Persistent low mood, anhedonia and reduced energy ≥2 weeks causing functional impairment.
Clinical features
- • Core: low mood, anhedonia, low energy
- • Cognitive: guilt, hopelessness, suicidal ideation
- • Biological: sleep, appetite, libido, diurnal variation
Investigations
- • PHQ-9 severity
- • Exclude organic: TFT, B12/folate, glucose
- • Risk assessment (suicide, self-neglect)
Management
- • Mild: guided self-help, CBT
- • Moderate-severe: SSRI (sertraline first-line) + psychological therapy
- • Severe / refractory: SNRI, mirtazapine, ECT if psychotic / catatonic
- • Safety plan, crisis contacts
Complications
- • Suicide
- • Self-neglect
- • Substance misuse
- • Functional impairment
Clinical pearls
- • Check QTc with citalopram >40 mg / elderly
- • Serotonin syndrome with multiple serotonergic agents
Educational — verify locally.
