Depression

Question 1

1st line treatment for moderate-severe depression ?

Answer 1

high-intensity psychological intervention + medication (SSRI - fluoxetine or sertraline)

Question 2

what high-intensity psychological interventions are effective in treating depression ?

Answer 2

CBT
behavioural activation
interpersonal therapy
behavioural couples therapy

Question 3

how often are high-intensity psychological interventions delivered ?

Answer 3

CBT, IPT, behavioural activation typically delivered;
16-20 sessions over 3-4 months
1 per week if moderate- severe depression (CBT & behavioural activation)
consider 3/4 follow up sessions over next 3-6 months

Question 4

what 2 questions are used to screen for depression ?

Answer 4

during the past month have you often been bothered by feeling down, depressed or hopeless ?

during the past month have you been bothered by having little interest or pleasure in doing things ?

Question 5

what are the core symptoms of depression ?

Answer 5

mood is low
energy is low
interest is low (apathy)

Question 6

what is the ICD-10 definition of depression ?

Answer 6

low mood almost every day for the past 2 weeks
not attributable to psychoactive substance or organic mental disorder
no hypomania or mania in lifetime
if psychotic symptoms or stupor then severe depression with psychotic symptoms

Question 7

features of somatic syndrome ?

Answer 7

4 or more of the following;

• lack of pleasure/interest in activities usually find interest in (anhedonia)
• lack of emotional response to events/activities normally would (flat affect)
• loss of appetite
• weight loss
• loss of libido
• wakening up 2 hours or more earlier than usual
• depression worse in the morning
• psychomotor retardation or agitation

Question 8

how would you determine mild, moderate and severe depression ?

Answer 8

mild: 2 core symptoms + 2 cognitive symptoms
moderate: 2 core symptoms + 3/4 cognitive symptoms
severe: 3 core symptoms + at least 5 cognitive symptoms

presence of psychotic symptoms classifies depression into severe depression with psychotic symptoms

but NICE use the DSM-IV criteria to grade depression

• sub threshold = < 5 symptoms
• mild = 5 symptoms
• moderate = symptoms/functional impairment between mild and severe
• severe = most symptoms and they interfere with functioning

Question 9

what tool scan be used to assess the degree of depression ?

Answer 9

hospital anxiety and depression scale (HAD)

patient health questionnaire