Depression is a huge problem in the UK and worldwide...
- It is the 2nd leading cause of years lived with disability around the world
- The prevalence of depression is currently 3.3 per 100 people in the UK, and is rising
- Nearly 20% of adults aged 16 years plus in the UK show signs of depression
- Depression costs the UK approximately £70-100 billion per year (includes the wider costs of depression, such as reduced productivity); about 4.5% of the UK annual gross domestic product (GDP)
But what is depression? It's certainly far more than just feeling low...
What do you think are the symptoms that someone with depression might suffer from?
There are 3 'core' symptoms of depression, and these are:
- Low mood
- Low energy (anergia)
- Lack of enjoyment of activities you normally find enjoyable (anhedonia)
There are also several 'associated' symptoms of depression
- Sleep disturbance (too much or too little sleep)
- Reduced appetite
- Trouble with concentration and attention
- Poor memory
- Sexual dysfunction
- Feelings of guilt, hopelessness or worthlessness
- Thoughts of self-harm or suicide (it's really important for doctors and other HCPs to ask about this!)
But most people either are or have experienced some of these symptoms at some point... so when do we call it 'depression?'
According to the ICD-10 (a manual used by UK doctors for classifying mental health disorders), you can diagnose depression as 'mild', 'moderate' or 'severe', based on the symptoms a patient experiences:
- Mild - at least 2 core symptoms + at least 2 associated symptoms
- Moderate - at least 2 core symptoms + at least 4 associated symptoms
- Severe - all 3 core symptoms + at least 5 associated symptoms
And you need to have these symptoms for at least 2 weeks.
As well as the symptoms above, what other things should a doctor be asking the patient about?
Using the pictures below, think about the things in a patient's life that might be affecting their mental health, and that might help a doctor decide the best treatment for them...
- School & Education (Top Left) - things such as school performance and experience, particularly bullying
- Sex & Relationships (Top Middle) - not just the current relationship but also previous relationships and partners
- Existing health problems (Top Right) - can be a huge factor in a patient's mental health; their health condition might cause terrible chronic pain, reduce their mobility, stop them doing things they once did, or cause them to be discriminated against
- Alcohol use (2nd row, Left) - people often drink alcohol to cope, but this can exacerbate their mental health issues and lead to addiction, alongside bringing about physical problems associated with alcohol
- Drug use (2nd row, Right) - like alcohol, people can sometimes turn to drugs to cope, which can in turn bring about problems with money, work and health among others.
- Existing or previous psychiatric problems (3rd row, Left) - mental health problems often make someone more likely to develop more mental health issues, or a patient might be experiencing a difficult time in an existing long-term condition
- Financial difficulties (3rd row, Right) - not always the patient's fault and can cause massive stress. People with drug problems in particular are at risk financially
- Work (4th row, Left) - work pressures can have a massive impact on mental health, and unemployment similarly
- Family history (4th row, Top Right) - people with parents, siblings or children that suffer mental health problems are generally more likely to suffer themselves. Issues with other family members might also be directly affecting the patients mental state
- Home (4th row, Bottom Right) - learning about the home situation, such as the availability of basic resources such as heating and shelter, is crucial
As well as the history, a doctor might also do some blood tests to find other anomalies that can affect mood. But no scans or other tests are normally needed.
Given the huge number of variables to consider for someone with depressive symptoms... can you see how two cases of depression can be so different?
This means a doctor may need a completely different approach to treating one case of depression compared to another.
What are the different things that you think a doctor could do to help someone suffering from depression?
- Reassurance - something so easy for a doctor to do! Simply reassuring patients can help put them at ease, make them listen to the treatment options you propose and help you develop a rapport with them.
- Medications - there a range of different tablets that can be prescribed by GPs for people who are depressed. They are thought to be generally effective in most people, but a tablet alone won't completely get rid of depression! They need to be tried with other solutions to get the best results.
- Technology - you can direct them towards some websites and apps that can help people. Moodgym.com is a popular app that allows patients to self-provide a form of Cognitive Behavioural Therapy (CBT), to help them overcome negative thoughts that might be driving their depression. Emoodji is an app designed specifically for university students to help with mood issues related to the particular pressures high-level education can bring
- CBT - as talked about briefly above, CBT seeks to identify some of the thoughts and processes that drive someone's depression. Formal CBT invovles talking through these issues with another human being
- Referral - sometimes, a GP might want to get extra help with managing a depressed patient, and organise an appointment for them with a mental health expert, such as a specialist nurse or a psychiatrist
If you want to read more about depression...
The Royal College of Psychiatry (RCPSYCH) has published a Depression fact-sheet on their website that outlines the presentation and treatments of depression, which you can access here:
The World Health Organisation (WHO) also has produced a simple fact-sheet outlining the problem of depression on a worldwide scale, which you can also access below:
Mind.org.uk is a mental health charity with some really good online resources. Click below to read some real patients stories below:
NHS moodzone is a website for depressed patients that offers practical help and advice on managing depression as well as some other mental health issues:
If depression is more than just 'low mood', anxiety is far more than just worrying all the time...
But how would you explain to someone what 'anxiety' means? Healthy Place (a website dedicated to providing information on various mental health problems) have a comprehensive list of quotations and images aiming to describe it, including:
To access the full list of quotations, click below:
In it's worst form, anxiety can manifest as 'panic attacks' - periods of intense worrying with mental and physical features, including:
- Palpitations
- Sweating
- Dizziness & fainting
- Increased or reduced muscle tension
- Feelings of impending doom
Some of the other consequences of anxiety might include:
- Low mood
- Poor sleep
- Poor concentration & memory
- Guilt & worthlessness
- Hopelessness
Sound familiar? Depression and anxiety actually share lots of features, and unfortunately they do often both occur together.
Watch the video below from mind.org.uk, where sufferers of anxiety share their stories and experiences with each other:
What can be done to help patients with anxiety?
- Self-help
- Mindfullness
- Support groups
- CBT can help people work through some of the thoughts and problems causing their anxiety, and help with prevention and/or coping mechanisms for panic attacks
- Some medications can help with controlling anxiety, but only when other things are also being done; these medications are not for curing
If you want more information...
Anxiety UK is a charity that promotes relief and rehabilitation from anxiety-related health issues and aims to spread awareness of these. They have plenty of useful resources, including a blog of patient stories, that can be accessed here:
NHS choices has published a summary of GAD, the causes and treatments available:
One more thing...
Mental health problems can happen to anyone. Unfortunately, rates of mental health problems are high among medical students and doctors. We obviously hope you get to study medicine some day! But if you are or ever end up struggling to cope, you must get help.
Credits:
Created with images by BiljaST - "blackboard learn language" • Clem Onojeghuo - "The shapes of Love" • Presidencia de la República Mexicana - "Inauguración del Hospital Municipal de Chiconcuac" • alles - "beer beer mug foam" • stephenphampshire - "IMG_9550.CR2" • stux - "pound coins currency" • Tumisu - "resume cv curriculum" • Pexels - "architecture family house front yard" • Mario Azzi - "untitled image"