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Depression in adults

Last reviewed: 23 Sep 2025
Last updated: 19 Mar 2025

Summary

Definition

病史和体格检查

关键诊断因素

  • depressed mood
  • anhedonia
  • functional impairment
完整详情

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
完整详情

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
完整详情

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
完整详情

需考虑的检查

  • 24-hour free cortisol
  • vitamin B12
  • folic acid
完整详情

治疗流程

急症处理

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

持续性治疗

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

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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 diferenciais
  • Diretrizes

    • 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 Diretrizes
  • Folhetos informativos para os pacientes

    Depression in adults: what is it?

    Depression in adults: what are the treatment options?

    Mais Folhetos informativos para os pacientes
  • Calculadoras

    Geriatric Depression Scale

    Depression (any) Screening by a Two Item PHQ-2

    Mais Calculadoras
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