UPDATE Clinical chemistanddruggist.co.uk/update-plus

Module 1795

Diagnosing depression From this module you will learn:

●●What depression is and its prevalence in both adults and children

July Practice: ● Pharmacy counselling

2 July*

Clinical: ● Diagnosing depression

9 July

●●How the condition is diagnosed and potential alternative diagnoses

● Body dysmorphic disorder

16 July

● ADHD

23 July*

●●The role of pharmacy in identifying individuals who have depression and the support that can be provided

● Sleep disorders

30 July

*Online-only for Update Plus subscribers

Asha Fowells MRPharmS

Depression is the most common mental health condition in Britain. Precise figures are hard to come by as not all people with depression seek help, but according to the charity Rethink Mental Illness, around one in 10 people will be diagnosed with depression during their lifetime. This illness is not confined to adults. The National Collaborating Centre for Mental Health estimates that about 1% of prepubescent children and some 3% of postpubescent young people are affected. This module looks at how depression is diagnosed in both adults and children, with the aim of arming pharmacists and their staff with the knowledge to help identify and support those who may have the condition. The treatment of depression is outside the scope of this article, but the module will teach you to empower your patients to seek further help.

What is depression? Everyone feels down from time to time, and while there is often a rational explanation – a bereavement, or difficulties at home or work – sometimes there is not. These feelings of unhappiness soon pass, usually in a matter of days, and life carries on as it did before. However, someone with depression experiences feelings of hopelessness and sadness for weeks and months. Life becomes a struggle, not just in terms of day-to-day living, but also because relationships with friends and family can deteriorate. There is sometimes a trigger for depression – such as a difficult life event, physical illness, or personal circumstances – but in many cases, the individual is unable to pinpoint exactly when and why they started to feel down. For many years, depression was attributed to a chemical imbalance in the brain. The presence of too much dopamine, or too little serotonin, was thought to affect transmission of signals from one nerve cell to another. Although it is now recognised that these neurotransmitters are important, they do not tell the full story. This is well illustrated by the fact that the drugs designed to address this imbalance – the most widely used class being selective serotonin 18 CHEMIST+DRUGGIST 09.07.2016

Depression can present as persistant sadness or low mood, and a marked loss of interest or pleasure

reuptake inhibitors (SSRIs) – are often ineffective at treating depression. The Royal College of Psychiatrists (RCP) estimates that between 3550% of people treated with an antidepressant for depression do not see an improvement.

Diagnosing depression in adults In its recently updated guidance on the recognition and management of depression in adults (CG90), the National Institute for Health and Care Excellence (Nice) highlights the difficulties that exist in diagnosing the condition, stating: “A wide range of biological, psychological and social factors, which are not captured well by current diagnostic systems, have a significant impact on the course of depression and the response to treatment.” In order to diagnose depression, Nice states that five or more of the following symptoms must have been present for most of the time, on most days, during the previous two weeks. This must include at least one of the first two listed below: ●●persistent sadness or low mood ●●marked loss of interest or pleasure ●●signi