Last reviewed:September 2019
Last updated:March  2019

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk 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
  • postnatal status
  • personal or family history of depressive disorder or suicide
  • corticosteroids
  • interferon
  • propranolol
  • oral contraceptives
  • isotretinoin
  • co-existing medical conditions¬†
  • comorbid substance use
  • personality disorders
  • gene-environment interaction

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
  • metabolic panel
  • FBC
  • 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
Full details

Investigations to consider

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

Treatment algorithm

Contributors

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 topic.

Peer reviewersVIEW 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.

Use of this content is subject to our disclaimer