Major depressive disorder
Epidemiology
Etiology
Subtypes
Tip
Each one of the diagnosis is superseded by the one above it: Bipolar I > Bipolar II > Depression > Cyclothymia > Dysthemia
Persistent depressive disorder (dysthymia)
- Clinical features: Unlike in MDD, thoughts of suicide, loss of interest, and psychomotor agitation or retardation are not typical features of persistent depressive disorder; therefore, dysthymia is often regarded as a milder form of MDD.
- Diagnostic criteria
- Depressed mood in addition to ≥ 2 of the clinical features mentioned above
- The symptoms are present for most of the day, and for the majority of days, for ≥ 2 years in adults.
Pathophysiology
Clinical features
Diagnostics
Diagnostic criteria
A. Five or more of the nine symptoms listed below, for at least 2 weeks, with at least one of the symptoms being depressed mood or anhedonia
- Sleep disturbances
- Anhedonia (↓ Interest in pleasurable activities)
- Guilt or feelings of worthlessness
- ↓ Energy
- ↓ Concentration
- Appetite/weight changes (either gain or loss)
- Psychomotor retardation or agitation
- Suicidal ideation
Mnemonic
SAGE CAPS
Imagined a very sad wizard in a fancy hat.
2 weeks = too blue
Tip
Some individuals with MDD do not report feeling depressed due to poor recognition or concerns of stigma and may come to their primary care physicians with excessive worry over physical health, pain symptoms (eg, muscle aches, abdominal cramps, headaches), and other somatic symptoms (eg, fatigue, sleep disturbance, appetite change).
Further assessment
Suicide risk
- Screen all patients with MDD for suicidality.