Depression

Condition	Depression
Demographics	10% of the population have significant depressive illness  Lifetime risk: 12% for men and 25% for women
Murtagh Triad	No Murtagh Triad but 2 questions particularly helpful : In the past month, have you been bothered by feeling down, depressed or hopeless? In the past month, have you often been bothered by little interest or pleasure in doing things?
History features	Trying to see whether the patient’s symptoms fit into the criteria of depression and also determine the severity.  It is also important to exclude other diagnoses, such as adjustment disorder, bipolar and psychotic depression.  **The most important thing is risk assessment** If you don’t ask this in the exam, you will definitely fail  Major Depression Diagnostic criteria
Examination	Mental state examination: Appearance: varies greatly depend on severity Behaviour: psychomotor retardation or agitation Mood: low  Affect: poor eye contact, tearful  Thought stream: normal to slow  Thought form: usually normal, sometimes blocking Thought content: guilt, worthlessness, hopeless, suicidal ideation Perception: Hallucination congruent with the depressive process Cognition: disordered, intact most of the time but disinterested Attention and concentration: may be poor
Investigations	Mainly to exclude organic causes. Suggested investigations: FBE, UEC, LFT, CRP, ESR, TSH, Vit D, Folate/B12  Objective measurement tool to assess depression: K10, DASS
Management	Non pharmacological treatment: Lifestyle changes (e.g. exercise, eat healthy), CBT (online or face to face) Pharmacological: SSRI (1st line), SNRI (2nd line), TCA (not recommended in elderly people), MAOI (specialist area)