EPC Depression (in a GP setting) presentation

1. DEPRESSION
IN A GP SETTING

2. Epidemiology
- 10% lifetime risk
- 1 in 4 women and 1 in 10 men will develop depression severe enough to require
treatment at some time in their lives
- Most depressive states are the mild-to-moderate end of spectrum, seen mainly in
GP and primary care

3. Risk Factors
- Female
- Pregnancy and post-natal depression
- Past history of depression
- Significant chronic illness causing disability and/or pain
- Other mental health problems such as dementia
- African-Caribbean background.

4. Symptoms
- Persistent sadness or low mood
- Marked loss of interests of pleasure
- Disturbed sleep
- Change in appetite and/or weight
- Fatigue or loss of energy
- Slowing of movements
- Poor concentration and indecisiveness
- Feeling worthless or inappropriate guilt
- Suicidal thoughts or acts – 15% (male, middle age or older, divorced, chronic
physical illness, made previous attempts of self-harm)

5. Severity
‐ Subthreshold depressive symptoms: <4 symptoms
‐ Mild depression: 4 symptoms
‐ Moderate depression: 5-6 symptoms
‐ Severe depression: 7 or more symptoms

6. Diagnosis
- MMSE
- PHQ-9 (patient health questionnaire)
- HAD scale (hospital anxiety and depression scale)
- BDI-II (Beck depression inventory)

7. Management
- Tri-cyclic antidepressants,TCAs eg amitryptiline
- Monoamine oxidase inhibitors, MAOI eg moclobemide
- Selective serotonin reuptake inhibitors, SSRI eg citalopram (adults), fluoxetine
(children)
- Serotonin/noradrenaline reuptake inhibitors eg venlafaxine
- Noradrenaline reuptake inhibitors eg reboxetine
- Atypical antidepressants

8. Referrals
- Talking therapy and counselling
- CBT