DEPRESSION AND ANXIETY

Presented by: Dr. Renato A. Carasig

AIM:
To know about depression and anxiety in
primary care; their prevalence
assessment and diagnostic issues and the
treatment available.
LEARNING OBJECTIVES:
By the end of the session students should be
able to:
Discuss concepts of major and minor
depression and anxiety disorders their
prevalence in primary care and
factors affecting presentation and detection.

Describe groups of patients at high risk of

depression and anxiety.
Demonstrate the ability to undertake a basic
psychiatric assessment of a patient with
depression and /or anxiety in general
practice.

Describe the management of depression and

anxiety in primary care. Including a range of
interventions and the potential role of
other primary care team members.
SUGGESTED LEARNING METHODS
Small group discussion with case
presentations by the students,
followed by concepts about
different presentations of and treatment
for anxiety and depression in primary
care.
PREVALENCE
Anxiety and depression
very common
may occur independently or together
can be both very debilitating
can have significant impact not only on the
patient, but also on the patient's family and
friends and are a major causes of absences
from work.
DEPRESSION AND ANXIETY IN PRIMARY
CARE
Most people feel down or anxious at
times. Usually these feelings pass, but
sometimes they linger and make it
difficult for people to live their lives as
normal.
THE ROLE OF PRIMARY PHYSICIAN
A. Identify depression and anxiety.
1. Which group/groups are most risk?
2. Ask about symptoms when you are
considering depression and or anxiety by asking
flowing questions
a. During the past month have you often been
bothered by feeling down or hopeless?
b. During the past month have you often been
bothered by having little interest or pleasure in
doing things you usually enjoy?
NB An answer of " yes" to one of
these should prompt the primary care
physician to ask further questions. An
answer of "no" suggests that depression is
unlikely.
B. Psychiatric Assessment
Encourage patient to give complete
description of their symptoms and the impact
in their life.
REMEMBER TO INCLUDE
The symptoms- both biological and
psychological.
The impact of the problem on the
patient and their family, friends, home and
work.
Underlying circumstances which may be
precipitants or perpetuating factors(e.g.
sociial or occupational factors, adverse life
events).
Remember to consider a physical cause e.g.
Hypothyroidism,
Past psychiatric and medical history
Drug history ( including recreational drugs,
alcohol, caffeine).
What do the patient does to allay or lessen
symptoms?
What are their thoughts and beliefs about
treatment and recovery?
Mental status examination
ISSUES OF CONCERN
Suicide risk
Do you think depressed people make any
concrete plans? If so what and where?
Are the means to carry out the plan available
to them?
Have they ever tried to harm themselves
before? What did they do and what was the
outcome? Did they tell anyone else?
Have they made any concrete preparations
(e.g. making a will, written a suicide note)?

Do they think that any factor(s) would stop

then harming themselves e.g. consideration
of the act on their close relatives and friends.
MANAGEMENT OF DEPRESSION AND
ANXIETY
▪ Both pharmacological and psychological
▪ Patient should be encouraged to be
actively involved in the choice of treatment.
▪ Consider psycho-social aspects which may be
contributing to or even in some cases, causing
the problem. (e.g. financial debts, severe
torture or abuse).
DEPRESSION
Mild or probably “self limiting" episodes
a. Guided self-help programme
b. Exercise
c. Sleep hygiene
d. Referral for benefits or housing advice
e. Pharmacological therapy is usually not
indicated in mild depression
Moderately severe depression
▪ Anti depressant therapy should be
considered if patient has significant troubling
and persistent symptoms.

▪ Psychological therapies.
Severe Depressive Episodes
ANXIETY
▪ Almost similar with depression.
▪ May use psychological therapy, guided-self
help programmes.
▪ Advice on self-help and support groups.
▪ Psychological approaches, particularly the so
called Cognitive Behavior Therapy.
ICD -10 CLASSIFICATION OF DEPRESSION(WORLD
HEALTH ORGANIZATION)

A symptoms
Depressed mood
Loss of interest and enjoyment
Reduced energy with increasing fatigability
B symptoms
Reduced concentration and Attention
Reduced self-esteem and self-confidence
Ideas of guilt and unworthiness
Bleak and pessimistic views of the future
Ideas or acts of self-harm or suicide
Disturbed sleep
Diminished appetite
▪ MILD DEPRESSION: at least 2 of
A and 2 of B for at least 2 weeks
▪ MODERATE DEPRESSION: at
least 2 of and 3 of B for at least 2
weeks
▪ SEVERE DEPRESSION: at least 3
of A and 4 of B for at least 2 weeks
NB: People with mild depression have some
difficulty and people with moderate
depression have considerable difficulty in
continuing with social, work and domestic
activities. People with severe depression are
unlikely to be able to continue with these
activities except to a very limited extent.
Thank you!