Depressive Disorder

Question 1

Define depressive disorder

Answer 1

Depressive disorders are typically characterised by persistent low mood, loss of interest and enjoyment, neurovegetative disturbance, and reduced energy, causing varying levels of social and occupational dysfunction

Question 2

What are the causes/risk factors of depressive disorder?

Answer 2

• Life events
• substance misuse
• bereavement

Risk Factors: 
• female
• past history
• physical illness
• other mental health problems

Question 3

What are the signs and symptoms of depressive disorder?

Answer 3

both negative affect (low mood) and/or absence of positive affect (loss of interest and pleasure), accompanied with emotional, cognitive, physical and behavioural symptoms

At least one of:
• Persistent sadness or low mood nearly every day
• Loss of interests or pleasure in most activities
• Plus five of:
- Fatigue or loss of energy
- Worthlessness, excessive or inappropriate guilt
- Recurrent thoughts of death, or self harm
- Diminished concentration
- Psychomotor agitation
- Insomnia
- Changes in appetite

Sub-threshold (<5 of the symptoms)
Mild (few over 5 symptoms) Moderate (between mild and severe)
Severe (most, if not all, symptoms present)

Question 4

What investigations are used for depressive disorder?

Answer 4

• clinical diagnosis

Consider organic causes to the depression (e.g. hypothyroidism, hypercalcaemia, Addison’s disease, Cushing’s disease)

Investigations for other causes: 
• Blood glucose  
• U&Es 
• TFTs 
• Calcium  
• FBC  
• MRI/CT