Depression

Question 1

Describe the typical presenting features of depression in adults.

Answer 1

Persistent low mood, hopelessness, depressed
Loss of interest and enjoyment – anhedonia
Libido changes
Sleep and appetite changes
Guilt or self-criticism
Psychomotor problems
Poor concentration
Reduced energy
Risk Factors – age>65, postnatal status, FH, corticosteroids

Question 2

Differentiate between low mood and depression in adults

Give some other differentials for depression

Answer 2

Low mood usually lifts within a couple of days. Continuation beyond 2 weeks could be a sign of depression. Low mood also tends to lift with some self help measures, mainly remembering to stay connected.

Grief reaction – however, active suicidal thoughts, psychotic symptoms and inappropriate guilt (guilt over a specific thing rather than in excess) are rare with normal bereavement.
Anxiety disorders
Bipolar disorders
Premenstrual dysphoric disorder
Dementia – do not offer antidepressants to manage mild to moderate depression in people with mild to moderate dementia. 
Substance abuse 
Hypothyroidism 
Obstructive sleep apnoea syndrome

Question 3

What questions are asked in a PHQ 9 questionnaire?

Answer 3

Over the last two weeks, how often have you been bothered by any of the following problems?

Little interest or pleasure in doing things?

Feeling down, depressed, or hopeless?

Trouble falling or staying asleep, or sleeping too much?

Feeling tired or having little energy?

Poor appetite or overeating?

Feeling bad about yourself - or that you are a failure or have let yourself or your family down?

Trouble concentrating on things, such as reading the newspaper or watching television?

Moving or speaking so slowly that other people could have noticed

Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual?
Thoughts that you would be better off dead, or of hurting yourself in some way?

Question 4

Develop appropriate management plans for mild, moderate and severe depression in accordance with NICE guidelines

Answer 4

Mild depression - guided self-help, based on the principles of cognitive behavioural therapy (CBT) — this consists of 6–8 sessions over 9–12 weeks.

Mild to moderate depression -group-based CBT — usually consists of 10–12 meetings of 10 participants over 12–16 weeks.

Moderate-to-severe depression - Individual CBT — usually over 16–20 sessions over 3–4 months.

CBT is most effective when given alongside antidepressant medication

Signpost to CRISIS, samaritans, LetsTalk Wellbeing

Question 5

Answer the typical questions asked by patients suffering from depression

Answer 5

Explain that symptoms may initially worsen as the medication does take time to work.
The medication should also be continued for at least 6 months following remission of symptoms as this greatly reduces the risk of relapse.
If you miss a dose, take it as soon as you remember, unless it’s time to take your next dose, in which case you should just skip the missed dose. Don’t take a double dose to “make up” for the one you missed. If you take more tablets than prescribed, contact your GP as soon as possible for advice