II. Epidemiology
- Lifetime Major Depression Incidence: 21 to 25%
- Major Depression Prevalence: 6 to 8% (16 Million/year adults in U.S.)
- Age of Peak Incidence: 55 to 65 years old
- Women have higher risk of Major Depression
- Men have higher completed Suicide rate (esp. over age 75 years)
- Leading Disability cause worldwide (Prevalence 300 Million)
- Accounted for 10% of physician office visits in 2014
-
Family History: Twin concordance
- Monozygotic twins: 75%
- Dizygotic twins: 38%
- Under-diagnosed
- Depression is missed in elderly and Nursing Homes
- Up to 50% of Nursing Home population may have Major Depression
- Brown (2002) J Am Geriatr Soc 50:69-76 [PubMed]
- Only 5% of the clinic population is screened for Major Depression
- Depression is missed in elderly and Nursing Homes
III. Pathophysiology
- Since the 1960s chemical imbalance theory, and esp. Serotonin deficiency has been theorized to cause depression
- Has lead to a focus on serotonergic agents to treat depression
- However, evidence is variable for Serotonin imbalance and mechanism of activity is not clear
- Chemical imbalances (e.g. Serotonin) may be a consequence of depressive symptoms, rather than a cause
- References
IV. Risk Factors: General
- Prior episodes of Major Depression
- Prior Suicide attempts
- Age under 40 years old
- Comorbid medical condition (see associated neurologic and other medical causes below)
- Stressful life events
- Increased stress reaction with associated negativity (neuroticism)
- Family History of depression
- Female gender
- Recent childbirth
- Lack of social support (divorce, widowed, parental loss, disturbed family environment)
- Anxiety Disorder history
- Low self esteem
- Conduct Disorder
- Childhood sexual abuse or other lifetime Trauma
- Current Chemical Dependency or Substance Abuse
V. Risk Factors: Neurologic Conditions Predisposing to Major Depression
VI. Risk Factors: Medical Conditions Predisposing to Major Depression
- See Medications Predisposing to Depression
- Alzheimer's Disease or other Dementia
- Cancer
- Chronic Fatigue Syndrome
- Chronic Pain Syndrome
- Chornic Liver Disease
- Collagen vascular disease
- Coronary Artery Disease
- Congestive Heart Failure
- Crohn's Disease
- Diabetes Mellitus
- Fibromyalgia
- Human Immunodeficiency Virus (HIV)
- Hypothyroidism
- Insomnia
VII. Differential Diagnosis
VIII. Symptoms
- Core symptoms
- Depressed mood
- Anhedonia (decreased interest)
- Suicidality
- Appetite change (decreased or increased)
- Psychomotor Agitation retardation or Agitation
- Decreased energy
- Excessive Guilt (e.g. worthlessness, hopelessness or regret)
- Sleep disorder (increased or decreased)
- Atypical presentations in women
- Headaches
- Myalgias
- Gastrointestinal symptoms
- Atypical presentations in men
- Anger and aggression
- Substance Use Disorder
- Risky behavior
IX. Evaluation
- Evaluate for Suicide Risk
- Screening Mnemonics
- Screening Tools
- Patient Health Questionaire 2 (PHQ-2)
- Most common initial screening tool
- Positive result should prompt other screening tools and clinical interview
- Patient Health Questionaire 9 (PHQ-9)
- Beck Depression Inventory
- Zung Self-Rating Depression Scale
- Hamilton Depression Scale
- Mazmanian Mania-Depression Mood Scale
- Patient Health Questionaire 2 (PHQ-2)
- Screening Tools for Adolescents (ages 12 to 18 years old)
- Beck Depression Inventory
- Patient Health Questionaire 2 (PHQ-2)
- Patient Health Questionaire for Adolescents (PHQ-A)
- Nearly identical to PHQ-9 except wording includes concentration on school work
- Screening Tools in pregnancy and Postpartum Period
- See Postpartum Major Depression
- Edinburgh Postnatal Depression Scale (most commonly used Postpartum Depression screening tool)
- Patient Health Questionaire 2 (PHQ-2)
- Patient Health Questionaire 9 (PHQ-9)
- Postpartum Depression Screening Scale (PDSS)
- Screening Tools for the Elderly
X. Diagnosis
XI. Labs
- Thyroid Stimulating Hormone (TSH)
-
Hemoglobin (or Complete Blood Count)
- Consider Vitamin B12 Deficiency screening
- Consider additional lab studies
XII. Comorbid Conditions (Differentiate or Integrate)
- Major Depression
- Anxiety Disorder
- Panic Disorder
XIII. Criteria: Indications for Psychiatric Consultation
- Serious Suicidal Ideation
- Psychotic symptoms with poor judgment
- Acute manic symptoms
- Bipolar Depression
- Refractory to Antidepressant medications
- Refuses medications despite severe depression
- Inpatient psychiatric care
- Electroconvulsive Therapy
XIV. Management
XV. References
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Related Studies
Definition (MSH) | An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. |
Concepts | Mental or Behavioral Dysfunction (T048) |
MSH | D003866 |
ICD10 | F32.9 , F34.1 |
SnomedCT | 35489007, 192372006, 21061000119107, 78667006 |
DSM4 | 311 |
LNC | LA10576-9 |
English | Depressive Disorders, Depressive Disorder, Depressive Neuroses, Disorder, Depressive, Disorders, Depressive, Neuroses, Depressive, Neurosis, Depressive, DEPRESSIVE DISORDERS, Depressive Disorder NOS, Depressive Neurosis, Depressive disorder, DEPRESSIVE DIS, depression, depression (diagnosis), depressive neurosis, Depressive disorders, Depressive disorder NOS, Depressive Disorder [Disease/Finding], depressive illness, depressive disorder, [X]Depressive disorder NOS, Mood disorder of depressed type (disorder), Mood disorder with depressive feature, Mood disorder of depressed type, -- Depression, Depressive neurosis, Depression, Depressive illness, Depressive episode, Depressive disorder (disorder), depression; behavioral disorder, depressive; disorder, depressive; neurosis, disorder; depressive, neurosis; depressive, Depressive disorder, NOS, Disorder;depressive |
Italian | Disturbi depressivi, Malattia depressiva, Nevrosi depressiva, Disturbo depressivo |
Dutch | depressieve stoornis, depressieve aandoening, depressieve neurose, depressie; gedragsstoornis, depressief; neurose, depressief; stoornis, neurose; depressief, stoornis; depressief, depressieve stoornissen, Depressieve stoornis, Neurose, depressieve |
French | Maladie dépressive, Troubles dépressifs, Névrose dépressive, Trouble dépressif |
German | depressive Krankheit, depressive Stoerung, depressive Neurose, Depressive Stoerungen, Neurose, depressive, Depressionen, Depressive Störung |
Portuguese | Doença depressiva, Neurose depressiva, Perturbação depressiva, Perturbações depressivas, Neurose Depressiva, Transtorno Depressivo |
Spanish | Enfermedad depresiva, Neurosis depresiva, Trastorno depresivo, trastornos depresivos (trastorno), trastornos depresivos, trastorno depresivo (trastorno), trastorno depresivo, depresión, enfermedad depresiva, trastorno del estado de ánimo de tipo depresivo (trastorno), trastorno del estado de ánimo con característica depresiva, trastorno del estado de ánimo de tipo depresivo, neurosis depresiva, Trastornos depresivos, Neurosis Depresiva, Trastorno Depresivo |
Japanese | うつ病性障害, ウツビョウセイショウガイ, ウツビョウ, ヨクウツシンケイショウ, 神経症性鬱病, うつ病-神経症性, 鬱病-内因性, メランコリー, 憂欝病, 抑うつ神経症, うつ病-単極性, 内因性うつ病, 鬱病-神経症性, 抑うつ性神経症, 重症憂うつ病, 単相性抑うつ, 抑うつ病, うつ病-内因性, 単極性うつ病, 抑うつ性障害, 憂うつ病, 抑鬱性障害, 内因性鬱病, 抑うつ性症候群, 神経症-抑うつ性, 神経症性うつ病, 抑うつ症, うつ病, 鬱病, 抑鬱性症候群, 抑鬱病 |
Swedish | Depressiv sjukdom |
Czech | depresivní poruchy, Depresivní poruchy, Depresivní porucha, Depresivní onemocnění, Depresivní neuróza, depresivní neurózy |
Finnish | Masentuneisuushäiriö |
Russian | DEPRESSIIA ENDOGENNAIA, DEPRESSIVNYI SINDROM, MONOFAZNAIA DEPRESSIIA, ODNOFAZNAIA DEPRESSIIA, DEPRESSIVNYE RASSTROISTVA, DEPRESSIIA ODNOPOLIARNAIA, MELANKHOLIIA, DEPRESSIIA ODNOFAZNAIA, DISTIMICHESKIE RASSTROISTVA, DEPRESSIIA NEVROTICHESKAIA, NEVROZ DEPRESSIVNYI, ДЕПРЕССИВНЫЕ РАССТРОЙСТВА, ДЕПРЕССИВНЫЙ СИНДРОМ, ДЕПРЕССИЯ НЕВРОТИЧЕСКАЯ, ДЕПРЕССИЯ ОДНОПОЛЯРНАЯ, ДЕПРЕССИЯ ОДНОФАЗНАЯ, ДЕПРЕССИЯ ЭНДОГЕННАЯ, ДИСТИМИЧЕСКИЕ РАССТРОЙСТВА, МЕЛАНХОЛИЯ, МОНОФАЗНАЯ ДЕПРЕССИЯ, НЕВРОЗ ДЕПРЕССИВНЫЙ, ОДНОФАЗНАЯ ДЕПРЕССИЯ |
Croatian | DEPRESIVNI POREMEĆAJ |
Polish | Zespół depresyjny, Depresja, Zaburzenie depresyjne, Melancholia |
Hungarian | Depressziós betegségek, Depressziós zavar, Depressiós neurosis, Depressziós betegség |
Norwegian | Depressiv forstyrrelse, Depressiv lidelse |
Ontology: Major Depressive Disorder (C1269683)
Definition (MSH) | Marked depression appearing in the involution period and characterized by hallucinations, delusions, paranoia, and agitation. |
Definition (PSY) | Affective disorder marked by dysphoric mood, inactivity, lack of interest, insomnia, feelings of worthlessness, diminished ability to think, and thoughts of suicide. Use DEPRESSION (EMOTION) for nonclinical depression. |
Definition (CSP) | one or more periods of depression in the absence of history of manic or hypomanic episodes; chronic type lasts 2 or more years; melancholic type is more severe, has vegetative signs, and responds well to somatic therapy. |
Concepts | Mental or Behavioral Dysfunction (T048) |
MSH | D003865 |
ICD10 | F32.9 |
SnomedCT | 370143000, 35489007 |
English | Disorder, Major Depressive, Disorders, Major Depressive, Major Depressive Disorders, MDD, MAJOR DEPRESSIVE DISORDER, DEPRESSIVE DIS MAJOR, MAJOR DEPRESSIVE DIS, Major depressive disorder NOS, Major depressive illness, Major depression NOS, Depressive Disorder, Major [Disease/Finding], major depressive illness, major depressive disorder, major depression, Major depressive disorder (diagnosis), Major depression, Major depressive disorder (disorder), Major depressive disorder, Major depression, NOS, Major depressive disorder, NOS, Depressive Disorder, Major, Depressive Disorders, Major, Major Depressive Disorder, Major Depression |
Dutch | depressieve ziekte, depressieve stoornis NAO, major depression, Depressieve stoornis, ernstige, Ernstige depressieve stoornis, Involutiepsychose, Melancholie, involutionele, Parafrenie, involutionele, Psychose, involutionele, Involutiedepressie, Involutionele depressie |
French | Syndrome dépressif majeur SAI, Épisode dépressif majeur, Dépression grave, Grave dépression, Dépression majeure, Trouble dépressif majeur |
German | Major Depression NNB, schwere depressive Krankheit, Endogene Depression, Involutionsdepression, Melancholie, Involutions-, Paraphrenie, Involutions-, Psychose, Involutions-, Depressive Störung, majore, Majore depressive Störung |
Italian | Depressione maggiore NAS, Malattia depressiva maggiore, Depressione maggiore, Disturbo depressivo maggiore |
Portuguese | Doença depressiva major, Perturbação depressiva major NE, Depressão grave, Transtorno Depressivo Maior |
Spanish | Trastorno depresivo mayor NEOM, Enfermedad depresiva mayor, depresión mayor, trastorno depresivo mayor (trastorno), trastorno depresivo mayor, Depresión mayor, Trastorno Depresivo Mayor |
Japanese | 大うつ病NOS, オオウツビョウ, ダイウツビョウ, ダイウツビョウNOS, うつ病-退行期, 大うつ病性障害, 大鬱病, うつ病-更年期, 大うつ病, 初老期うつ病, 更年期うつ病, 更年期鬱病, 精神病-更年期, 退行期うつ病, 退行期パラフレニー, 退行期メランコリア, 退行期精神病, 鬱病-更年期, パラフレニー-退行期, 更年期うつ状態, 更年期メランコリー, 更年期精神病, 更年期鬱状態, 精神病-退行期, 退行期鬱病 |
Swedish | Involutionsdepression |
Czech | psychóza involuční, deprese involuční, depresivní porucha unipolární, melancholie involuční, parafrenie involuční, Velké depresivní onemocnění, Velká deprese, Velká depresivní porucha NOS |
Finnish | Laaja-alainen masentuneisuushäiriö |
Russian | DEPRESSIVNOE RASSTROISTVO TIAZHELOE, DEPRESSIIA INVOLIUTSIONNAIA, MELANKHOLIIA INVOLIUTSIONNAIA, PSIKHOZ INVOLIUTSIONNYI, PARAFRENIIA INVOLIUTSIONNAIA, ДЕПРЕССИВНОЕ РАССТРОЙСТВО ТЯЖЕЛОЕ, ДЕПРЕССИЯ ИНВОЛЮЦИОННАЯ, МЕЛАНХОЛИЯ ИНВОЛЮЦИОННАЯ, ПАРАФРЕНИЯ ИНВОЛЮЦИОННАЯ, ПСИХОЗ ИНВОЛЮЦИОННЫЙ |
Polish | Wielkie zaburzenie depresyjne, Zaburzenie depresyjne wielkie, Ciężkie zaburzenie depresyjne, Depresja wielka, Parafrenia inwolucyjna, Depresja głęboka, Epizod depresji dużej, Depresja inwolucyjna |
Hungarian | Major depressiós betegség, Major depressio, Major depressiós zavar k.m.n. |
Norwegian | Depresjon, alvorlig, Markert depresjon, Depresjon, markert, Alvorlig depresjon, Markant depressiv forstyrrelse |