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