This is depression, periods of reduced mood and affect, loss of interest, and decreased energy.
What is Depression
Depression is a serious, widespread and high impact condition.
Epidemiology
Depression is reported to be higher is women, young people and Māori when compared to men, older people, and NZ europeans.
Average onset is 19.5 years
Sadness vs MDD vs grief
Sadness
- Sadness is temporary
- Healthy response to loss
- Undiminished self image
- Doesn’t affect the persons ability to function
Depression
- Diminished self image
- Often involves feelings of hopelessness and helplessness
- Involves complex pattern of physiological and psychological symptoms
- Often involves negatively biased thoughts
- Is a mental illness
- Prescence of suicidal thoughts
Grief
- Feelings of emptiness and loss
- Slowly decreases
- Dysphoria occurs in waves (pangs of grief associated with reminders)
- May have positive emotions
- Memories of deceased
Medications can have depressogenic effects
Certain medication can lead to depression like effects.
Screening for depression (important)
Top 2 screening questions:
- During the past month have you often been bothered by feeling down, depressed or hopelessness?
- During the past month have you often been bothered by little interest or pleasure in doing things?
Also you can give patient health questionnaire-9. It is not a diagnosis but can give supporting evidence and guide further steps
Further assessment:
Present symptoms:
- Frequency of symptoms
- Intensity od symptoms
- Duration of symptoms
- Impact of symptoms
- Suicidal ideation intention plans and attempts
- Onset Background symptoms;
- medicaiton
- substance abuse
- medical conditions
- cultural background
- family history previosu interventions
Biopsychosocial factors that can contribute to depression
Biological:
- Genetic vulnerability
- Physical health
- Disability Social:
- Loneliness, isolation
- Lack social support
- Family circumstances
- Relationship issues
- Adverse childhood events Psychlogical: low self esteem sensitivity to rejection rumination coping skills hopelessness negative interpretation bias
Treatment and Management
Existing treatments for MDD are medications (antidepressants, mood stabilisers, and stimulants) or Talk therapy (Cognitive behavioural therapy, aceptance commitment therapy, schema therapy). These can be administered separately but both are reccomended.
Diagnosis of MDD
Symptoms: A. must have at least 1 of the following:
- depressive mood
- anhedonia Including the previous section there needs to be 5 overall.
- feelings of worthlessness or guilt
- suicidal ideation, plan or attempt
- fatigue or loss of energy
- sleep changes
- weight or appetite changes
- lack of cognitive ability
- psychomotor retardation or agitation B. Must have clinically significant distress or impairment C. Not attributable to anything else D. Not better explained bt different forms of schizophrenia spectrum disorders E. Never been a manic/hypomanic episode (or would be bipolar depression)
You can alsp have extra modifiers eg with seasonal pattern or with peripartum onset
Prognosis of MDD
Each time an episode presents the chance of a recurring episode heightens and the length of episodes increases.
Meihana factors of depression
physical health chronic conditions poor nutrition insufficent sleep environment life stressors trauma poverty disconnection from rootr spiritual health disconnection from spiritual idenitit lack of spiritual support unresulces spiritual distress mental and emotional health guilt hopelessness negative self talk rumination
4 winds colonisation marginalisation migration racism
Further assessment quesitons present symptoms frequency intensity duration impact of symptoms suicidal ideation onset background medical history substance use cultural history family history previous interventions
Epidemiology:
Prevalence: 5.7% but can be underreported Age of onset peaks to 19.5 yrs
Impact
2x likely to suffer from 1+ chronic disease 3x as likely to suffer from a pain related disorder 7x as likely to suffer from alcohol ro substance use Negatively effects family physical work and financial
Treatment/management
medication pros lower cost convenience speed cons side effects addication symptom relief isnt adequate
talk therapy pros medication long term chanfe meneage other areas of life limited side effects cons cost time dependant on patient morivations
Severe depression
in sev ere depression there is less psychological factors and mostly biological factors
Melancholic depression: mood: intense unremitting apprehesnsion psychomotor disturbance: jittery or slow as molasses cognitive impairment lowered concentration and memory vegetative dysfunction interrupted sleep amd reduced appetitie psychosisi si often rpesent common themes are nihilistix delusions of hopelessness, guilt sin ruin or disease.
Depressive psychosis mood congruent delusions (poverty death guilt) mood congruent hallucinations in 50%
- auditory: hearing dead ancestors calling out
- olfactory smelling ones body decaying
- tactile feeling onbes intestines falling out from rot cotard syndrome
epidemiology of melancholia 5% of all cases of MDD M=F likelihood increases with age
hypercortisolemia and sleep eeg changes - reduces latency to first rem period
hospitalsation and maybe MHA institionalisation
- high risk of suicid eand self neglect antidepressant and antipsychotic needed ECT (electroconvulsive therapy) very low response rates to PBO and psychotherapy