depression

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Introduction

A mental state marked by feelings of despair, discouragement, & sadness.

* also see major depression & depression in the elderly

Etiology

* increasing use of drugs that list depression as possible adverse effect[82]

Epidemiology

  • 10-15% of general medical outpatients[17]
  • female/male ratio is about 2-3/1
  • lifetime incidence of major depression is ~20% in women & about ~12% in men[3]
  • prevalence of depression in reproductive age women
  • prevalence of antidepressant use in reproductive age women with depression
  • more common among blacks & Hispanics than whites
  • more common among middle-aged adults than among younger & older adults
  • individuals without health insurance more likely to be depressed than those with coverage[17]
  • common among resident physicians (29%)[58]
  • common in persons with medical disease[3]
  • disconnect of treatment & screening
    • 29% of adults who screen positive for depression receive treatment[71]
    • among adults treated for depression, only 30% screened positive for depression[71]

Pathology

  • resting leukocyte telomerase activity is elevated in major depression
    • pretreatment telomerase activity is directly correlated with depression ratings
    • lower pretreatment telomerase activity with relatively greater increase in telomerase activty during treatment correlates with better treatment response[23]
    • comment: difficult to envision a mechanism
  • the frontal-striatal network is expanded nearly twofold in the cortex of most individuals with depression[102]

Genetics

History

(self-report scales for depression)

Clinical manifestations

Diagnostic criteria

  • depression must be present for at least 2 weeks[47]

Laboratory

Diagnostic procedures

* changes in sleep also seen with aging; effects may be additive

Radiology

Complications

Differential diagnosis

Management

* 2nd line agents during pregnancy; monitor levels once each trimester[4]

  • Follow-up:
    • within 1 week of initial presentations
    • weekly or biweekly for 6 weeks
    • 3 times within 3 months, one face to face
    • monthly or bimonthly if patient improving
    • at least quarterly while patient still on anti-depressant medications

More general terms

More specific terms

Additional terms

References

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