Depression

Question 1

ICD10 criteria

Depression

Answer 1

Low mood
Anhedonia
Low energy

Sleep/ early morning waking
Appetite/Weight loss
Low self-esteem
Guilt
Concentration
Diurnal variation in mood (? Worse in the morning)
Reduced libido
Hopelessness

Screen for psychosis

Always ask re deliberate self harm and suicidal thoughts

Previous history really important

Aetiology
Talk about vulnerabilities in terms of genetic’s and also life experiences and precipitants (stress, relationships, physical illness, childhood experiences/trauma)

Prognosis
Quarter fully recover
quarter remain depressed
50 to 75% get future episode

Question 2

Antidepressants

Answer 2

Star D

about third got better with one antidepressant
About a half in total got better with 1 to 2 antidepressants

Or 7/10 will get better on antidepressants

Social support exercise avoid excess alcohol CBT all help

Takes 2 to 8 weeks to have their full effect

Usually take for a minimum of six months after remaining well -two years for the elderly population

Need to actually increase but also gradually reduce-

Discontinuation syndrome headaches could like symptoms and electric shocks

Common side effects include sexual dysfunction nausea diarrhoea constipation dry mouth blurred vision

1/3 didn’t respond