Depression in adults

Last reviewed: 5 Sep 2022
Last updated: 27 Sep 2022

Summary

Definition

History and exam

Key diagnostic factors

  • depressed mood
  • anhedonia
  • functional impairment
More key diagnostic factors

Other diagnostic factors

  • weight change
  • libido changes
  • sleep disturbance
  • changes in movement
  • low energy
  • excessive guilt
  • poor concentration
  • suicidal ideation
  • bipolar disorder excluded
  • substance abuse/medication side effects excluded
  • medical illness excluded
  • schizophrenia excluded
Other diagnostic factors

Risk factors

  • postpartum status
  • personal or family history of depressive disorder or suicide
  • dementia
  • corticosteroids
  • interferon
  • propranolol
  • oral contraceptives
  • coexisting medical conditions
  • female sex
  • comorbid substance use
  • personality disorders
  • stressful life events
  • obesity
More risk factors

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
More 1st investigations to order

Investigations to consider

  • 24-hour free cortisol
  • vitamin B12
  • folic acid
More investigations to consider

Treatment algorithm

ACUTE

severe depression, nonpregnant: psychotic, suicidal, severe psychomotor retardation impeding activities of daily living, catatonia, or severe agitation

moderate depression, nonpregnant: severe symptoms, significant impairment but no psychotic symptoms, no suicidal ideation, and no severe psychomotor retardation or agitation

mild depression, nonpregnant: low to moderate severity symptoms, partial impairment, no psychotic symptoms, no suicidal ideation, and no psychomotor retardation or agitation

treatment-resistant/refractory depression

pregnant

ONGOING

treatment responsive

recurrent episode

Contributors

Authors

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

Scott McAfee, MD

Director

Residency Training

St Vincent's Hospital

Manhattan

NY

Disclosures

SM declares that he has no competing interests.

Dietmar Winkler, MD

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.

  • Differentials

    • Adjustment disorder with depressed mood
    • Substance-/medication- or medical illness-associated and other depressive disorders
    • Bipolar disorder
    More Differentials
  • Guidelines

    • Depression in adults: treatment and management
    • VA/DoD clinical practice guideline for the management of major depressive disorder
    More Guidelines
  • Patient leaflets

    Depression in adults: what is it?

    Depression in adults: what treatments work?

    More Patient leaflets
  • Calculators

    Geriatric Depression Scale

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

    More Calculators
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