Depression

Question 1

How common is it?

Answer 1

2. 6-15% prevalence

1. 6/100 new cases per year

Question 2

Who does it affect?

Answer 2

Higher rates in older people.

Mid 30s if recurrent, can occur at any age.

F:M 2:1.

Also people of low social class and unemployment.

Question 3

What risk factors are there?

Answer 3

Any history of depression comorbid mental health or physical disorders
poor interpersonal relationships
poor living conditions and social isolation.
Hx abuse, neglect, trauma

Question 4

What are the biological symptoms?

Answer 4

Loss of interest or pleasure
Lack of emotional reactivity
Loss of energy, fatigue
Insomnia, with early morning wakening (or hypersomnia)
Diurnal variation of mood
Psychomotor retardation

Question 5

What are the somatic symptoms?

Answer 5

Loss of appetite (or increased &weight gain)
Loss of weight
Constipation
Amenorrhoea
Loss of libido
Psychomotor agitation

Question 6

What are the psychological symptoms?

Answer 6

Poor concentration or attention, indecisiveness
Pessimistic thoughts (Negative cognitive triad: Self: Worthless, World: Critical, guilt, Future: hopelessness)
Poor self-esteem and low self confidence
Guilt and worthlessness
Hopelessness and thoughts of self-harm or suicide.

Question 7

Investigations

Answer 7

Mental state examination: psychotic features, suicidal thoughts.

Screen for risk, this has 3 main domains:

1. Suicide and self-harm: Past attempts, current thinking, acute stressors.
2. Risk to self: Able to cope at home, basic living skills, intoxication.
3. Risk to others: Forensic history, impulsivity, any identified targets?

Also protective factors.

PHQ-9 is also useful. There is also the geriatric depression scale (GDS) and Hospital anxiety and depression scale (HAD). ICD-10 core symptoms: Low or depressed mood, loss of interest and enjoyment, loss of energy, duration (more than 2/52, shorter durations my just be reactive to life events, and each symptom should be present at sufficient severity for most of every day.

Question 8

Treatment

Answer 8

Bio-psycho-social: CBT + Manage underlying physical disorders/ Alcohol & Drug Misuse

For biological causes use antidepressants (Carry on for 6 months after remission).

• SSRIs e.g. fluoxetine, citalopram, sertraline
• Tricyclics e.g. Amitriptyline, nortriptyline, lofepramine
• NaSSA e.g. Mirtazapine
• SNRI e.g. Venlafaxine, duloxetine

Question 9

Conditions that would present similarly

Answer 9

PTSD
alcoholism
anxiety and other neurotic disorders
somatisation
dementia