Depression

Question 1

Definition of depression

Answer 1

Depression is the absence of a positive affect, low mood and a range of associated emotional, cognitive, physical and behavioural symptoms

Question 2

Risk Factors of Depression - 5

Answer 2

• Female
• Older age
• Personal, social or environmental factors
• postpartum
• FH

Question 3

How is depression clinically diagnosed - 5

Answer 3

1) consider if pt has possible risk factors

2) Ask depression identifiers:
- During the last month, have you often been bothered by feeling down, depressed, or hopeless?
- During the last month, have you often been bothered by having little interest or pleasure in doing things?

3) If pt answers yes to either or both, ask about associated symptoms

4) ask about any plans to harm themselves or others

5) use a depression questionnaire e.g. PHQ-9

Question 4

Associated symptoms of depression - 7

Answer 4

• Disturbed sleep
• Decreased/increased appetite
• fatigue
• agitation
• poor concentration
• feelings of worthlessness
• suicidal ideas, thoughts or a specific plan

Question 5

Describe the PHQ-9 and what its results mean

Answer 5

Patient health questionnaire-9
Consists of 9 questions for pt to fill out. Maximum score is 27

Less than 16 - less severe depression

More than 16 - more severe depression

Question 6

Initial management of a person with depression - 3

Answer 6

• Direct them to support pages e.g. RCPsych website, MIND website, Samaritans
• Advice on activities that improve mental wellbeing e.g physical activity, diet, sleep, alcohol
• If more severe depression, arrange urgent referral to mental health services

Question 7

What factors must be considered when initiating antidepressants - 4

Answer 7

• patients treatment preferences
• Potential overdose risk (tricyclics are most risky)
• ADRs, Withdrawl, tolerability (SSRIs are generally most tolerable)
• co-morbidities

Question 8

difference between more and less severe depression 1st line management

Answer 8

More severe - CBT and anti-depressants immediately

Less severe - guided self help, then CBT

Question 9

name and give examples of the 3 types of antidepressants

Answer 9

SSRIs - citalopram, sertraline, fluoxetine

SNRIs -Desvenlafaxine,
Duloxetine

Tricyclics - amitriptyline, amoxapine

Question 10

Differentials of depression - 7

Answer 10

• bereavement
• anxiety disorders
• bipolar
• psychotic disorders e.g. schizophrenia
• PMDD
• Neuro e.g. dementia, MS, Parkinsons
• Substance misuse

Question 11

Low Mood Vs Depression

Answer 11

Low mood = feeling down, tired, low confidence and worried but it passes after a few days/weeks after making lifestyle changes

Depression = symptoms persist and you no longer gain pleasure from things most days for several weeks