II. 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]

III. 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

IV. Risk Factors: Neurologic Conditions Predisposing to Major Depression

VI. Differential Diagnosis

VII. 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

VIII. Evaluation

IX. Diagnosis

X. 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

XI. Comorbid Conditions (Differentiate or Integrate)

  1. Major Depression
  2. Anxiety Disorder
  3. Panic Disorder

XII. Criteria: Indications for Psychiatric Consultation

  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

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Ontology: Depressive disorder (C0011581)

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