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Symptoms and Signs – Differential Diagnosis of Depression
Depression is a mood condition marked by feelings of sadness, despair,and loss of interest or pleasure in activities. These sensations may be accompanied by somatic problems, such as changes in appetite, sleep disruptions, restlessness or lethargy, and impaired focus. Thoughts of hurting one’s self, death, or suicide may also occur.
Clinical depression should be differentiated from "the blues," which refer to occasional episodes of dysphoria that are less long-lasting and intense than the established clinical condition. The criterion for major depression is one or more episodes of low mood, or diminished interest or the ability to take pleasure in all or most activities, lasting at least 2 weeks.
An estimated 20.9 million Americans (9.5%) experience major depression annually. Approximately 12 million women (12%), 6 million men (7%), and 3 million adolescents (4%) experience depression each year. It affects all racial, ethnic, and socioeconomic categories, and it is twice as common in women as in men. It is the top cause of disability of women and men of all ages in the United States and internationally. The causes of depression are multifaceted, encompassing genetic and familial predisposition, medical and psychiatric diseases, and the consumption of specific medications. It can also occur in the postpartum period. Thorough psychiatric and physical examination should be performed to rule out any medical underlying factors.
History and Physical Examination
During the assessment, determine how the patient feels about herself, her family, and her environment. The objective is to investigate the manifestation of her depression, the degree to which other variables influence it, and her coping strategies and their efficacy. Begin by inquiring about her current concerns. How does her current mood differ from her regular mood? Then, ask her to express the way she feels about herself. What are her prospects and aspirations? In what degree are they realistic? Is she generally content with what she has accomplished in her work, relationships, and other interests? Inquire about any alterations in her social contacts, sleep patterns, eating, regular activities, or cognitive competence in decision-making and concentration. Determine trends of drug and alcohol use. Listen for signals that she may be suicidal. (See Suicide: Caring for the High-Risk Patient.)
Ask the patient about her family — its patterns of interaction and characteristic responses to success and disappointment. What role does she perceive herself to have in her family life? Find out if other family members have been depressed and whether someone important to the patient has been sick or has died in the past year. Finally, inquire about the patient's surroundings. Has her lifestyle undergone any changes throughout the the last month? Six months? Calendar year? When she’s feeling blue, where does she go and what does she do to feel better? Ascertain her sentiments regarding her position within the community and the various resources at her disposal. Evaluate whether she has a sufficient support system to assist her in managing her depression.
Medical Causes
Organic diseases
Various organic ailments and chronic illnesses create mild, moderate, or severe depression. Among these are metabolic and endocrine disorders, such as hypothyroidism, hyperthyroidism, and diabetes; infectious diseases, such as influenza, hepatitis, and encephalitis; degenerative diseases, such as Alzheimer’s disease, multiple sclerosis, and multi-infarct dementia; and neoplastic disorders such as cancer.
Psychiatric disorders
Affective disorders are often characterized by sudden mood swings from sadness to exaltation (mania) or by extended periods of either mood. In fact, severe depression may continue for weeks. More mild depression occurs in cyclothymic diseases and frequently alternates with moderate mania. Prolonged and consistent moderate depression over a period of two years usually arises from dysthymic disorders. In addition, several persistent anxiety disorders, such panic and obsessive-compulsive disorder, may coexist with depression.
Alcohol abuse.
Long-term alcohol use, intoxication, or withdrawal commonly produces depression.
Drugs
Various drugs cause depression as an adverse effect. Among the more common are barbiturates; chemotherapeutic drugs, such as asparaginase; anticonvulsants, such as diazepam; and antiarrhythmics, such as disopyramide. Other depression-inducing drugs include centrally acting antihypertensives, such as reserpine (common in high dosages), methyldopa, and clonidine; beta-adrenergic blockers, such as propranolol; levodopa; indomethacin; cycloserine; corticosteroids; and hormonal contraceptives.
Postpartum period
Although the cause hasn’t been proved, depression occurs in about 1 in every 2,000 to 3,000 pregnancies and is characterized by various symptoms. Symptoms range from mild postpartum blues to an intense, suicidal, depressive psychosis.
Special Considerations
Caring for a depressed patient needs time, tact, and energy. It also takes a knowledge of your own vulnerability to sentiments of despair that can come from engaging with a depressed patient. Assist the patient in establishing attainable objectives; facilitate her development of self-esteem by expressing her viewpoints and exercising autonomy in decision-making. Try to evaluate her suicide potential, and take steps to help secure her safety. The patient may require strict observation to prevent a suicide attempt.
Ensure that the patient is provided with sufficient sustenance and relaxation, while maintaining a stress-free and stimulating living environment. Arrange for ordered diagnostic tests to evaluate if her depression has an organic basis, and deliver recommended medicines. Additionally, schedule a follow-up counseling session or reach out to a mental health specialist for direct referral.
Patient Counseling
Education the patient about depression; underscore the existence of efficacious interventions to alleviate symptoms. Reassure the patient that she may help to ease depression by expressing her thoughts, engaging in joyful activities, and enhancing her grooming and cleanliness. Stress the significance of compliance with antidepressant drugs, and evaluate adverse effects.
Guidelines for Pediatrics
Because emotional lability is natural throughout adolescence, depression can be difficult to measure and diagnose in teenagers. Manifestations of underlying depression may encompass physical symptoms, sexual promiscuity, academic underachievement, and substance misuse.
Using a family systems model typically helps establish the etiology of depression in adolescents. Once family roles have been established, counseling sessions with family members or group therapy with peers might assist the patient in overcoming her depression. In instances of great severity, the use of an antidepressant may be necessary.
Guidelines for Geriatrics
The diagnosis of depression in elderly people is often challenging due to the presence of physical disorders, somatic symptoms, restlessness, or alterations in cognitive function, such as memory impairment. Depressed older individuals at most risk for suicide are those who are aged 85 and older, have low self-esteem, and need to be in control. Even a feeble nursing home resident with these traits may have the strength to murder herself.
Depression is a mood condition marked by feelings of sadness, despair,and loss of interest or pleasure in activities. These sensations may be accompanied by somatic problems, such as changes in appetite, sleep disruptions, restlessness or lethargy, and impaired focus. Thoughts of hurting one’s self, death, or suicide may also occur.
Clinical depression should be differentiated from "the blues," which refer to occasional episodes of dysphoria that are less long-lasting and intense than the established clinical condition. The criterion for major depression is one or more episodes of low mood, or diminished interest or the ability to take pleasure in all or most activities, lasting at least 2 weeks.
An estimated 20.9 million Americans (9.5%) experience major depression annually. Approximately 12 million women (12%), 6 million men (7%), and 3 million adolescents (4%) experience depression each year. It affects all racial, ethnic, and socioeconomic categories, and it is twice as common in women as in men. It is the top cause of disability of women and men of all ages in the United States and internationally. The causes of depression are multifaceted, encompassing genetic and familial predisposition, medical and psychiatric diseases, and the consumption of specific medications. It can also occur in the postpartum period. Thorough psychiatric and physical examination should be performed to rule out any medical underlying factors.
History and Physical Examination
During the assessment, determine how the patient feels about herself, her family, and her environment. The objective is to investigate the manifestation of her depression, the degree to which other variables influence it, and her coping strategies and their efficacy. Begin by inquiring about her current concerns. How does her current mood differ from her regular mood? Then, ask her to express the way she feels about herself. What are her prospects and aspirations? In what degree are they realistic? Is she generally content with what she has accomplished in her work, relationships, and other interests? Inquire about any alterations in her social contacts, sleep patterns, eating, regular activities, or cognitive competence in decision-making and concentration. Determine trends of drug and alcohol use. Listen for signals that she may be suicidal. (See Suicide: Caring for the High-Risk Patient.)
Ask the patient about her family — its patterns of interaction and characteristic responses to success and disappointment. What role does she perceive herself to have in her family life? Find out if other family members have been depressed and whether someone important to the patient has been sick or has died in the past year. Finally, inquire about the patient's surroundings. Has her lifestyle undergone any changes throughout the the last month? Six months? Calendar year? When she’s feeling blue, where does she go and what does she do to feel better? Ascertain her sentiments regarding her position within the community and the various resources at her disposal. Evaluate whether she has a sufficient support system to assist her in managing her depression.
Medical Causes
Organic diseases
Various organic ailments and chronic illnesses create mild, moderate, or severe depression. Among these are metabolic and endocrine disorders, such as hypothyroidism, hyperthyroidism, and diabetes; infectious diseases, such as influenza, hepatitis, and encephalitis; degenerative diseases, such as Alzheimer’s disease, multiple sclerosis, and multi-infarct dementia; and neoplastic disorders such as cancer.
Psychiatric disorders
Affective disorders are often characterized by sudden mood swings from sadness to exaltation (mania) or by extended periods of either mood. In fact, severe depression may continue for weeks. More mild depression occurs in cyclothymic diseases and frequently alternates with moderate mania. Prolonged and consistent moderate depression over a period of two years usually arises from dysthymic disorders. In addition, several persistent anxiety disorders, such panic and obsessive-compulsive disorder, may coexist with depression.
Alcohol abuse.
Long-term alcohol use, intoxication, or withdrawal commonly produces depression.
Drugs
Various drugs cause depression as an adverse effect. Among the more common are barbiturates; chemotherapeutic drugs, such as asparaginase; anticonvulsants, such as diazepam; and antiarrhythmics, such as disopyramide. Other depression-inducing drugs include centrally acting antihypertensives, such as reserpine (common in high dosages), methyldopa, and clonidine; beta-adrenergic blockers, such as propranolol; levodopa; indomethacin; cycloserine; corticosteroids; and hormonal contraceptives.
Postpartum period
Although the cause hasn’t been proved, depression occurs in about 1 in every 2,000 to 3,000 pregnancies and is characterized by various symptoms. Symptoms range from mild postpartum blues to an intense, suicidal, depressive psychosis.
Special Considerations
Caring for a depressed patient needs time, tact, and energy. It also takes a knowledge of your own vulnerability to sentiments of despair that can come from engaging with a depressed patient. Assist the patient in establishing attainable objectives; facilitate her development of self-esteem by expressing her viewpoints and exercising autonomy in decision-making. Try to evaluate her suicide potential, and take steps to help secure her safety. The patient may require strict observation to prevent a suicide attempt.
Ensure that the patient is provided with sufficient sustenance and relaxation, while maintaining a stress-free and stimulating living environment. Arrange for ordered diagnostic tests to evaluate if her depression has an organic basis, and deliver recommended medicines. Additionally, schedule a follow-up counseling session or reach out to a mental health specialist for direct referral.
Patient Counseling
Education the patient about depression; underscore the existence of efficacious interventions to alleviate symptoms. Reassure the patient that she may help to ease depression by expressing her thoughts, engaging in joyful activities, and enhancing her grooming and cleanliness. Stress the significance of compliance with antidepressant drugs, and evaluate adverse effects.
Guidelines for Pediatrics
Because emotional lability is natural throughout adolescence, depression can be difficult to measure and diagnose in teenagers. Manifestations of underlying depression may encompass physical symptoms, sexual promiscuity, academic underachievement, and substance misuse.
Using a family systems model typically helps establish the etiology of depression in adolescents. Once family roles have been established, counseling sessions with family members or group therapy with peers might assist the patient in overcoming her depression. In instances of great severity, the use of an antidepressant may be necessary.
Guidelines for Geriatrics
The diagnosis of depression in elderly people is often challenging due to the presence of physical disorders, somatic symptoms, restlessness, or alterations in cognitive function, such as memory impairment. Depressed older individuals at most risk for suicide are those who are aged 85 and older, have low self-esteem, and need to be in control. Even a feeble nursing home resident with these traits may have the strength to murder herself.
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