Depression

Question 1

What is depression?

Answer 1

Depression is a disorder characterised by low mood and loss of interest in previously enjoyed activities.

Question 2

Risk factors for depression?

Answer 2

Female sex
Older age
Past hx of depression

Personal, social, or environmental factors
- relationship problem
- bereavement
- stress
- poverty
- unemployment
- homelessness

Postpartum period
FHx of depressive illness
Hx of other mental health conditions and/or substance misuse
Other chronic physical health conditions (e.g. diabetes, COPD, CVD, epilepsy, stroke disease)

Question 2

How does depression present?

Answer 2

Low mood, energy
Irritability, fatigue
Anhedonia (a lack of pleasure/interest in activities)
Changes to weight, appetite, and sleep (increase or decrease)
Anxiety and worry
Poor concentration
Avoiding social situations (e.g. school)
Hopelessness about the future, suicidal thoughts
Physical symptoms such as abdominal pain
Psychotic features (delusions, hallucinations)

Question 3

What investigations can you do in relation to depression?

Answer 3

No blood test or scan can identify depression, hence it is clinical diagnosis alongside scoring scale e.g. PHQ-9.

To rule out an organic cause:
- Glucose
- U&Es
- LFTs
- Calcium
- FBC
- inflammatory markers

-MRI or CT (if intracranial pathology suspected -e.g. persistent headaches or personality change)

Question 4

How is depression diagnosed?

Answer 4

Clinical diagnosis
Ask:
- During the last month, have you often been bothered by feeling down, depressed, or hopeless?
- During the last month, have you often been bothered by having little interest or pleasure in doing things?
- Associated symptoms

Mental State Examination (MSE)

PHQ-9

Neurological examination (if there are comorbidities)

Question 5

How is depression managed?

Answer 5

Biological:
- 1st line: SSRI
- Electroconvulsive therapy
- Augment with lithium or an antipsychotic

Psychological:
- Self-help
- CBT
- Behavioural activation

Social:
- consider safeguarding
- lifestyle advice (exercise, healthy and balanced diet, reduce alcohol)
- mindfullness and meditation

Mild-moderate depression
- 1st line: low-intensity psychological interventions
- 2nd line: high-intensity psychological interventions
- 3rd line: antidepressants

Moderate-severe depression
- 1st line: high-intensity psychological interventions and antidepressants (SSRI)
- 2nd line: switch antidepressants

Severe depression and poor oral intake/psychosis/stupor
- 1st line: Electroconvulsive therapy (ECT)

Question 6

What is the prognosis like for depression?

Answer 6

With tx, depression lasts for 3-6 months.

More than 50% of people experiencing a major depressive episode recover within 6 months, and 75% of people recover within a year.

Risk of relapse is increased in:
- hx of recurrent episodes of depression within the last two yrs
- incomplete response to previous tx
- unhelpful coping styles
- other chronic physical or mental health problem
- personal, social, environmental factors contributing to their depression