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Click to edit Master title style Depression D r M it c he ll Os e i- J unior M B B S B Sc ( H ons ) PG C e r t M e d Ed PC B T ( Founda t ion) C l i n i c a l E d u c a to r a t U n i v e r s i ty o f Bu c k i n g h a m N e u r o d i v e rs i ty A d v o c a te Yo u th M e n ta l H e a l th Fi r s t A i d e r 1Activity: Close your eyes & imagine this 22ThiikkobeduitMhesasrtiilesyolu were really sad about something… • How was your sleep? • How was your energy levels? • How was your appetite? • How was your concentration levels for important task? 33IniendtedeLetMrasterOuiceomtee By the end of this session, you should be able to: • Recall the ICD-11 diagnostic criteria for depression • Identify biological, cognitive and psychosocial risk factors for depression in young adults. • Describe biological and psychological methods to treat depression. • Apply NICE CKS guidelines to treat depression. • Apply NICE CKS guidelines to manage self-harm behaviours and suicidal ideations in a primary care setting. 44W ickisoDedpreMsaoteritpterstnl? Did you know that…. (most statistics deliberately pre-pandemic) • Pre-pandemic, Mental Health Foundation (2014) findings suggests that 3% of the UK population have depression at any one point. • Medical students have higher rates of depression (39.4%) in comparison to non-medical students (33.6%) according to a national study by Medisauskaite et al. (2022) 55Click to edit Master title style Diagnostic Criteria for Depression ILO 1 66Dlepcretosiodnit Master title style Core Symptoms (for at least 2 weeks) Biological symptoms • Early morning waking • Dysthymia • Anhedonia • Sleep disturbances • Anergia • Anorexia • Effects on concentration • Effects on memory • Guilt PHQ-9 can be a tool to grade severity. Out of 27. >16- more severe 16 or < - less severe 77PliQ-to edit Master title style 88Click to edit Master title style Risk Factors for Depression in Y oung Adults ILO2 9Dlscustoiedit Master title style What do you think are common risk factors of depression in young adults? 10RlikkftctodrtoMfDstpretilonstnlY oung Adults Biological Cognitive Psychosocial • Physical health iss• Personality- neuroticRelationship issues • Genetic risk • Neurodiverse • Difficult friendships • Social expectations • University/Work pressures • Family responsibility • Trauma 11Click to edit Master title style Biopsychological methods of treating depression ILO3 112Biipkstcedltgiaslerodtleotyleating depression There are 2 main angles Psychological 13BiicogtoceltreMaastenrtiolf sepeession This is how we divide up the main biological treatments of depression Mirtazapine SSRIs SNRIs 14SSlRcksto edit Master title style Selective Serotonin Reuptake Inhibitors • SSRIs (i.e. sertraline, fluoxetine) – prevent presynaptic reuptake of serotonin (5-HT) therefore increasing acute effect of 5-HT transmission and eventually would lead to normal serotonin levels due to the inhibitory feedback loop. • Side Effects: diarrhoea, agitation, bradycardia, postural hypotension, increased suicidal ideations in young people in first 8 weeks. 115 SlickIsto edit Master title style Selective Serotonin-Noradrenaline Reuptake Inhibitors • SNRIs (i.e. Venlafaxine, Duloxetine) – prevent presynaptic reuptake of serotonin (5-HT) & noradrenaline. Therefore, increasing acute effect of both transmission and eventually would lead to normal serotonin levels due to the inhibitory feedback loop. • Side Effects: headaches, dry mouth, dizziness, nausea, agitation, postural hypotension (hypertension in higher doses), potential sexual dysfunction 16 Mlitaztopeidit Master title style NaSSa (Noradrenergic & Specific Serotinergic antidepressant) • Acts by antagonising adrenergic alpha-2 receptors and 5-HT2 & 5-HT3 receptors. Therefore, increasing serotonin and noradrenaline levels. • Side Effects: drowsiness, sedation, weight gain, appetite increase, increased serum cholesterol, hypertriglyceridemia, constipation, thrombocytopenia 117PslckhologiiaM retermtiltsstfeepression This is how we divide up the main psychological treatments of depression Psychological Psychotherapy/counselling Mindfulness CBT 118 Mlickftolnedst Master title style Focusses on the present in a holistic way • Mindfulness aims to change the relationship between you and your thoughts. • Grounds you in the present by being aware of acknowledging and making acceptance with one’s thoughts, feelings, body sensations and surroundings. • Examples of techniques: meditation, breathing exercises, heightened attention to daily activities. 19 CockitivedithMasterralteheraley (CBT) Focusses on the present in a cognitive & physical way • CBT aims to challenge your thoughts. • CBT looks at biases that maintain the thoughts and aims to challenge them. • CBT suggests a relationship between thoughts, feelings and both physical and psychosocial behaviours. 20 Plcch otheditMya/teurtselllnyle Addresses the past & prioritise the therapist-client relationship • (Psychodynamic) Psychotherapy aims to improve wellbeing by exploring emotional, behavioural and psychological concerns whilst addressing past experience which could have contributed to it. • Counselling aims to empower clients to develop personal growth and positive change by making healthier decisions and cope with challenges whilst providing a space for more active listening. 221Click to edit Master title style NICE CKS Guidelines of treating depression ILO4 222GluiiketlinedsitoratsrearttngtlDespyression Step 1: Self-help Step 2: Psychological Step 3: Medications therapies o SSRIs oSelf-help o CBT - Generally, 1 line if 1 -Square breathing - The usual preferred 2 steps fail/marked -Mood diary/Headspace first line therapy functional impairment. -Mindfulness activities approach - For patients with higher suicidal risk o Counselling/Psycho NICE recommends - 2-3 weekly reviews with therapy course and reviewrter psychological therapies earlier than you would otherwise. 223Click to edit Master title style NICE CKS Guidelines of managing self-harm & suicidal ideations in primary care ILO5 24M ainagtom eedittMoafStelf-hialemstyIlef II Self-harm review When to ginvolvementealth Team • If has recently self-harmed, assess the • The patient’s levels of concern or distress are severity of the injury and how urgently medirising, high or sustained treatment is needed. • The frequency/degree of self-harm/suicidal • Assess person’s mental state and level of intent is increasing. distress. • If you the primary care provider is concerned. • Assess for immediate concern of person’s • The patient themselves ask for mental health safety and any safeguarding concern. team involvement • Assess is there a need to refer a person to• Levels of distress in family members/carers their current MHT with consent.ce or informiare rising despite attempts to help. 25M inkatomeeditMofstelftiarm sIIef II What should the GP do? • Ensure regular appointments for review of self-harm, ideally with the same GP they disclosed to. • Medications review • Provide information to available support services & self-help resources. • Manage any co-existing mental health problems. • Refer to Mental Health services when appropriate. • If you are an accredited Mental Health Fi, you are permitted to give self-harm substitute suggestions. 26Dlscustoiedit Master title style When would you refer services/crisis team for suicidal ideations? 27Anisketr edit Master title style If they have thought out a plan or have attempted suicide 28M ainagtnegdsutMidsalidetatiosnsyin Primary Care • Do a risk assessment. • If having general suicidal ideations with no plan: manage co-existing mental health disorder. • If having suicidal ideations with a plan but not ready to act on it or thought to do it: they ideally need an assessment by wellbeing/Mental Health/Crisis in 14 days. • If have intentions to act on a plan: immediate same day referral to crisis team. • If have acted on it: Assess health and send to A&E as necessary. Crisis team involvement. 229Pleic k atry edit Master title style Case Questions • Mr JJ is a 32-year-old man who has come into your (a) How would you approach the consultation? primary care clinic after experiencing 4 weeks of low mood. • He has now been finding it to be really difficult to be (b) What management plan do you have in focussing on work as a salesman and his sales have mind? been going down. • At home he has a wife who is unplanned and pregnant. She does not work • Mr JJ comes to you breaking down during the appointment. 330Pleic k atry edit Master title style Approach Management • Take a full history screening for core • Step 1: Self-help (Offer mindfulness activities or encourage to make time for small hobbies. symptoms and biological symptoms of If he is the type to journal, consider offering depression. him to create a mood diary). • Screen for anxiety • Step 2: Referral to CBT (in the meantime 2-3 weekly reviews) • Do a risk assessment • Validate his stressors (family responsibility, • Step 3: If above not working or depressive work stressors) symptoms are severe then offer an SSRI with counselling of the side effects. • Actively listen 331Click to edit Master title style Thank you- Any questions? 32