Transcript PowerPoint Presentation - Victoria Medical Centre

Depression
Dr Sara Ketteley
Consultant Psychiatrist
Victoria 3 Community Mental Health
Team
• The difference between a normal ‘down’
and true depression depends on the
number of symptoms, their severity and
duration
How common is it?
• 15% of adults will experience an episode
of depression in their lifetime
• Nearly 25% of all people living with 2 or
more chronic physical problems have
depression
• 3rd most common reason to see GP
• 1.24 million in England (and rising)
Cost of depression
• 1.7billion for health services
• Increasing to 7.5 billion including lost
employment
• 2/3 of all suicides have depression
• Mild depression increases suicide risk by
4
• Severe depression increases suicide risk
by 20
Risk factors
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genetic and family factors,
Gender - Women more than men
adverse childhood experiences,
personality
social circumstances
Risk Factors
• not having a confiding relationship with
another person
• having three or more children
• under the age of 14 years living at home
• having no paid employment outside the
home
Protective Factors
• Supporting and confiding relationship
• Befriending
Factors influencing course of
illness
• People with depression vary in the pattern
of symptoms they experience,
• their family history,
• personalities,
• premorbid difficulties (for example, sexual
abuse),
• Psychological mindedness
• current relational and social problems
Complicating factors
• It is also common for depressed people to
have a comorbid psychiatric diagnosis,
such as
• anxiety,
• social phobia,
• panic and
• various personality disorders
• and physical comorbidity
Components
• Emotional
• Cognitive
• Physical
• Behaviour/Function
Typical symptoms
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Depressed mood
Loss of interest and enjoyment
Reduced energy
Increased fatiguability
Diminished activity
Common symtpoms
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Reduced concentration and attention
Reduced self esteem and self confidence
Ideas of guilt and unworthiness
Bleak and pessimistic views of the future
Ideas or acts of self harm or suicide
Disturbed sleep
Diminished appetite
Anhedonia
• It was autumn of 1826. I was in a dull state of nerves,
such as everybody is occasionally liable to;
unsusceptible to enjoyment or pleasurable excitement;
one of these moods when what is pleasure at other
times, becomes insipid or indifferent….In this frame of
mind it occurred to me to put the question directly to
myself, ’suppose that all your objects in life were
realised: would this be a great joy and happiness to
you?’ And an irrepressible self-consciousness distinctly
answered, ‘No!’ At this my heart sank within me. JS Mill
Autobiography1870
Suicidal thinking
• “the pain of severe depression is quite
unimaginable to those who have not
suffered it, and it kills in many instances
because its anguish can no longer be
borne” William Styron 1990
Diagnosis
• Symtpoms for at least 2 weeks
• +/- somatic syndrome
• 4 clinical distinctions-influence treatment
choices
• Mild
• Moderate
• Severe without psychotic symptoms
• Severe with psychotic symtpoms
Message to take home
• Depression is a common disorder that can
be recognised and treated.