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Major Depressive Disorder
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Defined as severe depression that has a significant effect on a patient's ability to function. Variable age of onset. Those aged 18 to 29 years are three times more likely to have major depressive disorder (MDD) than those who are 60 years or older. There is a two- to four-fold ↑ risk in first-degree family members. Variable course for MDD with patients experiencing remission (depression resolving completely or nearly completely). Recovery (extended remission of symptoms) can begin as early as 3 months of onset. Relapse is common.
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MNEMONIC
Symptoms of depression:
SIG E CAPS
Sleep—hypersomnia/insomnia
Interest—loss of interest or pleasure in activities (anhedonia)
Guilt—a feeling of worthlessness or inappropriate guilt
Energy—low energy
Concentration—poor concentration
Appetite—↑ or ↓ appetite
Psychomotor agitation (ie, inability to sit still, hand wringing) or retardation
Suicidal ideation
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Defined as one or more episodes of depressed mood or anhedonia (loss of interest or pleasure) for at least 2 consecutive weeks, as well as by at least five of the symptoms of depression, summarized by the mnemonic SIG E CAPS.
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KEY FACT
Often insomnia and fatigue are the presenting complaints for MDD. Other psychosomatic complaints (abdominal pain, chest pain, headache, lethargy, weight loss, dizziness, and syncope) can be seen in adults as well as children/adolescents with depression.
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Adjustment disorder with depressed mood: A reaction to a specific incident or psychosocial stressor, leading to depressed mood. Symptoms begin within 3 months of the stressor and lessen within 6 months (after removal of stress, behavior change and adaptation).
Grief: Feelings of emptiness and loss that occur in waves, which mostly occur after death of a love one or major loss of functioning due to illness/accident or with a parent or significant other's loss of functioning such as with progressive dementia. Differentiated from MDD due to MDD being persistent depressed mood.
Mood disorder due to a medical condition: A variety of disorders (eg, anemia, hypothyroidism, pancreatic cancer, Parkinson disease, SLE, infection, organic CNS disorders-tumors, vascular lesions) can lead to MDD.
Substance/medication-induced depressive disorder: Depressive symptoms that start after use of a medication or after substance use or withdrawal, and that reappear after subsequent use of the substance/medication.
Bipolar disorder: Episodes of major depressive symptoms alternating with manic periods.
Schizoaffective disorder: Predominantly a psychotic disorder with accompanying mood symptoms.
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KEY FACT
When looking for medical causes of depression, check TSH, CBC, and drug history for medications implicated in depressive symptoms (β-blockers, corticosteroids, digoxin, H2 blockers, metoclopramide, sedative-hypnotics, methyldopa, clonidine, OCPs, anabolic steroids, psychostimulants, L-dopa). Also consider paraneoplastic causes and parkinsonism.
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Behavioral: Many forms of individual, couple, family, and group psychotherapy are appropriate and are as effective or more effective ...