Depression

Question 1

Differential diagnosis for being tired all the time

Answer 1

Depression
Obesity
Obstructive sleep apnoea
Poor sleep pattern, hard work, stress
Treatment with sedative, caffiene withdrawal
Chronic fatigue syndrome
Anaemia
Cancer
Renal disease
Liver disease
Heart failure
Hypothyroidism
Diabetes
Autoimmune: SLE, RA, Sjogrens

Question 2

Risk factors

Answer 2

Older age +65
Female
Postpartum
Family history
Chronic comorbidities (T2DM,COPD, CVD, chronic pain syndromes).
Medicines (corticosteroids)
Psychosocial issues such as divorce, unemployment, poverty, homelessness.
Adverse childhood experiences (poor parent-child relationship, physical or sexual abuse).

Question 3

Symptoms

Answer 3

Low mood
Anhedonia: diminished interest or pleasure activities
Functional impairment: impairment in social and/or occupational function
Weight change: weight loss or gain, with decreased or increased appetite
Sleep disturbance: insomnia or hypersomnia
Psychomotor agitation or retardation
Feelings of worthlessness or guilt
Suicidal ideation
Poor concentration
Low energy or fatigue*

Question 4

Pharmacological treatment

Answer 4

SSRI’s: Citalopram
- Fluoxetine = first line in children and young people
- Sertraline = post-myocardial infarction
Severe: Electroconvulsive therapy

Question 5

Phycological treatment

Answer 5

Cognitive behavioural therapy (CBT) = thoughts and pattern behaviours make you more likely to be depressed
Interpersonal therapy (IPT) = problems in personal relationships
Mindfulness-based cognitive therapy (MBCT) = focus on present moment
Behaviour therapy = encourages activities that are rewarding, pleasant or satisfying
Self guided help = work through workbook/course with help of therapist