Depression

Question 1

What is the definition of depression?

Answer 1

ICD-10: constellation of symptoms for longer than 2 weeks, with lowering of mood, reduction of energy and decrease of activity

Question 2

How common is depression?

Answer 2

Very common, especially in females and older people

Question 3

What is the pathophysiology of depression?

Answer 3

• Mild, moderate or severe
• Altered levels of CRH (stress hormone regulator)
• ↓ in levels of serotonin, norepinephrine or dopamine

Question 4

What are the risk factors/aetiology of depression?

Answer 4

• Female
• Past history of depression
• Family history of depression
• Traumatic events in life – especially in childhood
• Significant physical illness causing disability/pain
• Other mental health problems
• African-caribbean/Asian/redugee/asylum seeker communities
• Hypothyroidism
• Drugs: centrally acting antihypertensives, lipid soluble bet blockers, benzodiazepines, progesterone contraceptives

Question 5

What are the signs/symptoms of depression?

Answer 5

• Biological
• Persistent sadness/low mood nearly everyday
• Loss of interest/pleasure in most activities
• Fatigue/loss of energy
• Psychomotor agitation/retardation
• Insomnia/hypersomnia
• Psychological
• Worthlessness
• Excessive/inappropriate guilt
• Recurrent suicidal thoughts/suicidal attempts
• Lack of concentration
• Increased indecisiveness
• Somatic
• Changes in appetite/weight
• Constipation
• Amenorrhoea
• Loss of libido

Question 6

What diseases present similarly to depression?

Answer 6

• Bipolar disorder
• Psychosis
• Dementia
• Seasonal affective disorder
• Bereavement

Question 7

What investigations are carried out to diagnose depression?

Answer 7

• Patient Health Questionnaire (PHQ-9)
• Geriatric depression scale
• Hospital Anxiety and Depression Scale
• Mental state examination
• Speaking to family members
• Blood glucose, U&Es, LFTs, TFTs, Ca, FBC, inflammatory markers
• MRI/CT

Question 8

What are the surgical treatments for depression?

Answer 8

• Electroconvulsive therapy

Question 9

What are the pharmacological treatments for depression?

Answer 9

Antidepressants - SSRI normally first line

Question 10

What are the non pharmacological treatments for depression?

Answer 10

• CBT – therapy or computerised
• Relaxation therapy
• Brief psychological therapies