Depression

Data gathering – History

• Red flags
  • Harming self or others
  • Specific plans
  • Lack of protective factors
• Others
  
  • Low mood | Low energy | Anhedonia
  • Sleep | Appetite | Confidence | Concentration | Guilt
• SH
  • Work | Home | Alcohol | Drugs
• PMH
  • Previous self harm
• FH
  • Mental health issues
  • Suicide

Data gathering – Examination

• Mental State Examination
  • Appearance
  • Behaviour
  • Speech
  • Affect, Mood
  • Thoughts
  • Perception
  • Cognition
  • Insight

Clinical management

• Investigations
  • Bloods – FBC, TFTs, calcium
• Explanation
  • Feeling low is a normal experience that can affect us all from time to time.
  • Depression is a more persistent intense type of this and is often accompanied by physical effects such as sleep difficulties, loss of energy
• Treatment
  • Lifestyle
    • Exercise
    • Diet
    • Sleep hygiene
  • Psychological
    • CBT
    • Online psychological therapy resources
  • Medications
    • SSRI

• Follow up
  • Review within 4/52
• Safety net
  • CRISIS team, A+E

SSRI notes

• PPI if elderly/aspirin/NSAID
• Titrate 4 weekly
• Continue at least 6 months after improvement
• Stop gradually