Diagnosis and Treatment of Major Depressive Disorder
While keeping in mind that depression is often not reported to physicians, ask your patients about their mood and energy and listen for the symptoms of depression. If you suspect that your patient is depressed, the next step is a thorough diagnostic evaluation. A good diagnostic evaluation will include a complete history of symptoms, for example: when they started, how long they have lasted, how severe they are, whether the patient had them before and, if so, whether the symptoms were treated and what treatment was given. Physicians should ask about alcohol and drug use, and if the patient has thoughts about death or suicide. A history should also include questions about whether other family members have had a depressive illness and, if treated, what treatments they may have received and which were effective.
A diagnostic evaluation for depression should include a physical examination by a physician. It is important to note that certain medications such as antihypertensives, H2 blockers, oral contraceptives and corticosteroids and as some medical conditions such as thyroid conditions, viral infections, hepatitis and other chronic medical conditions often mimic the symptoms of depression. A physician should rule out these possibilities through examination, interview, and lab tests.
Last, a diagnostic evaluation should include a mental status examination to determine if thinking memory have been affected, as sometimes happens in the case of a chronic depressive or manic-depressive illness.
Treatment choice will depend on the outcome of the evaluation. There are a variety of antidepressant medications and psychotherapies that can be used to treat MDD. Research indicates that mild to moderate MDD can often be treated successfully with either medication or psychotherapy. However, severe MDD appears more likely to respond to a combination of psychotherapy and medication. Depending on the patient's diagnosis and severity of symptoms, the therapist may prescribe medication and/or one of the several forms of psychotherapy that have proven effective for MDD.
Research shows that MDD is often comorbid with other disorders, most often anxiety disorders and substance dependence/abuse. Many people with MDD abuse alcohol and/or drugs, in unsuccessful attempts to cope their symptoms. Appropriate diagnosis and treatment of other disorders such as substance abuse or anxiety are important to successfully treat MDD.
For more detailed information about the assessment and treatment of MDD and bipolar disorder, please consult one of the following practice guidelines: