Synopsis
Recognise a depressive syndrome through sustained mood, interest, energy, cognition and biological change, assess suicide and psychosis directly, and distinguish clinically significant illness from ordinary sadness without reducing diagnosis to a questionnaire score.
- Core depressive experiences include sustained low mood, reduced interest or pleasure and reduced energy, but the person's language may emphasise emptiness, irritability, numbness or inability to care.
- Biological or somatic changes include sleep disturbance, appetite or weight change, psychomotor slowing or agitation, reduced libido, fatigue and sometimes early-morning or diurnal worsening.
- Cognitive features include impaired concentration and decision making, guilt, worthlessness, hopelessness, negative expectations and recurrent thoughts of death.
Key red flags
Suicidal planning, rehearsal, available means, recent self-harm, severe hopelessness or the belief that others are better off after the person's death requires an immediate scenario-based formulation.
Investigation priorities
Establish mood, interest, energy, cognition, biological change, persistence and previous baseline.
Management branches
A person reports persistent low mood, reduced motivation, fatigue or loss of interest.
- Establish core, cognitive and biological symptoms, duration, baseline and concrete functional consequences using the person's own language.
- Ask directly about suicide, self-harm, psychosis, catatonia, mania, substances, physical illness and dependants.