Depression/Low Mood

Question 1

Aetiology of depression

Answer 1

Biological causes of depression include genetics (strong predicator), personality (dependent, anxious), physical illness, monoamine deficiency, neuroendocrine (HPA axis), co-morbid substance misuse, medication use (beta-blockers, steroids) or history of other mental illnesses (e.g. anxiety)

Psychological causes of depression include negative automated thoughts (worthlessness, helplessness, hopelessness), life events, environmental factors (e.g. support) and lack of education

Social causes of depression include lack of social support and poor economic status

Question 2

How is depression diagnosed?

Answer 2

The patient must be experiences at least two core symptoms and at least two symptoms from the other categories (biological or cognitive)

Question 3

What is depression?

Answer 3

It can either be a symptom (e.g. in bipolar) or a diagnosis

Question 4

What are the three core symptoms of depression?

Answer 4

Low mood
Anhedonia
Fatigability/decreased energy

Question 5

What are the biological symptoms of depression?

Answer 5

Low mood in the morning 
Disturbed sleep and early morning wakening
Loss of libido
Issues concentrating 
Loss of appetite

Question 6

What are the cognitive symptoms of depression?

Answer 6

Low self-confidence/self-esteem
Thoughts of self-harm or suicide
Feelings of guilt and worthlessness
Bleak and pessimistic views of the future

Question 7

Differential diagnoses for low mood

Answer 7

Dementia 
Delirium 
Organic mood disorders (organic bipolar affective disorder, organic depressive disorder and mixed affective disorder)
Psychoactive substances – intoxication, withdrawal and psychotic disorders 
- Alcohol 
- Methadone
Schizoaffective disorders – may be depressive or mixed type 
Schizophrenia 
Acute and transient psychotic disorders 
-Bipolar affective disorder 
Depressive affective disorder 
Depressive episode 
Recurrent depressive disorders 
Persistent mood disorders – cyclothymia or dysthymia 
OCD
Phobia anxiety 
Other anxiety disorders

Question 8

How is mild depression managed?

Answer 8

Short-term
- psychosocial interventions (CBT, structured group physical activity programme) 
- psychoeducation of the disease 
Long-term 
- same as moderate/severe depression

Question 9

How is moderate/severe depression treated in the short-term?

Answer 9

Combination of antidepressant therapy and high intensity psychosocial interventions
- individual/group CBT
interpersonal therapy, behavioural couples therapy
Antipsychotic if presenting with psychotic symptoms
Psychoeducation of disease

Question 10

How is moderate/severe depression treated in the long-term?

Answer 10

Risk assessment
Assess response to interventions and anti-depressant therapy
- compliance, side effects, etc.
Assess changes to quality of life
Relapse prevention plan
Assess social support and whether previous issue flagged during consultations have been addressed