Low mood
Psychiatry
Introduction
Author: Iqra Bibi
When taking a low mood history, create a supportive, non-judgmental space and use open-ended questions to explore symptom onset, duration, and severity. Assess associated features like sleep, appetite, energy, and concentration changes, along with functional impacts. Screen for risk factors, including suicidal ideation, self-harm, and substance use, while understanding the patient’s psychosocial context and support systems. Prioritise active listening, empathy, and validation to build rapport and gather comprehensive, relevant information.
WIPER
W – Wash/Sanitise hands.
I – Introduce yourself and establish patient demographics.
P - Patient details
E – Explain and obtain consent
Presenting Complaint
Enquire about core symptoms:
Low mood – Can you tell me more about how you’ve been feeling recently?
Anhedonia – Do you feel as if you are losing interest and enjoyment in you day to activities?
Fatigue – How are your energy levels? Do you feel more tired and run down recently?
Duration and progression – How long have you been feeling like this? How have things changed from when this first started to now? Do you feel there is a change in your mood throughout the day?
Identify triggers/ significant life events – Can you think of any reason for feeling like this or has anything happened in your life recently that you think might have set these symptoms off?
Other Symptoms
Sleep – Has your sleep been affected recently? Do you find yourself waking up earlier than you normally do?
Appetite – Are you eating and drinking okay? Have you lost or put on any weight recently?
Libido
Anxiety - Do you feel particularly worried or on edge?
Cognition – Do you feel your concentration levels have been since the onset of these symptoms?
Features of Psychosis (Must rule out in all mental health histories)
Bipolar – We’ve spoken about low mood, have you also felt really high mood or elated mood recently?
Psychosis – Have you ever heard or seen things you couldn’t explain or that other people couldn’t also see or hear?
Systems Review
Risk Assessment– In all psychiatry histories you must ALWAYS screen for risk of self harm and suicide.
Give a warning shot before asking the question as they can be quite distressing for some patients.
Have you thought about harming yourself or ending your life recently? Have you had thoughts about harming others?
Rule out physiological causes for symptoms
Ask specifically about recent weight gain, skin problems or hair thinning to rule out hypothyroidism
Use this opportunity to elicit ideas, concerns and expectations
Be sure to summarise the history
Past Medical History
W – Wash/Sanitise hands.
I – Introduce yourself and establish patient demographics.
P - Patient details
E – Explain and obtain consent
Medications
Are they on any regular medications?
Is there a history of recreational drug use?
Family History
Is there a family history of psychiatric conditions?
Social History
Ask about social circle and support systems
Who do you live with/ Who’s at home?
Do you work? What do you work as?
What are you hobbies? How often do you get to see your friends/family?
Smoking/alcohol?
Differential Diagnosis
Depression
Bipolar Disorder – episodes of elated mood/manic episodes alongside low mood
Schizoaffective Disorder – low mood with presence of hallucinations/ delusions
Hypothyroidism – intolerance to cold and other symptoms mentioned above
Management
Mental State Exam
Risk assessment
Thyroid exam if indicated
Blood tests – FBC and Thyroid function tests
Management:
Mild
Lifestyle changes – regular exercise, sleep hygiene, Cognitive Behavioural Therapy (CBT), counselling
Moderate – severe
Consider medication i.e. SSRIs
More frequent/ high intensity psychosocial interventions – CBT/ interpersonal therapy
Assess risk