Depression in Adults and Older Persons

Question 1

Depressive illness, facts

Answer 1

Probably the greatest masquerade of general practice

One of the commonest illnesses in medicine

Often confused with other illnesses

Many episodes of depression are transient:

• and should be regarded as normal
• but 10% of the population have significant depressive illness.

Question 2

Major depression

DSM-5 diagnostic criteria for major depression

Answer 2

• at least five of the following symptoms
• for 2 wks
• nearly every day (criterion 1 or 2 essential):

1. Depressed mood, subjective or objective (the essential feature)
2. Loss of interest or pleasure
3. Significant change in weight (5% over 1 mth) or change in appetite
4. Insomnia or hypersomnia (usually early-morning waking)
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive guilt
8. Impaired thinking or concentration; indecisiveness
9. Suicidal thoughts/thoughts of death or suicide

Question 3

Minor depression

Answer 3

basically a condition where fluctuations of symptoms occur with some vague somatic symptoms and a transient lowering of mood that can respond to environmental influences.

The diagnosis is based on a total of 2–4 symptoms from the above list, inc. 1 & 2.

These pts usually respond in time to simple psychotherapy, reassurance and support.

Question 4

Management of depression (adults)

Answer 4

Important considerations from the outset are:

• Is the patient a suicide risk?
• Have secondary causes been excluded, e.g. hypothyroidism, drug misuse/adverse effects?
• Does the patient require inpatient assessment?

Is referral to a specialist psychiatrist indicated?

If the symptoms are major and the patient appears in poor health or is a suicide risk, referral is appropriate.

Question 5

The basic treatments are:

Answer 5

Psychotherapy, inc.

• education
• reassurance and
• support.

All patients require minor psychotherapy.

More sophisticated techniques, such as:

• cognitive behavioural therapy, can be used for selected pts.

Cognitive therapy involves:

• have to be relevant and
• achievable for the patient.

Pharmacological agents (monotherapy is preferable)

Electroconvulsive treatment

Note: Reassurance and support are needed for all depressed patients.

Question 6

Useful guidelines

Answer 6

Mild depression:

• psychotherapy alone may suffice
• but keep medication in mind

Moderate to severe depression:

• psychotherapy plus antidepressants

Severe to morbid depression:

• cease drugs
• ECT then antidepressants

Question 7

Recommended reading for patients

Answer 7

Rowe D. Depression:

• the Way out of Prison.
• Routledge and Kegan Paul, London, 2003.

Gordon Parker.

Dealing with Depression.

Allen & Unwin, Sydney, 2004.