DEPRESSION

The most common mental health problem is a serious, under-detected condition in which severe feelings of sadness, hopelessness and loss of interest in life interfere with daily life and can last for weeks or months. Affects up to 1 in 3 at least once, and occurs in all age groups, including children and adolescents. Long-term medical conditions increase risk of major depression. A family history of depression also increases risk.

Clinical features of depression

• Symptoms of low mood: little interest (anhedonia), poor concentration, apathy/helplessness/hopelessness, tearfulness, pessimism
• Somatic symptoms: poor appetite, weight loss, insomnia, constipation, low libido.
• Psychotic symptoms: hallucinations, delusions.

Screening for depression

In primary care settings, NICE guidance advises:

• screening high-risk groups, e.g. if past history of depression, significant physical illnesses causing disability, long-term conditions, e.g. COPD, CVD, or other mental health problems such as dementia.
• use of at least two questions concerning mood and interest; for example:

1. During the past month, have you often been bothered by feeling down, depressed or hopeless? and

2. During the past month, have you often been bothered by having little interest or pleasure in doing things?

A ‘no’ response to both questions makes depression highly unlikely. A ‘yes’ answer to either question is considered a positive test, and the person should be reviewed by a practitioner competent in mental health assessment. Mixed anxiety/depression is common. See also Anxiety

Perinatal depression

Depression that occurs during pregnancy or within a year of delivery. Postnatal depression affects c. 1 in 10 mothers and untreated can last weeks or months. Lack of support (emotional or practical), socioeconomic difficulties and a history of mental illness can increase risk.