Depression is common, affecting 10% of people at some point in their lives. Risk factors include being female, past depression, chronic illness, and other mental health problems. Symptoms include persistent sadness, loss of interest, changes in appetite or sleep, feeling worthless, and suicidal thoughts. Severity is determined by number of symptoms, from mild (4 symptoms) to severe (7 or more). Diagnosis involves questionnaires like the PHQ-9 or HAD scale. Treatment includes antidepressants like SSRIs or SNRIs and talking therapies such as CBT. Referrals are made for counseling or more specialized therapies.

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