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Management of Depression in Primary Care Settings
Epidemiology of Depression
-Risk increase with age and higher in urban areas -40% had some type of depression during their lives Causes of Depression
-Social: early maternal death, parental neglect, a long period of separation from a parent during childhood, childhood sexual abuse -Current situation: unemployment, lack of a confiding relationship -Stressful life events: bereavement, being made redundant, the break up of a -Physical illness: post-stroke depression, heart disease -Monoamine hypothesis of depression: reduced serotonin (5HT), reduced Key Symptoms of Depression
-wake up at least 2 hours earlier than usual pattern -Present: inferior feeling, low self esteem, worthlessness Atypical symptoms of Depression
Diagnosis of Depression
-Plus at least 2 other symptoms from the followings DDx of Depression
addison’s disease, cushing’s disease -antihypertensive (beta-blockers), steroids, H2 blockers (ranitidine, -Alcohol, benzodiazepines, opiates, cannabis Management of Depression
-Focused on subjective mood symptoms, biological symptoms, suicidal -Focused on possible differential diagnosis Treatment of Depression
-Side effects: cardiac arrhythmia, constipation, urinary -Antidepressant drugs are effective in 70% of patients with depression -If no response to first drug with full dosage for 6 weeks, change to another -Maintain on the drug for 6 months after full recovery Antidepressant discontinuation symptoms
-Usually occur within 5 days of stopping treatment
-flu-like symptoms, dizziness, insomnia, excessive dreaming and -had anxiety symptoms at the start of antidepressant therapy -centrally acting medication: antihypertensives, antihistamines, -past history of discontinuation symptoms -antidepressant should be discontinued over at least a 4-week period Refer to specialist clinics if
-severe depression with psychotic symptoms Bereavement
-A normal grief reaction following the death of a close relatives or spouse -Shock: with a feeling of numbness and unreality, usually lasting a few
-Sadness: with tearfulness and loss of sleep and appetite, sometimes
along with anger or guilt at not having been able to do more, illusions or fleeting hallucinations of hearing or seeing the deceased person -Acceptance
-Treatment: brief counseling and psychoeducation on stages of normal grief
-Abnormal bereavement
-Symptoms longer than 6 months
-Severe or unusual symptoms
-More likely if unexpected death, abnormal relationship, interrupted
-Need treatment with antidepressant or psychotherapy
Seasonal affective disorder
Low self-esteem, hypersomnia, fatique, increased appetite and weight gain, decreased social and occupational functioning -Light therapy: rarely done in Hong Kong


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