Clinical review

ABC of mental health: Depression

	Introduction

Depression has a range of meaning—from a description of normal unhappiness, through persistent and pervasive ways of feeling and thinking, to psychosis. Textbook descriptions of depression seen in hospitals are often very different from presentations in primary care.

In recent community surveys, 2% of the population suffered from pure depression (evenly distributed between mild, moderate, and severe), but another 8% suffered from a mixture of anxiety and depression. Even patients with symptoms not severe enough to qualify for a diagnosis of either anxiety or depression alone have impaired working and social lives and many unexplained physical symptoms, leading to greater use of medical services.

Key practical questions relate to treatment. Is any required at all and, if so, what sort and for how long?

	Forms of depression

Most depressions have triggering life events, especially in a first episode. Many patients present initially with physical symptoms (somatisation), and some may show multiple symptoms . . . [Full text of this article]

Features of depression

Core features
Other features
Somatic syndrome

	Diagnosis

Depression in primary care

	Treatment

Reasons for referral to specialist psychiatric services

Medication versus psychotherapy
Choice of antidepressant

Drug treatment
Maintenance treatment

	Dysthymia

Classification of depression^*

Primary
Secondary
Depressive episode

	Psychotic depression

Electroconvulsive therapy in treating depression^*
Safety of electroconvulsive therapy

	Bipolar affective disorder

Suicide or deliberate self harm

Features to be assessed
High risk indicators for suicide

	Suicide and deliberate self harm

Further reading

Information leaflets for patients

	Notes

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