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Depression-persistent low mood and/or loss of pleasure in most activities…
Depression-persistent low mood and/or loss of pleasure in most activities and a range of associated emotional, cognitive, physical, and behavioural symptoms.
presence of at least five out of a possible nine defining symptoms, present for at least 2 weeks, of sufficient severity to cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
moderate is diagnosed if symptoms or functional impairment are between mild and severe
severe - most symptoms present which interfere with functioning, with or without psychotic symptoms
mild- diagnosed if the person has few, if any, symptoms in excess of five symptoms and they only result in minor functional impairment.
subthreshold- individual has some of the symptoms, but insufficient in number or severity, or presence to affect functional or physical health. At least two but fewer than five.symptoms
persistent subthreshold - persistence of subthreshold symptoms for more than 2 years
SAD - episodes of depression which occur at the same time annually
Diagnosis - core symptoms- disturbed sleep, decreased/increased appetite/weight, fatigue/loss of energy, agitation or slowing of movements, poor concentration or indecisiveness, feelings of inapt guilt, worthlessness, suicidal thoughts or acts
PHQ9 questionnaire, HADS or BDS I-II
Risk Factors
Chronic comorbidities, medications
Psychosocial issues,
Recent childbirth
Fhx and PMHx
Female gender, older age
Childhood experiences
Personality disorders
Past head injury including hypopituitarism following trauma
Complications
Reduced QOL person and families
Increased morbidity and mortality in a range of comorbid conditions
Exacerbation of pain, disability and distress
Impaired ability to function normally
Increased risk of substance abuse
Complications associated with antidepressant use
DDx
Anxiety
substance and adverse drug effects, hypothyroidism, poor diabetic control, anaemia, menopause
Grief reaction, dementia
Prognosis
Likelihood of recurrence is high, risk increases with every episode
Prognosis worse with psychotic features, prominent anxiety, personality disorders, sever depressive symptoms
episodes last 3-6 months
persistent depression
persistent subthreshold depressive symptoms
Investigations
Rule out physical illness
blood glucose, urea and electrolytes, creatinine, liver function tests, thyroid function tests, calcium levels. full blood count and erythrocyte sedimentation rate.
Referral
High suicide risk
Crisis Resolution and Home Team
Management
For people with mild depression who do not want an intervention, or people with subthreshold depressive symptoms who request an intervention, consider a period of active monitoring- information on depression, 2 week follow up
For people with moderate or severe depression — offer an antidepressant and a high-intensity psychological intervention.
comorbid condition managed
Antidepressant treatment
Last 6 months, make anxiety initially worse, take to work, assess risk of suicide/overdose
Sleep hygiene
Follow up
Antidepressant type-st episode SSRI, recurrent episode- previous treatment used, chronic ill health - sertraline, lower risk of drug interactions. SSRI used in elderly consider PPI if taking aspirin or NSAIDS