Persistent low mood and/or anhedonia for ≥2 weeks with cognitive and somatic symptoms causing functional impairment.
Clinical features
- • Low mood most of the day
- • Anhedonia
- • Sleep and appetite change
- • Fatigue, poor concentration
- • Guilt, worthlessness, suicidal ideation
Investigations
- • PHQ-9 severity score
- • TFT, FBC, U&E, calcium, B12/folate, glucose to exclude organic cause
- • Risk assessment for self-harm and safeguarding
Differential diagnosis
- • Bipolar depression
- • Hypothyroidism
- • Anaemia
- • Substance misuse
- • Adjustment disorder
- • Dementia (pseudodementia)
Management
- • Mild: guided self-help, structured exercise, CBT
- • Moderate–severe: SSRI (sertraline 50 mg) plus psychological therapy
- • Review at 1–2 weeks (weekly if <30 y or suicide risk)
- • Continue for ≥6 months after remission
- • Switch or augment if no response by 4 weeks at adequate dose
- • ECT for life-threatening or psychotic depression
Clinical pearls
- • Always screen for past mania before starting an antidepressant
- • Warn about early increase in anxiety and suicidal thoughts
- • Taper antidepressants to avoid discontinuation syndrome
Related in WardRound
Educational — verify locally.
