Depression

Question 1

What is the ICD-11 definition of a depressive episode?

Answer 1

Depressed mood, loss of interest, and reduced energy for ≥2 weeks.

Question 2

What is the DSM-5 definition of Major Depressive Disorder?

Answer 2

A major depressive episode lasting ≥2 weeks with mood, cognitive, and physical symptoms.

Question 3

What is Persistent Depressive Disorder (Dysthymia)?

Answer 3

Chronic depression lasting ≥2 years with ≥5 symptoms.

Question 4

How is depression severity classified?

Answer 4

Mild: few symptoms, mild impairment; Moderate: intermediate; Severe: many symptoms + marked impairment ± psychosis.

Question 5

How common is depression in primary care?

Answer 5

Third most common GP consultation in the UK.

Question 6

Which sex is more commonly affected?

Answer 6

Females.

Question 7

What factors contribute to depression?

Answer 7

Genetic predisposition, previous mental health issues, physical illness, social adversity, unemployment, divorce, poverty.

Question 8

What are the 9 DSM core symptoms of depression?

Answer 8

Sleep disturbance, Interest ↓ (anhedonia), Guilt/worthlessness, Energy ↓, Concentration ↓, Appetite/weight change, Psychomotor change, Suicidal ideation, Depressed mood.

Question 9

What additional features occur in severe depression?

Answer 9

Psychotic symptoms (nihilistic delusions, Cotard’s syndrome) and depressive stupor.

Question 10

What psychiatric conditions mimic depression?

Answer 10

Bipolar disorder, anxiety disorders, psychotic disorders, adjustment disorder.

Question 11

What organic causes should be ruled out?

Answer 11

Hypothyroidism, Parkinson’s, dementia, diabetes, cortisol abnormalities, B12/folate deficiency, chronic infection, neoplasm (e.g. pancreatic cancer), medication/substance use.

Question 12

What bedside tests are done for depression?

Answer 12

Observations, ECG, urine dipstick.

Question 13

What blood tests should be ordered?

Answer 13

FBC, U&E, LFT, TFT, glucose, B12, folate, cortisol, toxicology screen.

Question 14

What screening tools assess depressive symptoms?

Answer 14

PHQ-9, HADS.

Question 15

When is CNS imaging used?

Answer 15

If suspect organic causes or atypical presentation.

Question 16

First-line treatment for mild or persistent subthreshold symptoms?

Answer 16

Low-intensity psychological interventions (self-help, computerised CBT).

Question 17

Second-line for inadequate response?

Answer 17

High-intensity CBT or interpersonal therapy.

Question 18

When are antidepressants added?

Answer 18

Failure of psychological therapy or moderate–severe symptoms.

Question 19

First-line treatment for moderate or severe depression?

Answer 19

High-intensity therapy + SSRI.

Question 20

What is the first-line antidepressant class?

Answer 20

SSRIs (e.g., sertraline).

Question 21

How long should antidepressants be continued after remission?

Answer 21

At least 6 months.

Question 22

How should young adults (18–25) be monitored?

Answer 22

Close follow-up due to increased impulsivity and suicidal ideation.

Question 23

What is first-line for severe depression with psychosis or stupor?

Answer 23

ECT.

Question 24

What is the management for recurrent depression?

Answer 24

Antidepressant + lithium.

Question 25

What are common complications of depression?

Answer 25

Functional impairment, suicidal ideation, social withdrawal.

Question 26

What are severe complications?

Answer 26

Psychotic depression, depressive stupor, self-harm.

Question 27

What factors determine prognosis?

Answer 27

Severity, comorbidities, response to initial treatment.

Question 28

What is the course of depression?

Answer 28

Variable; can be recurrent or chronic.