Pocket ObGyn – Depression and Psychiatric Disease Screening
See Abbreviations
Definitions
- Major depression criteria: Depressed mood or anhedonia + 5 or more of the following sx present most of the day for nearly every day of 2 consecutive weeks: Depressed mood, anhedonia, insomnia/hypersomnia, change in appetite/wt, psychomotor retardation/agitation, low energy, poor conc, thoughts of worthlessness or guilt, recurrent thoughts of death or Remember, SIGE CAPS: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicide.
- Bipolar d/o: Includes both manic episodes (distinct periods of abnormally & persistently elevated, expansive, or irritable mood, lasting at least 1 w) & depressive
- Dysthymia: Depressed mood for at least 2 y w/ less numerous sx than major May have symptom-free periods of <2 mo during this time.
- Adjustment d/o: Depressed mood or functional impairment in resp to an identifiable stressor w/i 3 mo of onset of the stressor & resolved w/i 6
Epidemiology
- 17% lifetime prevalence for major depression, 3% for dysthymia in 40% recurrence rate in 2 y. 25–50% of people w/ bipolar dz attempt suicide.
- Women almost twice as likely as men to be
- Risks: Internalizing factors (genetics, neuroticism, low self-esteem, early-onset anxiety d/o, past h/o major depression), externalizing factors (genetics, substance misuse, conduct d/o), adversity (trauma, stressful life events, parental loss, low parental warmth, divorce, marital problems, low social support, low education).
Diagnostic Workup/Studies (Psychiatry Res 2011;187:130)
- Screening (2-item tool): “During the last month, have you felt down, depressed, or hopeless?” & “During the last month, have you felt little interest or pleasure in doing things?” PHQ-9: Assesses 9 sx of DMS-IV-TR definition of
- EPDS: Validated for postpartum depression
Treatment and Medications
- Screen for bipolar dz & manic sx prior to initiating therapy for
- Psychotherapy: Similar efficacy to pharmacotherapy. Includes cognitive therapy, behavioral therapy, & interpersonal
- Pharmacotherapy: 50–60% response w/ med (SSRIs, SNRIs, TCAs, MAOIs).
SSRIs are 1st-line therapy. Start low dose & as necessary to minimize side effects. Evaluate pts every 1–2 w in the 1st 8 w of therapy. If no resp in 8 w switch to another antidepressant.
- Refer if sev depression endangering the life of the pt or Failed to respond to initial rxs. Psychotic depression. Depression that is part of bipolar or schizoaffective d/o.