Summary
Definition
病史和体格检查
关键诊断因素
- depressed mood
- anhedonia
- functional impairment
其他诊断因素
- weight change
- libido changes
- sleep disturbance
- changes in movement
- low energy
- excessive guilt
- poor concentration
- suicidal ideation
- somatic symptoms
- bipolar disorder excluded
- substance abuse/medication side effects excluded
- medical illness excluded
- schizophrenia excluded
危险因素
- postpartum status
- personal or family history of depressive disorder or suicide
- history of an anxiety disorder, or anxiety symptoms
- adverse childhood experiences
- dementia
- corticosteroid use
- interferon use
- oral contraceptive use
- coexisting medical conditions
- female sex
- comorbid substance use
- personality disorders
- history of violent victimization
- obesity
- older age (≥65 years)
- separated/divorced marital status
诊断性检查
首要检查
- clinical diagnosis
- metabolic panel
- CBC
- thyroid function tests
- Patient Health Questionnaire-2 (PHQ-2)
- Patient Health Questionnaire-9 (PHQ-9)
- Edinburgh Postnatal Depression Scale
- Geriatric Depression Scale
- Cornell Scale for Depression in Dementia
需考虑的检查
- 24-hour free cortisol
- vitamin B12
- folic acid
治疗流程
at risk of harm to self or others (psychotic, suicidal, severe psychomotor retardation impeding activities of daily living, catatonia, or severe agitation): nonpregnant
at risk of harm to self or others (psychotic, suicidal, severe psychomotor retardation impeding activities of daily living, catatonia, or severe agitation): pregnant
more severe depression (PHQ score ≥16): nonpregnant
less severe depression (PHQ <16): nonpregnant
treatment-resistant/refractory depression
pregnant
treatment responsive
recurrent episode
撰稿人
作者
Dean F. MacKinnon, MD
Associate Professor
Psychiatry and Behavioral Sciences
The Johns Hopkins Hospital
Baltimore
MD
Disclosures
DFM declares that he has no competing interests.
Acknowledgements
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 topic.
Disclosures
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
Christopher Dowrick, BA MBChB MSc MD
Emeritus Professor
University of Liverpool
UK
Declarações
CD has been reimbursed by Novartis for participating in an educational event.
Erin K. Ferenchick, MD
Center for Family and Community Medicine
Columbia University Medical Center
Upper Manhattan
NY
Declarações
EKF declares that she has no competing interests.
Créditos aos pareceristas
Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.
Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
National Institute for Health and Care Excellence. Depression in adults: treatment and management. Jun 2022 [internet publication].Texto completo
American College of Physicians. Nonpharmacologic and pharmacologic treatments of adults in the acute phase of major depressive disorder: a living clinical guideline from the American College of Physicians. Feb 2023 [internet publication].Texto completo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Adjustment disorder with depressed mood
- Substance-/medication- or medical illness-associated and other depressive disorders
- Bipolar disorder
Mais Diagnósticos diferenciaisDiretrizes
- WHO Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioral and neurodevelopmental disorders (CDDR)
- Nonpharmacologic and pharmacologic treatments of adults in the acute phase of major depressive disorder
Mais DiretrizesFolhetos informativos para os pacientes
Depression in adults: what is it?
Depression in adults: what are the treatment options?
Mais Folhetos informativos para os pacientesCalculadoras
Geriatric Depression Scale
Depression (any) Screening by a Two Item PHQ-2
Mais CalculadorasConectar-se ou assinar para acessar todo o BMJ Best Practice
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