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Major Depression

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  1. See Also
    1. Dysthymic Disorder
    2. Seasonal Depression
    3. Atypical Depression
    4. Bipolar Disorder
    5. Suicide
    6. Athletes with Depression
    7. Antepartum Depression
    8. Postpartum Depression
  2. Epidemiology
    1. Lifetime depression Incidence: 25%
    2. Depression Prevalence: 6%
    3. Age of Peak Incidence: 55 to 65 years old
    4. Women have higher risk of depression
    5. Men have higher completed Suicide rate
    6. Family History: Twin concordance
      1. Monozygotic twins: 75%
      2. Dizygotic twins: 38%
    7. Depression is missed in elderly and nursing homes
      1. Brown (2002) J Am Geriatr Soc 50:69
  3. Risk Factors for Depression
    1. Prior episodes of depression
    2. Prior Suicide attempts
    3. Age under 40 years old
    4. Comorbid medical condition
    5. Stressful life events
    6. Family History of depression
    7. Female sex
    8. Recent childbirth
    9. Lack of social support
    10. Current Chemical Dependency or Substance Abuse
  4. Differential Diagnosis
    1. See Major Depression Differential Diagnosis
  5. Medical Conditions Predisposing to Depression
    1. Alzheimer's Disease or other Dementia
    2. Cancer
    3. Chronic Fatigue Syndrome
    4. Chronic Pain Syndrome
    5. Coronary Artery Disease
    6. Crohn's Disease
    7. Medications Predisposing to Depression
    8. Diabetes Mellitus
    9. Fibromyalgia
    10. Parkinson's Disease
    11. Cerebrovascular Accident (CVA)
  6. Evaluation
    1. Evaluate for Suicide Risk
    2. Screening Tools
      1. See Depression Screening with SALSA
      2. See Depression Screening with SIG E CAPS
      3. Beck Depression Inventory
      4. Zung Self-Rating Depression Scale
      5. Hamilton Depression Scale
      6. Mazmanian Mania-Depression Mood Scale
  7. Diagnosis
    1. Major Depression Diagnosis
  8. Labs
    1. Thyroid Stimulating Hormone (TSH)
    2. Hemoglobin
    3. Consider additional lab studies
      1. Liver Function Tests
      2. Urinalysis
  9. Comorbid Conditions (Differentiate or Integrate)
    1. Major Depression
    2. Anxiety Disorder
    3. Panic Disorder
  10. 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
  11. Management
    1. See Suicide
    2. See Depression Management
    3. See Depression Medical Management
    4. See Refractory Depression Management
    5. See Depression Management Special Circumstances
  12. References
    1. (1994) DSM-IV, APA, p. 320-7
    2. Bhatia (1997) Am Fam Physician 55(5):1683
    3. Kuzel (1996) Postgrad Med 99(5):179

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