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Major Depressive Disorder – Definitions and Diagnosis

Depression is a broad and heterogeneous diagnosis. This slide deck offers opportunities to discuss the core definitions of Major Depressive Disorder (MDD) as well as a presentation of the key components of its diagnosis, signs and symptoms.

This slide deck has been developed in collaboration with the former Lundbeck International Neuroscience Foundation.

Index for slide deck

Definitions and diagnosis, definitions.

This slide shows core definitions for depression based on World Health Organization’s ICD-10 classification system or the American Psychiatric Association’s DSM-IV and DSM-5 system.

References: NICE CG90. Depression in adults: recognition and management. 2009. Update Apri…

Reference: American Psychiatric Association. Diagnostic and statistical manual of mental disorders 5th edition:  American Psychiatric Association. 2013

Depression is a clinically heterogeneous disorder

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- References: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Health Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

Jaeger J et al. Psychiatry Res 2006; 145:…

Cognitive symptoms of depression have a negative impact on many aspects of the patient’s life

References : McIntyre RS et al. Depress Anxiety 2013; 30(6): 515–527.

Hammar A, Ardal G. Front Hum Neurosci 2009; 3:26. doi: 10. 3389/neuro. 09. 026. 2009.

MDD symptoms – American Psychiatric Association

The American Psychiatric Association (APA) describes nine depressive symptoms for diagnostic purposes. [APA, 2013]

Depressed mood

• Patients may describe their mood as depressed, sad, hopeless, discouraged, or ‘down in the dumps’. [APA, 2013] Alternatively, the patient may d…

MDD symptoms – The Montgomery-Åsberg Depression Rating Scale

The Montgomery–Åsberg Depression Rating Scale (MADRS), which was designed to be sensitive to the effects of antidepressants, includes ten depressive symptoms, six of which are described as ‘core symptoms’. [Montgomery & Asberg, 1979; Bech et al., 2002]

MADRS item 1. Appare…

The course of MDD

This slide illustrates the typical course of illness for patients with depression. Discontinuing antidepressant treatment in the acute phase before full symptomatic remission drastically increases the likelihood of relapse of the original episode, and discontinuing treatm…

MDD is a complex, often recurrent and remitting disorder

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- Previous slide illustrates the typical course of illness for patients with depression; either receiving only acute-phase treatment or receiving longer-term treatment designed to prevent relapse. It also highlights…

Depression – signs and symptoms

The slide aims at giving a simple definition for the terms signs and symptoms. It also highlights that the criteria used in the diagnostic manuals cover all major signs and symptoms of depression.

Reference: Shivani, et al. Alcohol Research & Health. 2002;26:90-8

Definitions of epidemiological terms

The slide explains the difference between prevelance and incidence as key epidemiological terms. While prevalence is the number of persons with disease, in a given population, at a designated time, the incidence looks into the number of new persons with disease over a spe…

Definitions of burden of disease and key epidemiological terms

This slide gives definitions for key epidemiological terms used in studies to quantify the burden of a disease. Term defined are the Burden of disease (BoD), Quality adjusted life years (QALYs), Years of life lost (YLLs), Years lived with disability (YLDs), Disability adj…

Definitions of Clinical Course and Treatment Outcomes

References: Nierenberg et al. J Clin Psychiatry 2003; 64 (suppl 15): 13–17; page 13 (‘Remission, relapse, recurrence’ section).

Riso et al. J Affect Disord 1997; 43 (2): 131–142.

Nierenberg & DeCecco. J Clin Psychiatry 2001; 62 (suppl 16): 5–9; page 8.

Frank et al. Arch G…

MDD is a chronic disorder, most frequently characterised by relapses and recurrences. [Frank et al., 1991] Relapse can be defined as an episode of MDD that occurs within 6 months of response or remission; [Nierenberg & Petersen 2003; Riso et al., 1997] theoretically, relaps…

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Prof. Philip Gorwood, MD, PhD

Head of CMME, Hopital Sainte-Anne (Paris Descartes University) and head of team 1 (INSERM U894), Centre de Psychiatrie et de Neurosciences (CPN). 1

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• Page 1 of 3

What is depression?

• It is a medical illness that involves the mind and body.
• It is more than feeling blue, down in the dumps, or sad about a particular issue or situation.
• It interferes with a person’s function in daily living, relationship, and work life.
• It is a condition that requires diagnosis and treatment by a trained healthcare provider.

What is NOT depression?

• It is NOT a normal part of aging
• It is NOT something to be a shamed of
• It is NOT a character flaw or sign of weakness
• It is NOT something you can just “snap out of”

Who suffers from depression?

Depression is a common condition that affects

about 19 million American adults every year.

What are the symptoms of depression?

Why do people get depression?

There is no one single cause.

Depression happens because of a combination of things:

• Brain chemistry
• Environment and psychological factors
• Medical conditions / medications - Must rule out!

Two neurotransmitters involved in depression

Concentration

Depressed Mood

Irritability

Thought process

Norepinephrine

Vague Aches and pain

�Can a person have depression and another illness at the same time?

• Anxiety disorders, including
• post-traumatic stress disorder (PTSD),
• obsessive-compulsive disorder (OCD),
• panic disorder,
• social phobia,
• generalized anxiety disorder (GAD);
• Alcohol and other substance abuse or dependence;
• Medical problems, including
• heart disease,
• stroke, cancer,
• Parkinson's disease.

Different forms of depression

• Major Depressive Disorder
• Melancholic
• Dysthymic Disorder
• Double Depression
• Postpartum Depression
• Seasonal Affective Disorder

What are my treatment options?

• Psychotherapy
• Electroconvulsive therapy

Psychotherapy, aka “talk therapy”

• Best treatment for mild to moderate depression
• 2 main types:
• Cognitive-behavorial therapy
• Interpersonal therapy

Medications

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin & norepinephrine reuptake inhibitors (SNRIs)
• Monoamine oxidase inhibitors (MAOIs)

Electroconvulsive therapy (ECT)

• For severe cases in which therapy and/or medication does not treat depression
• Used to have a bad reputation and was known as “shock therapy”
• Today, ECT has greatly improved and has shown to help those who cannot feel better with other treatments

How can I find help?

• Talk to your family doctor
• Others who can help: Psychiatrists, psychologists, licensed social workers, or licensed mental health counselors, Health maintenance organizations, Community mental health centers, Hospital psychiatry departments and outpatient clinics, Mental health programs at universities or medical schools, State hospital outpatient clinics, Family services, social agencies or clergy, Peer support groups, Private clinics and facilities, Employee assistance programs, Local medical and/or psychiatric societies.

How can I afford treatment?

• Low-fee / sliding scales at some clinics or health centers

�What if I or someone I know is in crisis?

• Call your doctor.
• Call 911 or go to a hospital emergency room to get immediate help or ask a friend or family member to help you do these things.
• Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor.
• Make sure you or the suicidal person is not left alone.
• National Institute of Mental Health http://www.nimh.nih.gov/
• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders . �Fourth Edition,Text Revision. Washington, DC; American Psychiatric Association. 2000:345-356,489.

• Preferences

What is Depression? - PowerPoint PPT Presentation

What is Depression?

More than just being “sad” as we often mean when we use the word depression, it entails more than just one emotion. it is basically characterized by feeling sad, helpless, and hopeless. – powerpoint ppt presentation.

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Mental health (depression and anxiety) PowerPoint

Image by Brian D'Cruz Hypno Plus ( https://www.briandcruzhypnoplus.com/ )

Attribution Non-commercial ShareAlike

About This Lesson

A PowerPoint exploring depression and anxiety with links to you tube clips.

Like this PowerPoint on depression and anxiety?

Check out more free lesson plans and resources in Share My Lesson's Mental Health Collection .

Main Image by Brian D'Cruz Hypno Plus .

Positive_Mental_Attitudes_–_Lesson_2.ppt

Positive_Mental_Attitudes_Lesson.ppt

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Depression. Objectives. Background. Prevalence rates for depression: 1% to 2% of prepubertal children 3% to 8% of adolescents. Depression and bipolar disorder equally common in both sexes. Unipolar depressive disorders in teens more common in girls than in boys (ratio of 3:1)

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Presentation Transcript

Background • Prevalence rates for depression: • 1% to 2% of prepubertal children • 3% to 8% of adolescents. • Depression and bipolar disorder equally common in both sexes. • Unipolar depressive disorders in teens more common in girls than in boys (ratio of 3:1) • Early onset of puberty in girls increases the risk for depression.

Clinical Features & When to Consider Diagnosis • Sad, irritable, or angry • may present with school or behavioral problems • Somatic complaints • headache, stomachache, muscle weakness, decreased or increased appetite, fatigue, insomnia, hypersomnia, or disturbed sleep-wake cycles • Self-injurious behaviors or suicidal ideation, plan, and intent

Identifying Risk FactorsEnvironmental • Abuse or neglect • Parental substance abuse • Marital problems • Low socioeconomic status and education level • Loss of parent, sibling, or close friend • Stress related to adolescent developmental or issues of sexuality (eg, homosexuality)

Identifying Risk FactorsGenetic • Depressed parent contributes both genetic vulnerability & emotional unavailability that can contribute • combination of adverse life events and the presence of the shorter allelic form of the serotonin transporter gene results in early-onset depression • Smaller prefrontal cortex and basal ganglia in depressed individuals

Identifying Risk Factors • Medications • glucocorticoids, immunosuppressives, isotretinoin, antiviral agents • Chronic illness • such as cystic fibrosis, juvenile diabetes

DiagnosisThe Basic Steps • Are symptoms present? • Evaluate child’s current level of functioning relative to his or her baseline • Any potential for self-injurious behavior, suicidal ideation, or suicide attempt? • History taken from: • Patient • Parents • Others : teachers, counselors, or coaches.

DiagnosisTools • Children’s Depression Inventory (CDI) • assesses the severity of depression in prepubertal school-age children • Beck Depression Inventory (BDI) Reynolds Adolescent Depression Scale (RADS-2) • Mood and Feelings Questionnaire (MFQ) Adolescents

DiagnosisTools • The Guidelines for Adolescent Depression in Primary Care (GLAD-PC) Toolkit • Has child and parent report measures and scoring instructions on their web site http://www.thereachinstitute.org/files/documents/GLAD-PCToolkit.pdf • This user-friendly online resource also includes management flowcharts, scales, and educational materials in English and Spanish as well as tracking forms and information on billing

TreatmentPharmacological • Currently, fluoxetine (Prozac)is the only antidepressant approved by the FDA in children and adolescents • research studies have demonstrated efficacy of other drugs such as citalopram, paroxetine, and sertraline • Dosing of Fluoxetine • Starting at 2.5 mg/day for prepubertal children • 10 mg/day for older adolescents • Most patients respond to fluoxetine at doses ranging from 20 to 80 mg/day

TreatmentPharmacological • 2006 FDA meta-analysis of children and adolescents taking SSRIs for depression • found an increased risk of suicidality in those patients treated with drugs versus those given placebo. • Subsequent meta-analysis including additional studies revealed that those who benefited from SSRI treatment outnumbered those who became suicidal during SSRI treatment by a ratio of 14:1.

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Patient Case Presentation

Ms. A. M. is a 23 year old biracial female who arrives to her primary care clinic for her annual physical. Ms A.M. has had a 15lb weight gain since her last visit. She complains of feelings of guilt and sadness with her parents’ recent divorce. Patient states she is not sleeping well and feels that she cannot concentrate during her nursing orientation classes. When asked about her interpersonal relationships, she states that she just ended her two-year relationship with her boyfriend and she states that she hasn’t been able to meet new friends or keep up with current friendships.

Past Medical/Surgical History

• Asthma diagnosed at age 8
• Hypothyroidism diagnosed at age 16

Pertinent Family History

• Older sister with suicide attempt 3 years prior.
• Father diagnosed with Bipolar II in his thirties, currently taking medication.
• Mother alive and healthy at age 54
• Uncle with history of substance abuse

Pertinent Social History

• recently graduated college and is starting her career as a nurse at a large teaching hospital on the intensive care unit
• parents recently divorced
• moving out on her own for the first time