04: Depression

Question 1

What are the criteria for a Major Depressive Episode?

Answer 1

1. Sleep disturbance
2. Loss of Interest (anhedonia)
3. Guilty/worthless
4. Loss of Energy (fatigue)
5. Poor Concentration/indecisive
6. Appetite/weight change
7. Psychomotor agitation/retardation
8. Suicidal ideation
9. Depressed mood

Mnemonic: SIG E CAPSD

Question 2

How does one qualify for a Major Depressive Episode?

Answer 2

• Must have one of the following:
  
  • Depressed mood
  • Anhedonia
• Plus 4 additional criteria
• Symptoms present for at least 2 weeks
• Change from previous functioning
• Most of the day, nearly every day
• Causes significant distress
• Not due to:
  
  • Other medical condition (e.g., hypothyroidism)
  • Substance (i.e., recreational or prescribed drug)

NB: Polythetic diagnosis: various patients may have many, but not all criteria in common.

Question 3

What is “depressed mood”?

Answer 3

• Sad
• Down
• Hopeless
• Complicated by alexithymia: the inability to experience emotions
• Obtained in Hx & observed in MSE

Question 4

What is anhedonia?

Answer 4

• Loss of interest
• Loss of pleasure (not just lack of seeking out pleasure)
• Includes loss of libido
• Obtained in Hx

Question 5

What constitutes change in appetite?

Answer 5

• Increase or decrease
• With or without weight change
• Obtained in Hx

Question 6

What constitutes change in sleep?

Answer 6

• Insomnia
  
  • Middle night awakening (MNA)
  • Early morning awakening (EMA)
    
    • Both very characteristic of MDD
  • Difficulty falling asleep (DFA)
    
    • Non-specific; could also be anxiety
• Hypersomnia (sleeping more; not just staying in bed)
• Characteristic sleep architecture changes observed on electroencephalography (EEG) (e.g., decreased REM latency)
• Obtained in Hx

Question 7

What constitutes psychomotor change?

Answer 7

• Psychomotor agitation
• Psychomotor retardation
• Obtained in Hx & observed in MSE

Question 8

What constitutes fatigue?

Answer 8

• May or may not be related to sleep disturbance
• Obtained in Hx

Question 9

What constitutes poor concentration/indecisive?

Answer 9

• Pseudodementia: trouble remembering/concentrating
  
  • State of general apathy resembling dementia, but due to a psychiatric disorder rather than organic brain disease and potentially reversible
• Obtained in Hx & observed in MSE

Question 10

What constitutes worthless/guilty?

Answer 10

• May be delusion or overvalued idea
• Obtained in Hx or observed in MSE

Question 11

What constitutes suicidal ideation?

Answer 11

• Passive (no intent/plan)
• Active (intent/plan)
• Does not have to be present every day (as long as occurs just once in two weeks, qualifier)
• Obtained in Hx or observed in MSE

Question 12

What is the epidemiology of depression?

Answer 12

• Age of onset: 20s
• Population prevalence:
  
  • Current: 5%
  • Lifetime: 17%
    
    • Women: 20-25%
    • Men: 7-12%
  • Primary care population:
    
    • Current: 10%