This month we spoke to Dr Donna Grant, Consultant Psychiatrist at Priory Hospital Chelmsford, about depression. She discusses the most effective ways to support those living with the illness, and offers guidance on how best to approach a patient you are concerned about.
January has a reputation for being the most depressing month of the year, as the post-Christmas blues kick in. However, when someone is suffering from depression they feel extremely low and sad, and this can persist for months or years - not just for a few days.
Depression is a serious, life threatening disorder that occurs worldwide and can affect anyone, at any stage of their lives.
Around 10% of men and 25% of women in the UK will develop depression at some stage in their life. This article discusses the most effective treatments and best approaches to support those who do, and also explores the symptoms of depression further.
- Depression isn’t something someone can 'snap out of'
- It is not a sign of weakness
- It isn’t something that everyone experiences
- It is not something that lasts forever
- It is something that can be treated
- The average age of onset is late 30s
- The highest prevalence is in lower social groups and amongst those who aren’t married
Symptoms of depression
It can sometimes be very difficult to recognise the signs and symptoms of depression and how best to support a patient that you suspect may be struggling with this illness. Understanding the signs and symptoms of depression can be helped by splitting them into five main categories:
- Behavioural - psychomotor retardation/agitation, altered facial expression, lack of expression, self-neglect and social withdrawal
- Emotional - low mood (pervasiveness lasting two weeks or more), tearfulness, loss of interest in activities that would normally have given pleasure, inability to experience pleasure (anhedonia), loss of reactivity of mood to external events, irritability and anxiety
- Cognitive - reduced speed/latency/volume/expressivity of speech, poor concentration/memory, negative views of self/the world/the future, hopelessness/worthlessness, guilt, thoughts of death/self harm/suicide
- Biological - diurnal mood variation, lack of sleep/early morning wakening, poor appetite, weight loss, loss of libido, fatigue/anergia, physical complaints such as constipation/aches and pains, and amenorrhoea
- Psychotic - delusions, cognitive distortions resulting in delusions in keeping with the mood (mood congruent) such as guilt, poverty, nihilism and hypochondriasis, and auditory hallucinations which are second person in nature
It is possible that people may present to a GP with other symptoms which can include negative effects from self-medicating and substance abuse. Therefore it is essential that a GP should assess for depression with all presentations in mind.
Assessing for depression
There are two specific questions which a GP can use to effectively begin a conversation with their patient:
- During the last month, have you often been bothered by feeling down, depressed or hopeless?
- During the last month, have you often been bothered by having little interest or pleasure in doing things?
If a person answers 'yes' to either of the above 'depression identification questions', the following questions should be asked:
During the last month, have you often been bothered by:
- Feelings of worthlessness?
- Poor concentration?
- Thoughts of death?
People should always be directly asked about suicidal ideation and intent. A mental health assessment should review the person's mental state and associated functional, interpersonal and social difficulties.
Management of depression
- Computerised cognitive behavioural therapy (CBT)
- Psychological interventions e.g. brief CBT/counselling/behavioural activation and/or problem solving
- Antidepressant medication
- A combination of antidepressant medication (SSRIs remain the first line antidepressant) and a high-intensity psychological intervention such as CBT
- Continuing treatment – ongoing regular reviews and trying a different SSRI
- Mirtazapine can be considered if there is a lack of response to initial medication
Antidepressants should not be routinely used to treat persistent mild depression because the risk/benefit ratio is poor, but should be considered for people with:
- A past history of moderate or severe depression
- An initial presentation of mild depressive symptoms that have been present for a long period (typically at least 2 years)
- Mild depression that persists after psychological interventions
A GP can also offer advice and guidance on how an individual can help improve their own wellbeing. The following activities and resources can be utilised alongside suggested treatment, to support patients in leading a more positive way of life:
- Self-help, e.g. www.getselfhelp.co.uk or www.mind.org.uk
- Encourage patients to establish regular sleep and wake times
- Create a proper environment for sleep
- Avoid excess eating, smoking or drinking alcohol, especially before sleep
- Take regular physical exercise – the effective duration is 45 to 60 minutes 3 times per week for 10 to 12 weeks
Priory offers tailored depression treatment programmes for individuals suffering with depression which are based on their medical history and personal experiences. There are a number of specialist consultant psychiatrists who will oversee the treatment, which may include a combination of both medication and psychological therapies. There is the option for receiving treatment on an inpatient basis if the severity, risk or personal choice is to do so.