Rural Emergency Medicine

This is part of the Med in Small Doses series, which aims to give you a snapshot of a disease or disorder. For information about the series, or common abbreviations click here.

Depression occurs in Females (lifetime prev. 11%) > Males (lifetime prev. 6%)

PATHO: Monoamine changes [Serotonin (5-HT), noradrenalin (NA) and dopamine (DA)], Neuroendocrine changes (HPA axis - over-activity is found in >50% of depressed patients, Oestrogen – F>M, other Neuropeptides), Genetics (57% concordance between monozygotic twins, 14% concordance between dizygotic twins), Immune system changes, sleep disturbance, psychosocial contributions.

1. Age
2. FHx
3. ↓ SES
4. Substance Abuse
5. Adverse life events
6. Relationships
7. Physical Illness

Dx Criteria: S A D A F A C E S (DSM-IV)

S leep
A ppetite and weight
D ysthymia/dysphoria
A nhedonia
F atigue
A gitation & Retardation
C oncentration
E steem or Excessive Guilt
S uicidal thoughts

5 of the above, 1 being dysthymia or anhedonia, present most of the day for >2 consecutive wks. Must not be a drug or medical condition.

Ix: FBC (anaemia, infection), blood chem, urinalysis, thyroid FTs (hypo/hyper), ECG, ESR


Meds (Antidepressants): 1st Line – SSRIs, SNRIs, Buproprion
2nd Line – Mirtazapine, TCAs, MAOi (wait 5wks before starting)
Other: CBT, ECT, IPT. Psychoeducation, lifestyle changes, exercise, ↑ folate, relaxation, cease other drugs.

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