Low mood Flashcards
Symptoms to ask about if suspect depression
What has been going on in the patients life recently? Any triggers e.g. stress, financial concerns, bereavement
Core - low mood, anhedonia, fatigue
Somatic - sleep (e.g. early morning waking), appetite, libido
Cognitive - concentration, motivation and memory
How long have you been feeling low for? Symptoms must be present for at least 2 weeks if it is depression
Insight/ICE - what do you think may be going on? What are you concerned about
Mania
Psychosis sx
Thoughts/plans of suicide/self-harm
- Ask about protective factors - are there aspects/people in your life that prevent you from wanting to go through with thoughts to harm yourself?
Do you have a good support network?
Questions to ask to exclude other causes of low mood/fatigue
Hypothyroidism - feel the cold more than you expect, weight gain
Anaemia - any fatigue with SOB, palpitations
PMH to ask about in low mood
Mental health problems
Thyroid problems
DH and allergies
Taking or previously taken any treatment for mental health
FH
Depression, mania, suicide
Thyroid problems
SH
Occupation - stress at work
Living arrangements
Social support from family/friends etc…
Alcohol, smoking, substance misuse
Examination in low mood
Mental state examination - signs of neglect, mood etc…
Thyroid examination - if suspect thyroid pathology
Investigations in low mood
PHQ 9 questionnaire
Bloods - FBC (any anaemia), TFTs
Management of depression (mild, moderate, severe)
Mild:
Explain diagnosis
Direct to NHS website, online support groups
Lifestyle measures - regular outdoor exercise, social activities, sleep hygiene, alcohol abstinence
Group based CBT self-referral
Antidepressants can be a future option
Drop off any means of suicide/self-harm to the GP or a pharmacy - e.g. paracetamol
Moderate to severe -
- SSRI e.g. citalopram (can take up to 3-6 weeks to work and symptoms may initially worsen)
- Refer/self-refer to CBT
- Refer to psychiatry if severe (PHQ9>20)
Follow up and safety netting
Like to meet again in one or 2 weeks to assess if these measures are helping improve your mood, if not can discuss CBT, SSRIs
SN - if have urge to self-harm then arrange an urgent GP appointment, if having suicidal thoughts or making plans then contact crisis team or Samaritan’s (available 24/7 if need support)
If get any symptoms of elation or experiencing things you can’t explain - come back
Suspect bipolar or schizoaffective disorder - management
Refer to psychiatry - for assessment
If suspect hypothyroidism
Examine for goitre
Investigations - FBC, TFTs
(TFTs would show increased TSH and reduced T4)
Start levothyroxine with follow up and bloods in 4-6w
Discussion around starting antidepressants - what counselling to give
Before starting - any allergies or heart problems
When starting - may take a few weeks to work and may make mood worse initially, side effects include GI upset
When stopping - should not stop suddenly, must continue for 6 months after recovery
