Depression

Question 1

NICE use the DSM-IV criteria to grade depression, name 5 of the 9 features

Answer 1

• Depressed mood most of the day, nearly every day
• Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
• Significant weight change or appetite change
• Insomnia or hypersomnia nearly every day
• Psychomotor agitation or retardation nearly every day
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness or excessive or inappropriate guilt nearly every day
• Diminished ability to think or concentrate, or indecisiveness nearly every day
• Thoughts of death or suicide, or suicide plan

Question 2

Using the DSM-IV criteria, when can a diagnosis of depression be made?

Answer 2

If 5 of these 9 features are seen, and are present nearly every day for 2 weeks or longer

Question 3

Name 2 risk factors for developing depression

Answer 3

• Female gender
• Past history of depression
• Significant physical illness
• Other mental health problems
• Social issues i.e. divorce, unemployment, poverty

Question 4

Initial management of depression
1) What is first line for mild-moderate depression (2)?
2) What is the next step (2)?
3) What group of drugs are first line, and give an example
4) Give an example of a high intensity psychological intervention
5) Patients who have benefitted from antidepressants should be continued for at least how long?
6) Why is this?
7) When stopping antidepressants, doses should be reduced gradually over how long?

Answer 4

1) Low intensity psychological interventions or group-based CBT
2) Pharmacological therapy or high intensity psychological intervention
3) Selective serotonin reuptake inhibitors (SSRIs) i.e. sertraline, fluoxetine, citalopram
4) CBT, interpersonal therapy, behavioural activation, behavioural couples therapy
5) 6 months
6) Reduce relapse
7) 4 weeks

Question 5

Management of severe depression
1) If antidepressants alone do not work, they can be augmented with what drug?
2) For severe depressive episodes that are life-threatening or require a rapid response, what does NICE recommend?

Answer 5

1) Lithium
2) Electroconvulsive therapy

Question 6

What is the first line antidepressant in children?

Answer 6

Fluoxetine