# Feeling Sad

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) - condition scope only, no dose · Major Depressive Disorder - StatPearls - NCBI Bookshelf (NBK559078) - https://www.ncbi.nlm.nih.gov/books/NBK559078/ · No dose - no medicine is given for this in primary care
- Verified date: 2026-08

## Verified against

- No dose - no medicine is given for this in primary care

## Treatment metadata

- No drug therapy in primary care (Assessment & Advice)

## Complete treatment card

```text
FEELING SAD
Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) - condition scope
         only, no dose · Major Depressive Disorder - StatPearls - NCBI Bookshelf (NBK559078) -
         https://www.ncbi.nlm.nih.gov/books/NBK559078/ · No dose - no medicine is given for this in
         primary care
Review status: REVIEWED against the source listed above  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (10)
    - Open with the bodily symptoms: sleep, appetite and energy
    - Five of nine symptoms are needed, one of them low mood or loss of interest and pleasure  [loss
      of interest · low mood]
    - Low mood  [low mood]
    - Less interest or pleasure in things
    - Disturbed sleep
    - Guilt, or a sense of being worthless
    - Altered energy or frank fatigue  [fatigue]
    - Poor concentration and attention  [poor concentration]
    - Change in appetite or in weight
    - Thoughts of suicide
  SIGNS - what you find (2)
    - Movement is disturbed, either slowed or agitated  [irritability]
    - The diagnosis rests on the history and the examination findings
  TESTS (12)
    - Every patient needs assessing for suicide risk, and any risk needs acting on at once
    - Take past and family medical history, and list current medicines
    - Take a social history centred on stressors and on drug and alcohol use
    - History and examination serve to rule out physical causes of the low mood
    - Standard depression questionnaires help gauge which symptoms are present and how severe
    - No blood test diagnoses it; the tests exist to exclude illnesses that imitate it
    - Blood count, thyroid-stimulating hormone and vitamin B12
    - Syphilis serology and an HIV test
    - Electrolytes with calcium, phosphate and magnesium; urea and creatinine; liver tests
    - Blood alcohol level, and toxicology screening of blood and urine
    - Dexamethasone suppression looks for Cushing disease, though depression itself can make it
      positive
    - An ACTH stimulation test looks for Addison disease; brain CT or MRI if organic brain disease
      or hypopituitarism is in question
  IF NOT THIS - what else fits (9)
    - Adjustment disorder
    - Underlying anaemia
    - Chronic fatigue syndrome
    - A dissociative disorder
    - Illness anxiety disorder
    - Low blood sugar
    - Underactive pituitary
    - Schizoaffective disorder, or schizophrenia
    - Somatic symptom disorder
  Source  StatPearls "Depression" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (ASSESSMENT & ADVICE)  [1st line]
   Adult    Everyday sadness or low mood reported by the patient without meeting criteria for a
            mental disorder; the GP's role is listening, exploring the cause, and distinguishing
            this from clinical depression, which is coded and treated separately. No medication is
            indicated for normal sadness itself. - Assessment and advice
   Peds     Children follow the same pathway: assessment, explanation and follow-up. No primary-care
            medicine is implied.
   Source   No dose - no medicine is given for this in primary care
   Why      Everyday sadness or low mood reported by the patient without meeting criteria for a
            mental disorder; the GP's role is listening, exploring the cause, and distinguishing
            this from clinical depression, which is coded and treated separately. No medication is
            indicated for normal sadness itself.
   Caution  No medicine is prescribed for this in primary care. The value of the consultation is
            recognition, explanation and follow-up, and referral if the red flags above appear.
            RED FLAG - Symptoms persisting beyond two weeks with loss of interest or function,
            suggesting a major depressive episode rather than simple sadness, or any expression of
            hopelessness or suicidal thoughts.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
```

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