Major Depressive Disorder

Criteria: 2 or more weeks of >= 5/9 of the following(M SIGE CAPS) that must include patient-reported depressed mood or anhedonia(inability to feel pleasure in normally pleasurable activities)

  1. Depressed mood
  2. Sleep disturbance
  3. Interest lost (anhedonia)
  4. Guilt of feelings of worthlessness(decreased self-esteem)
  5. Energy loss or fatigue
  6. Concentration problems
  7. Appetite/weight changes
  8. Psychomotor retardation/agitation
  9. Suicidal ideations

Treatment: Cognitive based therapy(CBT) and SSRI -> SNRI, mirtazapine, bupropion -> electroconvulsive therapy(ECT)

*All patients must be questioned and screened for past history of manic episodes to r/o bipolar disorder because initiation of antidepressive therapy may precipitate mania episodes.

Sleep stages changes associated with MDD:

  • Decreased slow wave sleep
  • Increase total REM sleep(decrease REM latency with increased REM early in sleep cycle)
  • Repeated nighttime awakenings
  • Early morning wakening(terminal insomnia)

Depression with atypical features:

  1. Mood reactivity(can experience happiness in positive situations)
  2. Reversed vegetative symptoms(hypersomnia, increased appetite)
  3. Leaden paralysis(Heavy feeling in arm/leg)
  4. Long-standing interpersonal rejection sensitivity

Bereavement(normal grief): 

  1. Normal reaction to loss of loved ones with feeling of loss and emptiness. Symptoms mostly resolve around the deceased and the functional decline is less sever.
  2. Waves of grief come and go as they are reminded of the deceased
  3. Worthlessness, self-loathing, guilt and suicidality is less common
  4. Sad feelings more specific to the deceased and thoughts of dying involve joining them
  5. Intensity decreases over time

Persistent depressive disorder(dysthymia):

Depression that is often milder and lasts >2 years with no symptom free period >2 months. Symptoms >= 2/6 of the following

  1. Depressed mood
  2. Sleep disturbance
  3. Guilt of feelings of worthlessness(decreased self-esteem)
  4. Energy loss or fatigue
  5. Concentration problems
  6. Appetite/weight changes


Q: 12530


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