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Depression - Coggle Diagram

- - - - CBT
      - IPT (interpersonal psychotherapy)
  - - - Single target
        
        SSRI
        
        Mechanism
        
        Increase 5-HT by blocking SERT, thus blocking reuptake
        
        Examples
        
        Usefully activating SSRIs
        
        Sertraline
        
        Fluoxetine
        
        Escitalopram
        
        Usefully sedating SSRIs
        
        Paroxetine
        
        Fluvoxamine
        
        Citalopram
        
        Side effects
        
        5 S's
        
        Sexual dysfunction (anorgasmia, decreased libido)
        
        Sleep difficulty
        
        Stress (anxiety/depression)
        
        Serotonin syndrome
        
        Increased neuromuscular activity (clonus, hyperreflexia, hypertonia)
        
        Increased sympathetic outflow (increased BP, increased T)
        
        Agitation
        
        Stomach upset (N/V)
        
        Withdrawal symptoms
        
        Depression/anxiety, N/V, headache
        
        NRIs
        
        Mechanism
        
        Increase NA by blocking NET, thus blocking reuptake
        
        Examples
        
        Usefully activating NRIs
        
        Reboxetine
        
        Side effect
        
        HTN
      - Multiple targets
        
        SNRIs
        
        Side effects
        
        Those of SSRIs + HTN
        
        Examples
        
        Usefully activating SNRIs
        
        Desvenlafaxine
        
        The active metabolite of venlafaxine (hence no DD effect)
        
        Duloxetine
        
        Venlafaxine
        
        Dose-dependent effect
        
        Mechanism
        
        Increases 5-HT and NA by blocking SERT and NET
        
        TCAs
        
        Examples
        
        Usefully sedating
        
        Amitriptyline
        
        Imipramine
        
        Nortriptyline
        
        Side effects
        
        Anti-cholinergic effects (e.g. blurry vision, dry mouth)
        
        Overdose (presents as low GCS)
        
        MAOIs
        
        Mechanism
        
        Prevents clearance/degradation of 5-HT/NA/DA
        
        Examples?
        
        Side effects
        
        Risk of serotonin syndrome, especially if taken in combination with SSRI/SNRI
        
        Hypertensive crisis, if MAOI taken in conjunction with tyramine-rich foods (acts as sympathomimetics)
        
        Cheeses
        
        Aged meats
        
        Yeast extracts
        
        Wine? Chocolate?
        
        NaSSAs
        
        Bupropion
        
        Function
        
        Only PBS-approved in AUS for smoking cessation (rest of world: for depression)
        
        Mechanism
        
        Increased NA and DA by inhibit NET and DAT, thus blocking reuptake
      - Anti-depressants with no sexual side effects
        
        NRIs, NaSSAs (e.g. mirtazapine) and Bupropion
    - - Washout period of a few days required (when nil anti-depressant is taken)
        
        Exception: MAOI requires a 2-week washout period before starting an SSRI/SNRI
  - - - e.g. SNRIs, NaSSAs, TCAs, MAOIs (not SSRIs or NRIs)
- - - - Purely psychiatric cause
    - - Secondary to a medical disease
  - - - ≥1 MDE (i.e. SIGECAPS) with no Hx of manic or hypomanic episodes
        
        ≥ 2 weeks duration
        
        Minimum 5 symptoms
        
        Depressed mood (can be irritable in children or adolescents) or anhedonia
        
        ≥4 of:
        
        Appetite or weight ∆ (up or down)
        
        Weight needs to be > 5% change (up or down) over 1 month
        
        Sleep ∆ (insomnia or hypersomnia)
        
        Interest decreased (anhedonia)
        
        Loss of interest/pleasure in (almost) all activities
        
        Guilt/feeling worthless
        
        Energy decreased (fatigue)
        
        Concentration ∆
        
        Psychomotor agitation or retardation
        
        Suicidal ideation
    - - Mood strongly reactive to environment
        
        e.g. Happy events –> very happy, and sad events –> very
      - ≥ 2 of:
        
        Increased weight or appetite
        
        Increased sleeping
        
        Leaden paralysis (heavy feeling in arms/legs)
        
        Long Hx of sensitivity to rejection
    - - Mood-congruent psychosis
        
        Delusions/hallucinations are depressive in nature
      - Mood-incongruent psychosis
        
        Delusions/hallucinations are not depressive in nature
    - - Anhedonia, or mood unreactive to usually pleasurable stimuli
      - Profound despondency/despair with 'empty feeling'
      - Diurnal mood variation – mood worse in morning
      - Early morning wakening
      - Marked psychomotor retardation
    - - Occurs every winter
- - - - e.g. laughing when telling doctor about their dead sister