Depression Flashcards
What is depression?
Depression is characterised by persistent low mood and/or loss of pleasure in most activities and a range of associated emotional, cognitive, physical, and behavioural symptoms.
According to DSM-5, how is depression defined?
The presence of at least five out of a possible nine defining symptoms, present for at least 2 weeks, of sufficient severity to cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
It is classified as mild, moderate or severe, determined by both the number and severity of symptoms, persistence, presence of other symptoms as well as the degree of functional and social impairment.
What is subthreshold depression?
Subthreshold (minor) depression is characterised by the presence of two to four depressive symptoms, including depressed mood or anhedonia, lasting longer than 2 weeks.
What is persistent depressive disorder?
Persistent depressive disorder (dysthymic disorder) is characterised by at least 2 years of three or four dysthymic symptoms for more days than not. Dysthymic symptoms include depressed mood, appetite change, sleep disturbance, low energy, low self-esteem, poor concentration, and hopelessness.
What % of the UK population have depression?
4.5%
What are the risk factors for depression?
- Chronic comorbidities
- Medicines (e.g.corticosteroids)
- Female gender.
- Older age
- Recent childbirth
- Psychosocial issues such as divorce, unemployment, poverty, homelessness
- Personal history of depression
- Genetic and family factors- a family history of depressive illness
- Adverse childhood experiences
- Personality factors
- A past head injury, including hypopituitarism following trauma
What chronic comorbidities are associated with depression?
- Diabetes mellitus
- COPD
- Cardiovascular disease
- Chronic pain syndrome
According to the DSM-5, what are the 2 core symptoms of depression which must have been present for the past 2 weeks?
Diminished interest or pleasure in all or almost all activities most of the day, nearly every day, for a period of 2 weeks along with 4 other symptoms of depression.
What are the symptoms of depression?
- Depressed mood
- Anhedonia
- Functional impairment
- Weight changes
- Libido changes
- Sleep disturbances
- Low energy
- Excess guilt
- Poor concentration
- Suicidal ideation
What are the signs of depression?
- Appearance: attire, signs of self-neglectm facial expression or evidence of substance misuse
- Behaviour: cooperation, eye contactor social behaviour
- Speech: articulation, quantity, rate or tone
What investigations should be ordered to rule out other causes that may mimic depression?
- Metabolic panel
- FBC
- Thyroid function tests
Give examples of scoring systems for depression
- Patient-Health Questionnaire-2 (PHQ-2)
- Patient-Health Questionnaire-9 (PHQ-9)
- Edinburgh Postnatal Depression Scale
- Geriatric Depression Scale
What are the goals of treating depression?
The goals of treatment are to eradicate symptoms of depression, improve daily functioning and quality of life, improve workplace functioning, reduce suicidality, minimise treatment adverse effects and prevent relapse.
What are the various treatment options for treating depression?
Treatment modalities include antidepressants, other pharmacotherapies, psychotherapies, supportive interventions and electroconvulsive therapy (ECT).
Briefly describe the treatment for mild-to-moderate depression
- Consider offering a low-intensity psychosocial intervention
- Avoid the routine use of antidepressants but consider this for people with:
- A history of moderate or severe depression
- Subthreshold depressive symptoms that have persisted for a long period (typically at least 2 years)
- Subthreshold symptoms or mild depression that persists after other interventions
- Mild depression that is complicating the care of a chronic physical health problem.
