Video Transcription

Hi everyone. Welcome to another psych student video.

Today we're talking about depression and how we would go about diagnosing this. 

So, to make a diagnosis of depression you need to ask primarily about three key symptoms. The first of which is low mood. The next being a loss of interest, so we call that anhedonia, and that's when you find people don't enjoy the things that they usually would enjoy. Maybe reading, going to the cinema, whatever their usual interest to might be. Low energy is the third symptom and that's different to having loss of interest in that they feel just very tired and anergic.

These symptoms, at least one of those core ones, must be present for most of the time, on most days, and for at least a period of two weeks. So, you can't diagnose depression if someone's had low mood for a few days. It needs to be a longer-term consistent state of mood.

There are key Associated symptoms that you'd like to ask about is part of a general history taking. This can include things like disturbed sleep or poor concentration. So, a good way to ask about that is if they can finish a TV program or finish reading a magazine article, whatever it might be. Low confidence, self harm and suicidal thoughts, changes in appetite, feelings of guilt or being a burden and sometimes symptoms of psychosis. Sleep and appetite in particular could be increased or decreased so you need to find out which way it’s gone, and psychosis is included particularly in ICD (ICD 10) criteria. When you’re thinking about diagnosis, is it depression with or without psychotic features?

Appetite when it does become low, could potentially be quite a life-threatening situation, and we might need to consider some intensive treatment. You might need to think about in a similar way to what we would be doing in eating disorders. Refeeding syndrome needs considering if we're starting diet again quite quickly if they're malnourished, and a dietitian will be really helpful here.

Depression is caused by lots of different things, or usually in a kind of combination. That could be stressful events, maybe a bereavement or a traumatic time, there could be a family history of depression. Sometimes depression is associated with giving birth. So, a postpartum depression. And it can be linked to physical illness, loneliness or other environmental factors, alcohol and drugs. And there's some really important neurochemical underpinning to all of those different things. 

The neurochemistry really feeds into the treatments in a biological way. But also, we need to think about it in a biopsychosocial approach. So biological, psychological and social. From a biological perspective we're thinking about those normal depression treatments in terms of pharmacology. SSRI’s or other kinds of antidepressants depending on the person's individual circumstances, and you might need to consider ECT as well (electroconvulsive therapy). Psychologically, you’re thinking more about kinds of therapies maybe CBT, but there are other types of therapies available depending again on the individual. Social support around finances, care needs or whatever it is that's gone on in that person's life that needs help.

A really important thing not to forget in depression is making sure it's not something that we can treat quite quickly with medication. So, for example, if it's a thyroid problem, we might need to be taking a different course of action.

Thank you very much for your time. I hope you enjoyed this video.