Sarah Fox qualified in medicine in the mid-1980s, and specialised in Psychiatry. She has worked in a pain clinic in Plymouth and part time in the Bath Centre for Pain Services until 2009. In 2007 she began working in Psychiatry for Older Adults in 2007 and has been involved with a project with Bristol PCT trying to improve pain assessment and management of residents with dementia in care settings. She also works with palliative care workers to improve end of life care for patients being treated by mental health services (whether in hospital or at home). As regards voluntary work, she has been involved with Arthritis Care since 2004. and continues to be involved with a number of support groups for people with chronic pain, especially arachnoiditis, both in the UK and abroad.
In the second of a two part series, Sarah talks about the assessment and management of depression. Professor Peter Tyrer of Imperial College once said ‘If the diagnosis of depression cannot be agreed satisfactorily by the best minds in psychiatry, why should we expect the general practitioner to be a reliable assessor of the condition’.
To help us arrive at a diagnosis there are a number of ways of assessing depression using assessment tools such as the Beck Depression Inventory, the Geriatric depression scale, the Hospital Anxiety and Depression score and the Mental State Examination. Sarah then looks at the treatments of depression such as the talking therapies such as CBT, DBT and ACT and medication using SSRI’s, SNRI’s, Tricyclics, MAOI’s, Mirtazapine, Lithium and atypical antipsychotics. Sarah offers up some useful tips in prescribing these drugs and uses published research to suggest how clinicians may offer sequenced treatments, either switching or augmenting. She also mentions other forms of treatment such as ECT, daylight, diet, herbal remedies and exercise to combat depression. Finally there are a number of good case studies with good practical solutions at the end of this presentation.