. Mild to moderate depression - Talking therapy3. Moderate to severe depression - Antidepressants - Combination therapy - Mental health teams

Talking treatment

- Cognitive behavioural therapy (CBT)

- Online CBT

- Interpersonal therapy (IPT)

- Psychodynamic psychotherapy

- Counselling

- Getting help

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs)

Tricyclic antidepressants (TCAs)

Other antidepressants

Withdrawal symptoms

Other treatments

St John's wort

Electric shock treatment

Lithium

Adverse Effects of Antidepressant drugs

Drug Class Drug Examples Adverse Effects

Selective Serotonin Reuptake Inhibitors

Citalopram - Nausea and Vomiting, - Diarrhoea, - Anorexia with weight lossFluoxetine

Paroxetine

Escitalopram

Tricyclic Antidepressants Amitriptyline - Sedation, - Dizziness, Confusion- Dry mouthClomipramine

Imipramine

Other Antidepressants Venlafaxine As SSRIs

Duloxetine Sedation, Dizziness, Nausea

Mirtazapine Dry mouth, Sedation, Weight gain

Adverse Effects of Antidepressant drugs

SUICIDAL BEHAVIOUR

MONITORING

MonitoringIs the patient at risk of Suicidal Behaviour or below age of 30?

YES NO

See them after 1 week prior to start of treatment and frequently as

appropriate till patient stabilizes

See them after 2 weeks prior to start of treatment

See them once every 2-4 weeks in the first 3

months

See them in longer intervals if response is

goodNICE clinical guidelines – Depression in Adults OCT 09

Monitoring

Progress of TreatmentSystematic Methods: PHQ-9

Patient Self-Monitoring

Side Effects

References

Websites

NICE guidelines

WebMDhttp://www.webmd.com/depression/

Psychiatry.orghttp://www.psychiatry.org/practice/dsm

NHS choiceshttp://www.nhs.uk/conditions/depression/Pages/Introduction.aspx

Patient.co.ukhttp://www.patient.co.uk/doctor/screening-for-depression-in-primary-care

UpToDate, Inc – Wolters Kluwer Health

APA – American Psychological Associationhttp://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/patient-health.aspx

Books/Journals

Parker C. Depression Management. Clinical Pharmacist 2012: 4:222-34

Walker R, Whittlesea C (eds) 2011. Clinical Pharmacy and Therapeutics 5th edition, London: Churchill Livingstone

Rang, HP, Dale, MM, Ritter, JM, Flower, RJ and Henderson, G. Rang and Dale’s Pharmacology, 7th edition Edinburgh: Churchill Livingstone (2011)

ANY QUESTIONS?