1. Depression Dr Sara Ketteley Consultant Psychiatrist Victoria 3 Community Mental Health Team

2. The difference between a normal ‘down’ and true depression depends on the number of symptoms, their severity and duration

3. 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 3 rd most common reason to see GP 1.24 million in England (and rising)

4. 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

5. Risk factors genetic and family factors, Gender - Women more than men adverse childhood experiences, personality social circumstances

6. 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

7. Protective Factors Supporting and confiding relationship Befriending

8. 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

9. 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

10. Components Emotional Cognitive Physical Behaviour/Function

11. Typical symptoms Depressed mood Loss of interest and enjoyment Reduced energy Increased fatiguability Diminished activity

12. Common symtpoms 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

13. 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

14. 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

15. 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

16. Message to take home Depression is a common disorder that can be recognised and treated.