Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • depressed mood
  • anhedonia
  • functional impairment

Other diagnostic factors

  • weight change
  • libido changes
  • sleep disturbance
  • psychomotor problems
  • low energy
  • excessive guilt
  • poor concentration
  • suicidal ideation
  • bipolar disorder excluded
  • substance abuse/medication side effects excluded
  • medical illness excluded
  • schizophrenia excluded

Risk factors

  • age >65 years
  • postpartum status
  • personal or family history of depressive disorder or suicide
  • corticosteroids
  • interferon
  • propranolol
  • oral contraceptives
  • isotretinoin
  • coexisting medical conditions (diabetes, MI, cancer, stroke, obesity)
  • comorbid substance use
  • personality disorders
  • gene-environment interaction

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
  • metabolic panel
  • CBC
  • TFTs
  • Patient health questionnaire-2 (PHQ-2)
  • PHQ-9
  • Edinburgh Postnatal Depression Scale
  • Geriatric Depression Scale
  • Cornell Scale for Depression in Dementia
Full details

Investigations to consider

  • 24-hour free cortisol
  • vitamin B12
  • folic acid
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Associate Professor

Psychiatry and Behavioral Sciences

The Johns Hopkins Hospital

Baltimore

MD

Disclosures

DFM declares that he has no competing interests.

Dr Dean F. MacKinnon would like to gratefully acknowledge Dr Roger S. McIntyre, Dr Tonya Fancher, and Dr Richard Kravitz, the previous contributors to this monograph. RSM has received research funds from Stanley Medical Research Institute and National Alliance for Research on Schizophrenia and Depression (NARSAD). RSM is on the advisory board for AstraZeneca, Bristol-Myers Squibb, France Foundation, GlaxoSmithKline, Janssen-Ortho, Solvay/Wyeth, Eli Lilly, Organon, Lundbeck, Biovail, Pfizer, Shire, and Schering-Plough. RSM is on the Speakers Bureau for Janssen-Ortho, AstraZeneca, Eli Lilly, Lundbeck, Biovail, and Wyeth. RSM has received research grants from Eli Lilly, Janssen-Ortho, Shire, and AstraZeneca. RSM has received travel funds from Bristol-Myers Squibb. TF declares that she has no competing interests. RK has received research grants from Pfizer on non-depression-related topics.

Peer reviewers VIEW ALL

Director

Residency Training

St Vincent's Hospital

Manhattan

NY

Disclosures

SM declares that he has no competing interests.

Department of Psychiatry and Psychotherapy

Medical University of Vienna

Vienna

Austria

Disclosures

DW has received lecture fees from CSC Pharmaceuticals, GlaxoSmithKline, and Pfizer, and has served as a consultant for GlaxoSmithKline.

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