Depression

Term

Clinical features

Major Depression

•  At least 2 weeks with > 5 of the following
  •  Anhedonia
  •  Change in appetite or weight
  •  Depressed mood
  •  Insomnia or hypersomnia
  •  Low energy
  •  Poor concentration
  •  Psychomotor retardation or agitation
  •  Recurrent thoughts of death or suicide
  •  Thoughts of worthlessness or guilt
•  At least one of the symptoms has to be depressed mood or anhedonia
•  Symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning
•  Episodes are not due to another medical condition or substance use
•  Episodes do not contain mania or hypomania

Classification by severity

•  Mild to moderate
  •  Intact judgment such that the patient or others are not at imminent risk of being harmed
  •  Little to no aggressiveness
  •  No obvious functional impairment
  •  No psychotic features (eg, delusions or hallucinations)
  •  No suicidal or homicidal ideation or behavior
•  Severe
  •  Malignant catatonia
  •  Persistent suicidal ideation with intent
  •  Score ≥20 points on the self-report Patient Health Questionnaire – Nine Item (PHQ-9)
  •  Severe weight loss, malnutrition, or dehydration due to decreased intake

Treatment Subtypes

•  Response
  •  > 50% improvement in symptoms with treatment
•  Remission
  •  Significant improvement below cutoffs by assessment tools
•  Resistant
  •  Inadequate response to at least 2 trials of antidepressant monotherapy
•  Refractory
  •  Highly resistant to treatment without satisfactory response to many sequential treatment regimens

Clinical assessment

•  History
  •  Assess for above symptoms, suicide risk, family history, and social history
•  Physical exam
  •  Mental status exam