eMedicine Specialties > Psychiatry > Adult

Depression: Differential Diagnoses & Workup

Author: Ravinder N Bhalla, MD, Assistant Clinical Professor of Child Psychiatry, University of Medicine and Dentistry of New Jersey; Medical Director, Mental Health Clinic of Passaic; Consulting Staff, Christian Health Care Center
Coauthor(s): Pascale Moraille-Bhalla, MD, Medical Director, Outpatient Clinic of Hoboken University Medical Center; Staff Psychiatrist, Mental Health Clinic of Passaic; Sarah C Aronson, MD, Associate Professor, Departments of Psychiatry and Medicine, Case Western Reserve School of Medicine/University Hospitals of Cleveland
Contributor Information and Disclosures

Updated: May 26, 2009

Differential Diagnoses

Adjustment Disorders
Obsessive-Compulsive Disorder
Alcoholism
Opioid Abuse
Anemia
Panic Disorder
Anorexia Nervosa
Personality Disorders
Anxiety Disorders
Phobic Disorders
Apnea, Sleep
Porphyria, Acute Intermittent
Bipolar Affective Disorder
Posttraumatic Stress Disorder
Bulimia
Premenstrual Dysphoric Disorder
Cannabis Compound Abuse
Primary Hypersomnia
Chronic Fatigue Syndrome
Primary Insomnia
Cushing Syndrome
Prolactinoma
Dissociative Disorders
Schizoaffective Disorder
Dysthymic Disorder
Schizophrenia
Graves Disease
Schizophreniform Disorder
Hashimoto Thyroiditis
Sedative, Hypnotic, Anxiolytic Use Disorders
Hypercalcemia
Sleep Disorder, Geriatric
Hyperparathyroidism
Somatoform Disorders
Hyperthyroidism
Stimulants
Hypochondriasis
Suicide
Hypoglycemia
Syphilis
Hypopituitarism (Panhypopituitarism)
Systemic Lupus Erythematosus
Hypothyroidism
Thyroiditis, Subacute
Insomnia
Vascular Dementia
Lyme Disease
Wernicke-Korsakoff Syndrome
Menopause

Other Problems to Be Considered

Dementia due to HIV disease
Thyrotoxicosis

Workup

Laboratory Studies

No diagnostic laboratory tests are available for diagnosis of major depressive disorder. Based on the clinical history and physical findings, focused laboratory studies are useful in excluding potential medical illnesses that may present as major depressive disorder. These might include the following:

  • CBC count
  • Thyroid-stimulating hormone (TSH)
  • Antinuclear antibody (ANA)
  • Erythrocyte sedimentation rate (ESR)
  • Vitamin B-12
  • Rapid plasma reagin (RPR)
  • HIV test
  • Electrolytes and calcium levels and renal function test
  • Liver function tests
  • Blood alcohol, blood, and urine toxicology screen
  • ABG
  • Dexamethasone suppression test (Cushing disease)
  • Cosyntropin stimulation test (Addison disease)

Imaging Studies

  • CT scan or MRI of the brain

Other Tests

  • EEG

Procedures

  • Lumbar puncture for VDRL, Lyme antibody, cell count, chemistry, and protein electrophoresis

More on Depression

Overview: Depression
Differential Diagnoses & Workup: Depression
Treatment & Medication: Depression
Follow-up: Depression
References

References

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  2. Ansorge MS, Hen R, Gingrich JA. Neurodevelopmental origins of depressive disorders. Curr Opin Pharmacol. Feb 2007;7(1):8-17. [Medline].

  3. Sheikh RM, Weller EB, Weller RA. Prepubertal depression: diagnostic and therapeutic dilemmas. Curr Psychiatry Rep. Apr 2006;8(2):121-6. [Medline].

  4. Spitz R. Anaclitic depression: An inquiry into the genesis of psychiatric conditions in early childhood. Psychoanalytic Study of the Child. 1946;Vol 2:313-342.

  5. Agency for Healthcare Research and Quality. Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression. AHRQ: Agency for Healthcare Research and Quality. Available at http://effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=rr&ProcessID=7%20&DocID=61. Accessed May 18, 2009.

  6. Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. Nov 2006;163(11):1905-17. [Medline].

  7. Berman RM, Marcus RN, Swanink R, McQuade RD, Carson WH, Corey-Lisle PK. The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a multicenter, randomized, double-blind, placebo-controlled study. J Clin Psychiatry. Jun 2007;68(6):843-53. [Medline].

  8. Hirschfeld RM, Williams JB, Spitzer RL, Calabrese JR, Flynn L, Keck PE Jr, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry. Nov 2000;157(11):1873-5. [Medline].

  9. Solomon DA, Leon AC, Maser JD, Truman CJ, Coryell W, Endicott J. Distinguishing bipolar major depression from unipolar major depression with the screening assessment of depression-polarity (SAD-P). J Clin Psychiatry. Mar 2006;67(3):434-42. [Medline].

  10. Sachs GS. Program and abstracts of the 58th Institute on Psychiatric Services Annual Meeting. The systematic treatment enhancement program for bipolar disorder (STEP-BD): recent findings and their implications. 2006:Symposium 13.

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  16. Elkin I, Shea MT, Watkins JT, et al. National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. Arch Gen Psychiatry. Nov 1989;46(11):971-82; discussion 983. [Medline].

  17. Katon W, Von Korff M, Lin E, et al. Collaborative management to achieve treatment guidelines. Impact on depression in primary care. JAMA. Apr 5 1995;273(13):1026-31. [Medline].

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  19. [Best Evidence] Marcus RN, McQuade RD, Carson WH, Hennicken D, Fava M, Simon JS. The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a second multicenter, randomized, double-blind, placebo-controlled study. J Clin Psychopharmacol. Apr 2008;28(2):156-65. [Medline].

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Further Reading

Keywords

clinical depression, major depression, depression treatment, anxiety depression, major depressive disorder, MDD, unipolar depression, unipolar affective disorder, serotonin, norepinephrine, dopamine, selective serotonin reuptake inhibitors, SSRIs, tricyclic antidepressants, TCAs, norepinephrine, NE, dopamine, DA, suicide, suicidality, dysthymia, electroconvulsive therapy, ECT, electroshock therapy, shock therapy, light therapy

seasonal affective disorder, SAD, antidepressants, lithium, psychotherapy, cognitive behavioral therapy, CBT, neurasthenia, insomnia, hypersomnia, psychomotor agitation, psychomotor retardation, feelings of worthlessness, anhedonia, irritability, dementia of depression, pseudodementia, Parkinson disease, Huntington disease, multiple sclerosis, stroke, seizure disorders, systemiclupuserythematosus, SLE, autoimmune cerebritis, obstructive sleep apnea, syphilis, Lyme disease, HIV encephalopathy, Addison disease, Cushing disease, hyperthyroidism, hypothyroidism, prolactinomas

hyperparathyroidism, alcohol abuse, cocaine abuse, amphetamines abuse, marijuana abuse, narcotics abuse, inhalant abuse, bright light therapy, anxiety disorders, panic disorder, obsessive-compulsive disorder, generalized anxiety disorder, posttraumatic stress disorder, phobia, eating disorders, bulimia, anorexia nervosa, psychosis, organic brain syndrome, hopelessness, psychosocial stress, chronic pain

Contributor Information and Disclosures

Author

Ravinder N Bhalla, MD, Assistant Clinical Professor of Child Psychiatry, University of Medicine and Dentistry of New Jersey; Medical Director, Mental Health Clinic of Passaic; Consulting Staff, Christian Health Care Center
Ravinder N Bhalla, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry
Disclosure: Bristol Meyer Squib Honoraria Speaking and teaching; Astrazeneca Honoraria Speaking and teaching

Coauthor(s)

Pascale Moraille-Bhalla, MD, Medical Director, Outpatient Clinic of Hoboken University Medical Center; Staff Psychiatrist, Mental Health Clinic of Passaic
Pascale Moraille-Bhalla, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: Nothing to disclose.

Sarah C Aronson, MD, Associate Professor, Departments of Psychiatry and Medicine, Case Western Reserve School of Medicine/University Hospitals of Cleveland
Sarah C Aronson, MD is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

Medical Editor

Barry I Liskow, MD, Professor of Psychiatry, Vice Chairman, Psychiatry Department, Director, Psychiatric Residency Program, University of Kansas School of Medicine; Director, Psychiatric Outpatient Clinic, The University of Kansas Medical Center
Barry I Liskow, MD is a member of the following medical societies: American Academy of Clinical Psychiatrists, American Academy of Psychiatrists in Alcoholism and Addictions, American Medical Association, American Psychiatric Association, and Research Society on Alcoholism
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Iqbal Ahmed, MBBS, Professor, Department of Psychiatry, John A Burns School of Medicine, University of Hawaii
Iqbal Ahmed, MBBS is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Speaking and teaching; Northstar Grant/research funds Research; Novartis Grant/research funds research; Pfizer  Speaking and teaching; Sanofi-avetis Grant/research funds research; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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