Week 7- Depression Overview, Epidemiology, Aetiology,Symptoms, Diagnosis and Differential Diagnosis

Question 1

what is the epidemiology for depression?

Answer 1

-Around 1 in 5 (19%) of
people have some
symptoms of anxiety or
depression
-A higher proportion of
women than men
-A higher incidence in those
who are divorced, not in
paid work, living alone,
dissatisfied with their health
or if caring for someone else in the household
-First episodes are often in
the ages 15-18
-Most common first episode
is between 30 and 40 years

Question 2

why may depression be more prominent in women?

Answer 2

due to them opening up about their symptoms

Question 3

what are some risk factors of unipolar depression?

Answer 3

•Genetics
•Anxiety
•Gender
•Lack of parental care or childhood sexual abuse •Social adversity, stress and the person’s reaction to it •Physical illnesses (e.g. kidney disease and diabetes gives a 5-times
higher risk)
•Poor sleep and chronic insomnia (2-fold increased risk)
•Vitamin D deficiency •Quitting smoking (increased risk)
•Mother having postnatal depression (5-fold increased risk)
•Drugs

Question 4

what are the risks to an individual for untreated depression?

Answer 4

• Increase in risky behaviours such as drug or alcohol abuse or dependence
• Cognitive impairment, including poor interactions with friends, family and colleagues
• Poor work
• Poor sleep and its consequences
• Suicidal ideation or suicidal acts

Question 5

what are some risk factors for recurrent depression?

Answer 5

• History of frequent and/or multiple episodes
• Onset after the age of 60
• Long duration of individual episodes
• Family history of affective disorder
• Poor symptom control during continuation therapy
• Co-morbid anxiety disorder or substance abuse

Question 6

what are some of causes of drug induced unipolar depression? (examples)

Answer 6

Well over 200 prescribed medicines have been reported to
lead to depressive symptoms:
•Alcohol
•Steroids (e.g. dexamethasone) •Benzodiazepines e.g. diazepam, clonazepam, temazepam,
lorazepam
•Antipsychotics •Anticonvulsants e.g. carbamazepine, lamotrigine,
levetiracetam, pregabalin, topiramate
•NSAIDs e.g. ibuprofen •Cardiovascular drugs e.g. beta-blockers, calcium channelblockers •Caffeine/caffeine withdrawal

Question 7

what are some symptoms of depression? 3 groups?

Answer 7

• emotional
• physical
• cognitive
• poor sleep
• hopelessness
• lack of enjoyment
• loss/gain of weight
• headaches
• short and long term memory
• bad decision making

Question 8

how is depression diagnosed?

Answer 8

ICD-10 - At least TWO key symptoms, most days, most of the
time for at least 2 weeks, minimum 4 symptoms
DSM IV -At least ONE of these key symptoms, most days, most of the time for at least 2 weeks and minimum 5 symptoms

-there are key symptoms and associated symptoms

Question 9

what are the key symptoms of depression used for diagnosis?

Answer 9

•persistent sadness or low mood
and/or
•marked loss of interests or pleasure
•Lack of Energy- (ICD 10 ONLY)

Question 10

what are the associated symptoms of depression used for depression?

Answer 10

• disturbed sleep (decreased or increased compared to usual)
• decreased or increased appetite and/or weight •fatigue or loss of energy •agitation or slowing of movements
• poor concentration or indecisiveness
• feelings of worthlessness or excessive or inappropriate guilt
• suicidal thoughts or acts

Question 11

what are the 5 divided depressions grades that NICE have created?

Answer 11

-Sub-threshold - where the person has a few symptoms and feels low, but can still function
-Mild - where the person has enough symptoms for a diagnosis but can function reasonably well
-Moderate - where the person has a range of symptoms and is not coping well
-Severe - where the person has a full set of symptoms, can’t function and may even suffer some psychotic symptoms too
-Complex - where the symptoms have failed to improve with treatment and may have psychosis, other symptoms and
problems

Question 12

how is there a differential diagnosis for depression?

Answer 12

• Bipolar depression
• GAD- Generalised Anxiety Disorder
• Drug-induced •Schizophrenia or Schizoaffective disorder •ADHD
• Substance misuse
• Personality disorders •Normal bereavement •Physical illness e.g. hormonal, infections, arthritis, anaemia, brain diseases
• Dementia
• Panic disorder
• Seasonal Affective Disorder

Question 13

what are some co-morbidities for depression?

Answer 13

The more common co-morbid conditions include: •Generalised Anxiety Disorder
•Psychosis
•Insomnia - caused by the depression (and vice versa) •OCD (Obsessive Compulsive Disorder)
•PTSD (Post-Traumatic Stress Disorder)
•Panic disorder
•Dementia (especially early dementia).