Depressive disorder

Question 1

What is depression?

Answer 1

Persistent low mood, loss of interest and enjoyment in everyday activities, neurovegetative disturbance and reduced energy, causing varying levels of social and occupational dysfunction.

Question 2

! What are the different types of depressive disorder? (x7)

Answer 2

• Major depressive disorder: has at least 5 symptoms of depression, where at least one is depressed mood or anhedonia
• Disruptive mood dysregulation disorder: severe and persistent irritability or angry mood nearly every day, and recurrent temper outbursts on average 3 or more times per week for at least a year
• Persistent depressive disorder aka dysthymia: low-grade depression for at least 2 years with three or four symptoms
• Postnatal depression: major depressive disorder with an onset in pregnancy or 4 weeks after delivery
• Premenstrual syndrome: cyclical physical and behavioural symptoms occurring at luteal phase. Premenstrual dysphoric disorder is a more severe variant
• Seasonal affective disorder (SAD): onset of depression usually in autumn and winter with remission in spring and summer
• Bipolar disorder: alternative periods of mood elevation and depression associated with an impairment in functioning

Question 3

What are the risk factors for depression in adults? (x6)

Answer 3

Family history, recent bereavement, stress, chronic medical condition, certain medications (such as corticosteroids, isotretinoin), trauma.

Question 4

What is the epidemiology of depression: Common? Gender? Age?

Answer 4

20% of adults are affected by a mood disorder at least once in their life. Higher in females. Increasing incidence in older age.

Question 5

What are the symptoms of depression? (x10)

Answer 5

• DEPRESSED MOOD
• ANHEDONIA
• Weight changes
• Libido changes
• Sleep disturbance
• Psychomotor problems manifesting from agitation
• Low energy
• Excessive guilt
• Poor concentration
• Suicidal ideation

Question 6

What are the complications of depression? (x3)

Answer 6

Paranoia, hallucinations and functional impairment (for example, in social or occupational functions)

Question 7

What are the investigations for depression? (x3)

Answer 7

• CLINICAL DIAGNOSIS using DSM-5 diagnostic criteria
• Metabolic panel: provides baseline
• FBC and TFTs: may suggest different aetiology to symptoms of low energy, weight changes etc.

Question 8

What screening tools are there for depression? (x5)

Answer 8

• Patient Health Questionnaire-2: ‘Over the past 2 weeks, have you felt down, depressed, hopeless?’ and ‘Over the past 2 weeks, have you felt little interest or pleasure in doing things?’. Positive response to either question indicates review
• Patient Health Questionnaire-9 (PHQ-9): 9-item depression screening tool that reflects the DSM-5 criteria.
• Edinburgh Postnatal Depression Scale: 10-item questionnaire for postnatal depression
• Geriatric Depression Scale: 15 yes/no questions to screen for depression but does not assess severity. At least 5 suggests depression
• Cornell Scale for Depression in Dementia: for geriatric patients with depression