Depression

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Background

Clinical Features

Must have 5 of the following features for major depressive disorder for >2 wks[1]

  • Depressed mood or anhedonia (must be present)
  • SIGECAPS
    • Sleep decreased (Insomnia with 2-4 am awakening)
    • Interest decreased in activities
    • Guilt or worthlessness (Not a major criteria)
    • Energy decreased
    • Concentration difficulties
    • Appetite disturbance or weight loss
    • Psychomotor retardation/agitation
    • Suicidal thoughts

Differential Diagnosis

General Psychiatric

Evaluation

Depression screening with PHQ-9, the PHQ-2, the Beck Depression Inventory for Primary Care, and the WHO-5

General ED Psychiatric Workup

Management

  • Consult with psychiatric team
  • Pharmocologic agents, typically not started in ED due to need for monitoring and adjustment
    • SSRIs (citalopram, fluoxetine, paroxetine, sertraline)
    • SNRIs (duloxetine, venlafaxine, milnacipran)
    • Serotonin modulators (trazodone)
    • Atypical (bupropion, mirtazpine)
    • TCAs (amitriptyline, clomipramine, desipramine, doxepin, imipramine, nortriptyline, trimipramine)
    • MAOIs (isocarboxazid, phenelzine, selegiline)

Disposition

See Also

External Links

Screening test for depression

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.