Summary
Definition
History and exam
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
- comorbid substance use
- personality disorders
- gene-environment interaction
Diagnostic investigations
1st investigations to order
- 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
Treatment algorithm
Contributors
Authors
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.
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
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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