Depression
When evaluating a patient suffering from depression, other possible diagnoses must be considered, such as adjustment reaction, hypoactive delirium or even dementia. Many of the biological symptoms of depression, such as anorexia, weight loss and disturbed sleep may be mistaken for, or present already because of the underlying illness and treatments. As patients often dismiss or diminish the psychological symptoms a therapeutic trial of antidepressants may be helpful.
Once again, a numerical or pictorial rating scale may benefit patients with learning difficulties or dementia who struggle to process the meaning of their feelings to communicate to us how they are feeling.
Risk factors
- Previous history of depression
- Loss of previous roles or plans
- Poor symptom control
- Isolation
- Uncertainty of diagnosis or prognosis
Non-drug treatment
- Given appropriate and accurate information
- Mindfulness
- Relaxation techniques
- Complementary therapies
- Psychological support
- Withdrawal of causative medications where possible
Drug treatment
- Selective serotonin reuptake inhibitors (SSRIs) are the first line drug treatment
- Where low appetite and poor sleep are features mirtazapine may be a better choice
- Tricyclic antidepressants may be useful when sleep is disturbed, and neuropathic pain is present