Depression Interview Questions

1. The graveness of depression as an illness has been glaringly brought to the fore with a top Mumbai
cop having allegedly committed suicide out of extreme depression just recently. How severe do you
estimate the problem to be in India today, and what challenges does it present?

Depression is one of the common health conditions affecting about 30 Crore (300 million) people
worldwide according to World Health Organization. It can cause the affected person to suffer greatly and
function poorly at work and at home. At its worst, it can lead to suicide. Close to 8 Lakh people die due
to suicide ever year. Suicide is one of the leading causes of death in 15-29 year-olds.

India has one of the highest suicide rates in the world. Challenges in identifying and managing
depression are due to –
1. Stigma related to psychological problems,
2. Lack of psychological and medical professionals (especially in the Rural India) and
3. Lack of awareness of the severity or frequent occurrence of depression.

2. What medical conditions are prominently linked with depression and how does a typical case of
depression present to the general physician?

Depression is commonly associated with Chronic medical conditions which need regular care either due
to complications or chronic pain. Some of the common medical conditions are –
1. Neurological: Epilepsy, Stroke, Parkinson’s Disease, Dementia, and Multiple Sclerosis
2. Diabetes, HIV/AIDS, Rheumatoid arthritis, SLE, CAD, Cancer
Depression may present to a general physician in various ways like –
1. Insomnia
2. Vague and generalised somatic symptoms like Fibromyalgia
3. Frequent non-adherence to treatment of chronic medical conditions like Diabetes, Hypertension
4. Substance use problems
5. Palpitations and anxiety with no cardiac reason

3. How does depression link with suicide? Any warning signs that could help predict (and thus pre-
empt) suicidal behaviour in patients with depression?

Many cases of suicide, except where the attempt is impulsive, are related to depression. There is a
logical flow of events from the depressed mood to an ideation of suicide. We should look out for suicidal
ideas or behaviour in every case of depression.

Extremes of age (i.e. less than 19 or more than 45), presence of previous attempt, psychotic symptoms
like delusions or hallucinations, excessive substance use, lack of social support, deliberation of an
organized plan in interview, chronic illnesses are some of the factors which should be taken as warning
signs for predicting the risk of suicide.
4. Please discuss how a general physician in his/her limited capacity can diagnose and medically
manage a patient of depression (Also include dosages of medications). Also, at what point is
medication warranted for depression and when should specialist referral be considered?

PHQ-9 is a standard screening tool for depression which can be part of the assessment to identify if
there is a suspicion of depression. Medication is warranted when the depressive symptoms are causing
disability in daily functioning like sleep, appetite, study or work for more than a week.

The common, efficacious and well tolerated anti-depressants used are called SSRIs. Though there are
many of them, two common ones are Escitalopram and Sertraline. These need not be changed with
medical co-morbidities as they have minimal or no drug interaction and no significant side-effects apart
from gastritis in few people in the first week. Escitalopram can be started at 5mg at night and increased
by 5mg every week till 20mg per day.

The circumstances which may necessitate referral to a specialist are –

a) Persistence of symptoms even after using above mentioned medication
b) Need for other interventions like counseling, rTMS or ECT
c) Severity of symptoms which require hospitalization like aggression, suicidal ideas etc

5. Today, as mental illnesses such as depression are increasingly gaining recognition among the lay
public as being worthy of urgent medical attention, how important do you reckon is the role of a
general physician in handling mental illnesses such as depression and acting as a link to the specialist?

General physicians are in a strategic position to identify depression early and manage or refer to
specialists. As depression worsens treatment outcomes of general medical conditions, it should be dealt
by the general physicians in a proper way.

Awareness about depression, early identification and initial management are the three main aspects
where general physicians make a lot of impact.

6. Please comment on the scope and importance of pro-active detection of cases in dealing with
depression.

Pro-active screening of depression should be done with valid tools like PHQ-9 questionnaire. It is better
done in people with clinical suspicion of depression. Early identification and management helps prevent
disability and early return to functioning.

7. What systemic measures do you think are needed in India today to combat mental illnesses such as
depression?

Systemic measures needed in India to address these issues are –

1. Awareness programs to reduce the societal stigma and facilitate access to care
2. Strengthening public healthcare system with training of general physicians with necessary and
minimal psychiatric knowledge
3. Recruiting teachers, employers and paramedical professionals for screening and early
identification of depression