Depression- Signs, Symptoms, Diagnostic Criteria

Question 1

Presentation of MDD

Answer 1

Initial symptoms develop over days-weeks
Symptoms of anxiety often appear first
If left untreated, can last 4 months or more
Symptoms vary from person to person
Depression may end completely, partially, or not at all
Repeat episodes are common
Medical disorders must be ruled out
TSH, CBC, electrolytes

Question 2

Suicide risk evaluation and management (risk factors)

Answer 2

Male
Single/living alone
Describing feelings of hopelessness/suicide plans
Substance abuse
Unusual behavior- missed work, giving things away
During initial stages of medication therapy, risk can increase with those recovering from MDD as they experience increased energy → can act on suicide plans)

Question 3

Emotional symptoms of MDD

Answer 3

Continued diminished capacity to experience pleasure in activities that brought pleasure before the episode
Life stressors may trigger depression in some but not others
Anxiety
Psychotic features may be present, but this may require hospitalization and stabilization with APS

Question 4

Physical symptoms of MDD

Answer 4

Psychomotor retardation- slowed physical movements to speech
Psychomotor agitation- pacing, purposeless restless movements
Sleep disorders- insomnia, early awakenings, daytime sleepiness
Watch for residual symptoms!

Question 5

Common physical symptoms of MDD in the elderly

Answer 5

Chronic fatigue and pain

Question 6

Diagnostic criteria of MDD

Answer 6

5 or more of the following have to be present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms has to be either depressed mood or loss of interest or pleasure

Depressed mood most of the day, nearly every day, as indicated by either subjective report or observations made by others (children and adolescents may have an irritable mood)
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, most of the day
Significant weight loss (when not dieting) or weight gain (change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day (children: fail to make expected weight gain)
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly every day (observed by others)
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day
Diminished ability to think or concentrate, or indecisiveness, nearly every day
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Question 7

Medical causes of MDD

Answer 7

Hypothyroidism, anemia, HIV/AIDS/STDs, autoimmune diseases, CVD, NEUROLOGIC DISORDERS (epilepsy, Huntington’s Disease, Parkinson’s, Alzheimer’s, post-stroke)

Question 8

Medication-induced causes of MDD

Answer 8

CV: beta-blockers, CCBs
Hormonal: OCs, steroids
Antiepileptics: topiramate, levetiracetam
Opioids
Stimulants