Diagnosis
Diagnosis is made clinically with help of validated tools like the PHQ-9
H&P:
-Common presentation:
-Clinical Manifestations
-Associated Conditions:
-Risk factors: Recent MI, significant, Medical Morbidities, Fam Hx, etc.
-Red flags.
-Complications:
Ddx & Etiology
Diagnostic studies: CBC, CMP, TSH, 25-Hydroxy Vit D.
Assess severity/acuity.
No SI/HI
PHQ-9 score:
GAD-7 Score:
Treatment
Refer to psychotherapy
SSRI – start low dose; instruct patient to increase to therapeutic dose in 2-3 weeks; be on the therapeutic dose for 2-3 weeks before f/u visit.
Problems discussed, alternative tx, as well as risks and benefits
F/u in 6 weeks
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MDD Pearls and Links
- Combining antidepressants: Can combine trazodone with SSRI for insomnia, etc.
- Mirtazapine (Remeron) will stimulate appetite. Use for a depressed patient who isn’t eating to stimulate appetite.
- Bupropion doesn’t cause ED side effects as all the SSRIs do. In fact, Bupropion can be given with SSRIs to help offset the side effects of ED.
- SNRIs increase HTN
- Citalopram and Escitalopram can prolong QT interval. Other SSRIs, SNRIs, Bupropion, Mirtazapine don’t prolong the QT.
- TCAs and Antipsychotics can prolong the QT interval as well.
**Child Psychiatrist Dr. Kallis checks vitamin D level in everybody with depression. Replacing it helps with mood.
She also checks vitamin D levels in all her ADHD patients.
References
DUNNER DL. Combining antidepressants. Shanghai Archives of Psychiatry. 2014;26(6):363-364. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311111/