≥2 weeks of depressed mood or anhedonia + ≥4 SIGECAPS symptoms causing impairment (DSM-5).
Clinical features
- • Low mood, anhedonia
- • Sleep / appetite / weight change
- • Fatigue, ↓concentration
- • Guilt, hopelessness
- • Suicidal ideation
Investigations
- • PHQ-9
- • Risk assessment
- • Exclude organic: TFT, B12, glucose
Diagnosis
- • DSM-5 / ICD-11 criteria
Differential diagnosis
- • Bipolar depression
- • Adjustment disorder
- • Hypothyroidism
- • Substance-induced
- • Dementia (pseudodementia)
Management
- • Mild: guided self-help, CBT
- • Moderate–severe: SSRI + CBT
- • Severe / treatment-resistant: ECT, augmentation
Drug therapy
- • Sertraline 50 mg OD (start)
- • Mirtazapine 15 mg nocte if insomnia/weight loss
- • Avoid stopping abruptly — discontinuation syndrome
Complications
- • Suicide
- • Functional decline
- • Substance misuse
Clinical pearls
- • Reassess at 2 weeks, full response at 6–8 weeks
- • Always assess suicide risk + collateral history
Related in WardRound
Educational — verify locally.
