Does my patient have depression?

Does the patient have any of the following symptoms?

 

  1. Low Mood
  2. Irritability
  3. Fatigue/tiredness
  4. Concentration problems
  5. Memory problems
  6. Sleep disturbances (insomnia/excessive sleep)
  7. Dizziness
  8. Weakness
  9. Anxiety
  10. Unexplained weight changes

 

If Yes, rule out common medical causes:

 

 

Differential Diagnosis of Major Depressive Disorder

 

Has the patient experienced five (5) or more of the below symptoms for at least two consecutive weeks?

 

  1. Low mood/Depressed mood/Sad mood nearly everyday for most of the day?
  2. Diminished interest or pleasure in all, or almost all, activities nearly everyday for most of the day?
  3. Significant weight changes (gain or loss of >5% of body weight in one month) or appetite changes?
  4. Sleep problems (e.g., insomnia, hypersomnia)?
  5. Psychomotor agitation or retardation (usually observed by others)?
  6. Fatigue or loss of energy?
  7. Feelings of worthlessness or excessive guilt?
  8. Concentration problems or indecisiveness?
  9. Thoughts of death? Suicidal thoughts?

 

If Yes: Major Depressive Episode. Screen for/Rule out  Mania and Hypomania (See Diagram “Rule Out Bipolar Disorder” Below)

 

If No: Screen for/Rule out Mania (See Diagram “Rule Out Bipolar Disorder” Below)

 

 

How to Rule out history of manic or hypomanic episodes:

 

Investigate Further:

 

If drug use was not present during the period of elevated/euphoric/irritable mood, did the patient have three (3) or more of the following additional symptoms?

  1. Inflated self esteem
  2. Decrease need for sleep (e.g. feels rested after only 3 hours of sleep)
  3. More talkative than usual or pressure to keep talking
  4. Flight of ideas or racing thoughts
  5. Increased goal-directed activities (socially, work related, school, sexual) or agitation 
  6. Easily distracted
  7. High risk behaviors/activities (e.g., speeding, buying sprees, sexual indiscretions, foolish business investments)

 

NOTE: If Bipolar Disorder is diagnosed, avoid starting antidepressants.

 

Click here below for Evidence Based Treatment of Bipolar Disorder

 

Depression Treatment Algorithm:

 

References:

 

  1. Puzantian, T., & Carlat, D. J. (2016). Medication fact book: for psychiatric practice. Newburyport, MA: Carlat Publishing, LLC.
  2. J. Ferrando, J. L. Levenson, & J. A. Owen (Eds.), Clinical manual of psychopharmacology in the medically ill(pp. 3-38). Arlington, VA, US: American Psychiatric Publishing, Inc.
  3. Schatzberg, A. F., & DeBattista, C. (2015). Manual of clinical psychopharmacology. Washington, DC: American Psychiatric Publishing.
  4. Schatzberg, A. F., & Nemeroff, C. B. (2017). The American Psychiatric Association Publishing textbook of psychopharmacology. Arlington, VA: American Psychiatric Association Publishing.
  5. Stahl, S. M. (2014). Stahl’s essential psychopharmacology: Prescriber’s guide (5th ed.). New York, NY, US: Cambridge University Press.
  6. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY, US: Cambridge University Press.
  7. Whalen, K., Finkel, R., & Panavelil, T. A. (2015). Lippincotts illustrated reviews: pharmacology. Philadelphia, PA: Wolters Kluwer.
  8. Stern, T. A., Freudenreich, O., Fricchione, G., Rosenbaum, J. F., & Smith, F. A. (2018). Massachusetts General Hospital handbook of general hospital psychiatry. Edinburgh: Elsevier.
  9. McCarron, Robert M., et al. Lippincotts Primary Care Psychiatry: for Primary Care Clinicians and Trainees, Medical Specialists, Neurologists, Emergency Medical Professionals, Mental Health Providers, and Trainees. Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009.
  10. Levenson, J. L. (2019). The American Psychiatric Association Publishing textbook of psychosomatic medicine and consultation-liaison psychiatry. Washington, D.C.: American Psychiatric Association Publishing.

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