Low Mood

Question 1

Screening for depression

• 2 core symptoms and timeframe
• associated symptoms

Questions you’d like to ask in a history
-symptom specific

Answer 1

Any core symptoms for most days in 2wks

• persistent low mood
• anhedonia

Disturbed sleep
Appetite, weight change
Anergia
Psychomotor activity
Poor concentration, indecisive
Worthless, guilt
Suicidal thought/acts
Psychosis

Question 2

What are the factors that may predispose to depression

Answer 2

Demographic - young females

Past psych history - past episodes and how were they managed

Past medical history - chronic/terminal illness

• DM
• hypothyroidism
• CVD (MI, stroke)

Family history - depression/bipolar affective disorder

Social history -

• relationship status, no of children
• employment, finances
• social/familial support
• accommodation

Substance use - alcohol, illicit substances => exacerbates symptoms, reduces treatment efficacy

Question 3

Diagnostic criteria for depression

• mild
• moderate
• severe

Answer 3

Subthreshold - U5
Mild - symptoms with minor ADL effects
Moderate - ADL effects between mild and severe
Severe - most symptoms and debilitating on ADLs

Question 4

Management for

• subthreshold/mild
• moderate/severe

Answer 4

Subthreshold/mild - low intensity psychosocial intervention (IAPT) or CBT

Moderate/severe - high intensity psychosocial intervention + antidepressant

Medication

• takes 2-4wks for symptomatic improvement
• if U30 or high suicide risk, review after 1 wk
• review after 2wks to check for response
• continue to take for 6 months post recovery to reduce relapse risk

Question 5

Describe

• low intensity psychosocial interventions
• high intensity psychosocial interventions

Answer 5

Low intensity

• self guided CBT
• structured group based physical activity program

High intensity

• individual CBT - addressing thoughts
• interpersonal therapy - address problems in relationships with people
• behavioral activation - practical steps in enjoying life again

Question 6

What does antidepressant therapy involve

• first line
• other options
• SE of each main type
• considerations to make

Answer 6

1st line - SSRIs
-sertraline/citalopram - adults
-fluoxetine - children, teens
SE - GI upset, bleeds, nausea, anxiety

Other options - mirtazapine, venlafaxine, TCAs, atypicals

TCA SE - anticholinergic
-agitation, arrythmias
-blurred vision
-constipation, confusion
-sedation, stasis of urine
-dry mouth
VERY EASY TO OD