Depression

Question 1

How is depression diagnosed?

Answer 1

Symptoms must be present on most days without significant changes throughout the day for over 2 weeks.
Must represent a change from normal personality without alcohol/drugs or bereavement.
There must be at least 2 core symptoms plus at least 2 typical symptoms.

Question 2

What are the core symptoms of depression?

Answer 2

Low mood (little variation with activity, slightly worse in the morning)
Anhedonia
Low energy

Question 3

What are the typical symptoms of depression?

Answer 3

Poor appetite with weight loss (rarely the reverse)
Disrupted sleep (initial insomnia/early wakening 3+ hours before)
Psychomotor retardation/agitation
Decreased libido
Feelings of guilt, worthlessness and hopelessness
Thoughts of death, suicide or suicide attempts

Question 4

How is depression classified?

Answer 4

Based on the number of episodes and severity of features

Question 5

How is the severity of depression classified?

Answer 5

Mild - 2 core and 2 other
Moderate - 2 core and 3+ other
Severe - 3 core and 4+ other

Question 6

What is the management for mild depression?

Answer 6

Low intensity psychological interventions (sleep hygiene, mindfulness, problem-solving techniques)
Self-help guides, computerised CBT, structured group-based physical activity programmes

Question 7

What is the management for moderate depression?

Answer 7

Combination of antidepressant (SSRI) and high-intensity psychological intervention (8-12 CBT sessions, interpersonal therapy)

Question 8

What is the treatment for severe depression? (Inc. psychotic depression, atypical depression, high risk of suicide)

Answer 8

Rapid specialist mental health assessment
Consideration of inpatient admission
ECT