Depress

Major Depression

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Major Depression, Major Depressive Disorder, Depressive Disorder

  • Epidemiology
  1. Lifetime Major Depression Incidence: 25%
  2. Major Depression Prevalence: 6-8% (16 Million/year adults in U.S.)
  3. Age of Peak Incidence: 55 to 65 years old
  4. Women have higher risk of Major Depression
  5. Men have higher completed Suicide rate (esp. over age 75 years)
  6. Leading Disability cause worldwide (Prevalence 300 Million)
  7. Accounted for 10% of physician office visits in 2014
  8. Family History: Twin concordance
    1. Monozygotic twins: 75%
    2. Dizygotic twins: 38%
  9. Under-diagnosed
    1. Depression is missed in elderly and Nursing Homes
      1. Up to 50% of Nursing Home population may have Major Depression
      2. Brown (2002) J Am Geriatr Soc 50:69-76 [PubMed]
    2. Only 5% of the clinic population is screened for Major Depression
      1. Akincigil (2017) Psychaitry Serv 68(7): 660-6 [PubMed]
  • Risk Factors
  • General
  1. Prior episodes of Major Depression
  2. Prior Suicide attempts
  3. Age under 40 years old
  4. Comorbid medical condition (see associated neurologic and other medical causes below)
  5. Stressful life events
  6. Increased stress reaction with associated negativity (neuroticism)
  7. Family History of depression
  8. Female gender
  9. Recent childbirth
  10. Lack of social support (divorce, widowed, parental loss, disturbed family environment)
  11. Anxiety Disorder history
  12. Low self esteem
  13. Conduct Disorder
  14. Childhood sexual abuse or other lifetime Trauma
  15. Current Chemical Dependency or Substance Abuse
  • Risk Factors
  • Neurologic Conditions Predisposing to Major Depression
  • Differential Diagnosis
  • Symptoms
  1. Core symptoms
    1. Depressed mood
    2. Anhedonia (decreased interest)
    3. Suicidality
    4. Appetite change (decreased or increased)
    5. Psychomotor Agitation retardation or Agitation
    6. Decreased energy
    7. Excessive Guilt (e.g. worthlessness, hopelessness or regret)
    8. Sleep disorder (increased or decreased)
  2. Atypical presentations in women
    1. Headaches
    2. Myalgias
    3. Gastrointestinal symptoms
  3. Atypical presentations in men
    1. Anger and aggression
    2. Substance Use Disorder
    3. Risky behavior
  • Evaluation
  • Labs
  1. Thyroid Stimulating Hormone (TSH)
  2. Hemoglobin (or Complete Blood Count)
    1. Consider Vitamin B12 Deficiency screening
  3. Consider additional lab studies
    1. Serum electrolytes
    2. Liver Function Tests
    3. Urinalysis
  • Comorbid Conditions (Differentiate or Integrate)
  1. Major Depression
  2. Anxiety Disorder
  3. Panic Disorder
  1. Serious Suicidal Ideation
  2. Psychotic symptoms with poor judgment
  3. Acute manic symptoms
  4. Bipolar Depression
  5. Refractory to Antidepressant medications
  6. Refuses medications despite severe depression
  7. Inpatient psychiatric care
  8. Electroconvulsive Therapy