Depression Assessment

Depression is a mood disorder in which the person experiences persistent low mood and loss of interest/pleasure, as well as other symptoms such as loss of sleep and appetite, and suicidal ideas.

It is important that we do not diagnose normal brief periods of unhappiness as depression. Therefore, you should make a diagnosis of depression only if (1) there are multiple symptoms, (2) these symptoms last at least 2 weeks, and (3) the person has difficulty carrying out their usual work, school, domestic or social activities.

IMPORTANT: It is very important to recognise and treat depression because:

Depression is disabling and distressing for the person and their family.
15% of people with moderate/severe depression commit suicide.
If depression is untreated it can become more severe or chronic.

Causes

People with a family history of depression and/or those who have experienced abuse in childhood are more vulnerable to depression.

Depression is often a reaction to ongoing stressors such as poverty or domestic violence.

Alcohol abuse and physical illnesses are other common causes.

Without treatment, an episode of depression usually lasts 4-6 months, though it can last longer especially if the person has ongoing social problems.

50% of people who have one episode of depression will go on to have further episodes. This is called recurrent depression.

Simplified Assessment

At least two weeks of:

Persistent low mood

and/or

Loss of interest in or pleasure from activities

AND

Several of the following additional symptoms:

Disturbed sleep or sleeping too much
Change in appetite or weight (usually loss)
Fatigue or loss of energy
Reduced concentration
Talking or moving more slowly than usual (or sometimes agitation and restlessness)
Thoughts of guilt, worthlessness and hopelessness
Suicidal thoughts or acts

AND

the person has difficulty carrying out their usual work, school, domestic or social activities.

In severe depression, people can experience false ideas (delusions) or hear voices (hallucinations). These will have negative content that matches the person’s low mood.

Typical MSE

A + B	Self-neglect, may look tearful, weight loss, slowed up movements, poor eye contact, looking downward
Speech	May say less and be quieter and slower than usual
Mood	Low, withdrawn, low energy, no enjoyment in life.
Thought	Slowed thinking, worthless, hopeless, pessimistic. May have thoughts of suicide. Only delusional in psychotic depression.
Perception	Hallucinations only in psychotic depression
Cognition	Poor concentration and sleep
Insight	Usually ok but may wish to die in and not accept treatment

Check for history of mania – treat for Bipolar Disorder if this exists (See Bipolar Disorder chapter)

Risk

10-15% of people with depression will commit suicide.
Self-harm and self-neglect are common.