Depression

Diagnostic Criteria

  • Depressed mood **
  • Loss of interest or pleasure in most or all activities **
  • Insomnia or hypersomnia
  • Change in appetite or weight
  • Low energy
  • Psychomotor retardation or agitation
  • Poor concentration
  • Thoughts of worthlessness or guilt
  • Recurrent thoughts of death or suicide
Major Depression: 5 of the above 9
  • Most of the day, for most days, for ≥2 weeks
  • Must include 1 of the **
  • Less severe diagnoses require fewer criteria
  • If suicidal ideation, evaluate for lethality

Never Tx Depression unless R/O Mania

Elevated, expansive, or irritable mood, PLUS  ≥3 of the following:

  • Inflated self-esteem; grandiosity
  • Decreased need for sleep (<3 hrs / day)
  • Talkative; pressure to keep talking
  • Racing thoughts / flight of ideas
  • Distracted by trivial stimuli
  • Increased goal-seeking (work/school/social/sexual)
  • Unrestrained sex / spending
** Mania = duration ≥1 wk.;  Hypomania = duration ≥4 days
  • Require 4 criteria if mood is irritable
** Disturbance must either:
  • markedly impair work, usual activities, or relationships;
  • require hospitalization; OR
  • have psychotic features

** Substances can’t be the cause

R/O Depression with Psychotic Features
            •  Hallucinations          •  Paranoias                 •  Delusions
 

Address Co-Existing Anxiety Disorders

  • Post-Traumatic Stress Disorder (PTSD)
  • OCD
  • Social / other Phobias
  • Panic disorder

See posting Depression and questions to ask about Mania.

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