Diagnosing Depression

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Diagnosing Depression

• VTS Teaching
• Ruth Gooch

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What is depression? (1)
Depression is an illness
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What is depression? (2)
Key Features

• Persistent sadness or low mood
• Loss of interests or pleasure
• Fatigue or low energy

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What is depression? (3)
Associated Features/Symptoms

• Disturbed sleep
• Reduced concentration or indecision
• Reduced self-confidence
• Poor or reduced appetite
• Agitation or slowing of movements
• Guilt or self-blame
• Suicidal thoughts

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Mild, Moderate and Severe

• Moderate
• 5-6 symptoms
• Inc gt1 key symptoms
• The pt is likely to have great difficultly in
  continuing normal activities

• Severe
• 7 symptoms
• Inc gt1 key symptom
• Highly dysfunctional pt. May show prominent
  features of worthlessness/ guilt /- suicidical
  ideas

• Mild
• 4 symptoms
• Inc gt1 key symptom
• The pt is generally disturbed but able to carry
  out normal activities

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But is it really depression?

• It is normal for people to feel down at times.
• Not everybody who feels low needs medicating.
• Use clinical knowledge along with certain tools
  to help assess which patients do need further
  help.

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NICE Guidance

• NICE guidelines encourage us to screen for signs
  of depression in
• Patients with a past history of depression
• Those with significant physical illness causing
  disability
• Patients who have other mental health problems,
  such as dementia.

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Screening Questions

• 96 sensitivity, 57 specificity
• During the past month have you often been
  bothered by little interest or pleasure in doing
  things?
• During the past month have you been bothered by
  feeling down, depressed or helpless?

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PHQ-9

• US Prevention Services Task Force, analysis 41
  different screening tools.
• Patient Health Questionnaire 9, cheap and quick
• A useful tool in assessing and monitoring
  depression in general practice
• QOF-able