depression
DEPRESSION

Depression is a mood disorder wherein the patient have a pervasive sad mood or loss of interest in most activities for at least 2 weeks.

It can cause significant distress & impairment. It is also a chronic, episodic and relapsing syndrome.

Treatment can either be by psychotherapy alone or pharmacotherapy alone or psychotherapy combined with pharmacological therapy.

Diagnosis

Perform Thorough Diagnostic Evaluation

  • Determine if other psychiatric or general medical conditions are present
  • Should include but is not limited to:
    • Physical exam
    • Mental status exam
    • History of past and current illnesses
    • History of suicidal thoughts and suicide attempts
    • General medical history
    • Psychiatric history
      • To include symptoms of mania because presence of manic symptoms would prompt that the patient be diagnosed with bipolar disorder
    • Family history of psychiatric disorders
    • Substance abuse history
    • Medication review
    • Mental status evaluation
    • Diagnostic tests as indicated
      • Screening tools eg Patient Health Questionnaire (PHQ9), PHQ2 or Two-Question Screen, Beck Depression Inventory for Primary care
    • Evaluation of functional impairment
    • Evaluation of life events and stressors

Evaluation

Diagnostic Criteria

  • Based on DSM-5 diagnostic criteria, major depressive disorder is diagnosed when 5 or more of the following symptoms that causes change or distress in previous functioning have been present during the same 2 week (and at least one of the symptoms is either depressed mood or lack of interest or pleasure):
    • Depressed mood in adults or irritable mood in children that either self-reported or observable most of the day, nearly every day
    • Lack or diminished interest or pleasure in almost all activities most of the time, nearly every day
    • Significant weight loss when not dieting, weight gain or appetite disturbance in adults. While in children, this can be failure to attain expected weight gain
    • Sleep disturbance that can be insomnia or hypersomnia nearly every day
    • Psychomotor agitation or retardation
    • Feeling of fatigue or lack of energy nearly every day
    • Sense of diminished/lost of self-worth or inappropriate guilt nearly every day
    • Inability to concentrate and there is indecisiveness
    • Frequent thoughts of death, could be of suicidal attempts, with or without specific plan
  • The symptoms should not be a physiological effect of any substance as well as any general medical condition
  • The disorder occurrence is not due to schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorders
  • Manic and hypomanic episodes have not occurred
  • Distinguishing between normal sadness and grief from major depressive disorder is important
    • Bereavement induces great suffering but does not typically induces major depressive disorder
    • When bereavement and major depressive disorder concurrently exist, the latter has more severe symptoms and functional impairment and worse prognosis compared to bereavement alone
    • Diagnosis of major depressive disorder in a patient who had significant loss would need clinical judgment based on the patient’s history and cultural context for expression of grief
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