This is depression, periods of reduced mood and affect, loss of interest, and decreased energy.
Clinical note:
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.