Depression Workup

  • Author: Jerry L Halverson, MD; Chief Editor: David Bienenfeld, MD   more...
 
Updated: May 23, 2012
 

Approach Considerations

in ruling out other potential diagnoses. Depression screening tests can be valuable, with the most widely one used being the Patient Health Questionnaire-9 (PHQ-9). It is important to understand, however, that the results obtained from the use of any depression screening or rating scales do not diagnose depression and may be imperfect in any population, especially in elderly patients.

Next

Screening Tests

The U.S. Preventive Services Task Force (USPSTF) recommends screening adults for depression in clinical practices that can ensure proper management; the USPSTF found insufficient evidence to recommend for or against routine screening of children or adolescents for depression. It is important to understand that the results obtained from the use of any depression rating scales are imperfect in any population, especially the geriatric population.[81]

The simplest screening test is a single question: Are you depressed? A pooled analysis found that single-question screening had a specificity of 97% but an overall sensitivity of 32% and, thus, would identify only 3 of every 10 patients with depression in primary care.[82]

The following 2-question test addresses depressed mood and anhedonia:

  • During the past month, have you been bothered by feeling down, depressed, or hopeless?
  • During the past month, have you been bothered by little interest or pleasure in doing things?

In a cross-sectional study, these 2 screening questions showed a sensitivity of 97% and a specificity of 67%.[83]

Longer self-report screening instruments for depression include the following:

  • PHQ-9 – The 9-item depression scale of the Patient Health Questionnaire; each item is scored 0 to 3, providing a 0 to 27 severity score
  • Beck Depression Inventory (BDI) – A 21-question symptom-rating scale
  • BDI for primary care – A 7-question scale adapted from the BDI
  • Zung Self-Rating Depression Scale – A 20-item survey
  • Center for Epidemiologic Studies-Depression Scale (CES-D) – A 20-item instrument that allows patients to evaluate their feelings, behavior, and outlook from the previous week

In contrast to the above self-report scales, the Hamilton Depression Rating Scale (HDRS) is performed by a trained professional, not the patient. The HDRS has 17 or 21 items, scored from 0-2 or 0-4; a total score of 0-7 is considered normal, while scores of 20 or higher indicate moderately severe depression.

The Geriatric Depression Scale (GDS), although developed for older adults, has also been validated in younger adults. The GDS comprises 30 items; a short-form GDS has 15 items (see the images below).

Media file 2: Geriatric Depression Scale. Media file 2: Geriatric Depression Scale. Media file 3: Geriatric Depression Scale-Short. Media file 3: Geriatric Depression Scale-Short.

Given that the commonly atypical presentation of depression in the elderly population can challenge even the most experienced clinician, rating scales in the elderly should be used and interpreted only in the context of a more thorough examination for depression.

Patients with major depressive disorder often complain of poor memory or concentration. This may be due to the depression itself or to an underlying dementia.

In older patients with established dementia, the Cornell Scale for Depression in Dementia (see the image below) can be used to determine the category and severity of depression. The clinician completes the scale on the basis of prior observation and interviews with the patient and the patient’s caregiver.

Media file 6: Cornell Scale for Depression in DemeMedia file 6: Cornell Scale for Depression in Dementia.
Previous
Next

Laboratory Studies to Rule Out Organic Causes

Depression is a clinical diagnosis, based on the history and physical findings. No diagnostic laboratory tests are available to diagnose major depressive disorder, but focused laboratory studies may be useful to exclude potential medical illnesses that may present as major depressive disorder. These laboratory studies might include the following:

  • Complete blood cell (CBC) count
  • Thyroid-stimulating hormone (TSH)
  • Vitamin B-12
  • Rapid plasma reagin (RPR)
  • HIV test
  • Electrolytes, including calcium, phosphate, and magnesium levels
  • Blood urea nitrogen (BUN) and creatinine
  • Liver function tests (LFTs)
  • Blood alcohol level
  • Blood and urine toxicology screen
  • Arterial blood gas (ABG)
  • Dexamethasone suppression test (Cushing disease, but also positive in depression)
  • Cosyntropin (ACTH) stimulation test (Addison disease)
Previous
Next

Neuroimaging

Neuroimaging can help clarify the nature of the neurologic illness that may produce psychiatric symptoms, but these studies are costly and may be of questionable value in patients without discrete neurologic deficits. Computed tomography (CT) scanning or magnetic resonance imaging (MRI) of the brain should be considered if organic brain syndrome or hypopituitarism is included in the differential diagnosis.

Positron emission tomography (PET) imaging provides the means for the study of receptor binding of certain ligands and the effect a compound may have on receptors. However, PET scanning is problematic for use with children and adolescents because it requires complex equipment and uses radiation.

Using single-photon emission computed tomography (SPECT) scanning, Tutus et al reported significant differences between the perfusion index values of untreated adolescents with depression and those of control patients. The researchers found that adolescents with major depressive disorder may have regional blood flow deficits in the left anterofrontal and left temporal cortical regions, with greater right-left perfusion asymmetry than healthy control patients.[84]

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Jerry L Halverson, MD  Medical Director of Adult Services, Rogers Memorial Hospital; Voluntary Clinical Assistant Professor, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health; Clinical Assistant Professor of Psychiatry, Department of Psychiatry and Behavioral Sciences, Medical College of Wisconsin

Jerry L Halverson, MD is a member of the following medical societies: American College of Psychiatrists, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Coauthor(s)

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

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.

Chief Editor

David Bienenfeld, MD  Professor of Psychiatry, Vice-Chair and Director of Residency Training, Department of Psychiatry, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Additional Contributors

Iqbal Ahmed, MBBS, FRCPsych (UK) Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych (UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, American Psychiatric Association, American Society of Clinical Psychopharmacology, and Royal College of Psychiatrists

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

Disclosure: Nothing to disclose.

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

Disclosure: Nothing to disclose.

Mohammed A Memon, MD Chairman and Attending Geriatric Psychiatrist, Department of Psychiatry, Spartanburg Regional Medical Center

Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Art Walaszek, MD Associate Professor of Psychiatry, Residency Training Director, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health; Consulting Staff, University of Wisconsin Hospital and Clinics, Meriter Hospital

Art Walaszek, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Terra Nova Learning Systems, Inc. Consulting fee Consulting; Wisconsin Psychiatric Association Honoraria Speaking and teaching; Care Wisconsin, Inc. Honoraria Speaking and teaching

References

  1. Dunlop BW, Nemeroff CB. The role of dopamine in the pathophysiology of depression. Arch Gen Psychiatry. Mar 2007;64(3):327-37. [Medline].

  2. Alexopoulos GS. Depression in the elderly. Lancet. Jun 4-10 2005;365(9475):1961-70. [Medline].

  3. Mayberg HS, Liotti M, Brannan SK, McGinnis S, Mahurin RK, Jerabek PA, et al. Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness. Am J Psychiatry. May 1999;156(5):675-82. [Medline].

  4. Kempton MJ, Salvador Z, Munafò MR, Geddes JR, Simmons A, Frangou S, et al. Structural neuroimaging studies in major depressive disorder. Meta-analysis and comparison with bipolar disorder. Arch Gen Psychiatry. Jul 2011;68(7):675-90. [Medline].

  5. Sacher J, Neumann J, Fünfstück T, Soliman A, Villringer A, Schroeter ML. Mapping the depressed brain: A meta-analysis of structural and functional alterations in major depressive disorder. J Affect Disord. Sep 2 2011;[Medline].

  6. Rice F. Genetics of childhood and adolescent depression: insights into etiological heterogeneity and challenges for future genomic research. Genome Med. Sep 20 2010;2(9):68. [Medline]. [Full Text].

  7. Tsuang MT, Faraone SV. The genetics of mood disorders. Baltimore, MD: Johns Hopkins University Press, 1990.

  8. Abkevich V, Camp NJ, Hensel CH, Neff CD, Russell DL, et al. Predisposition locus for major depression at chromosome 12q22-12q23.2. Am J Hum Genet. Dec 2003;73(6):1271-81. [Medline]. [Full Text].

  9. Holmans P, Zubenko GS, Crowe RR, DePaulo JR Jr, Scheftner WA, Weissman MM, et al. Genomewide significant linkage to recurrent, early-onset major depressive disorder on chromosome 15q. Am J Hum Genet. Jun 2004;74(6):1154-67. [Medline]. [Full Text].

  10. Lohoff FW. Overview of the genetics of major depressive disorder. Curr Psychiatry Rep. Dec 2010;12(6):539-46. [Medline]. [Full Text].

  11. Caspi A, Sugden K, Moffitt TE, Taylor A, Craig IW, Harrington H, et al. Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science. Jul 18 2003;301(5631):386-9. [Medline].

  12. Zhang X, Gainetdinov RR, Beaulieu JM, Sotnikova TD, Burch LH, Williams RB, et al. Loss-of-function mutation in tryptophan hydroxylase-2 identified in unipolar major depression. Neuron. Jan 6 2005;45(1):11-6. [Medline].

  13. Garriock HA, Allen JJ, Delgado P, Nahaz Z, Kling MA, Carpenter L, et al. Lack of association of TPH2 exon XI polymorphisms with major depression and treatment resistance. Mol Psychiatry. Nov 2005;10(11):976-7. [Medline].

  14. Yamada K, Hattori E, Iwayama Y, Ohnishi T, Ohba H, Toyota T, et al. Distinguishable haplotype blocks in the HTR3A and HTR3B region in the Japanese reveal evidence of association of HTR3B with female major depression. Biol Psychiatry. Jul 15 2006;60(2):192-201. [Medline].

  15. Binder EB, Salyakina D, Lichtner P, Wochnik GM, Ising M, Pütz B, et al. Polymorphisms in FKBP5 are associated with increased recurrence of depressive episodes and rapid response to antidepressant treatment. Nat Genet. Dec 2004;36(12):1319-25. [Medline].

  16. Akiskal HS, Weller ES. Mood disorders and suicide in children and adolescents. In: Kaplan HI, Saddock BJ, eds. Comprehensive Textbook of Psychiatry. Vol 2. 5th ed. Lippincott Williams & Wilkins; 1989.

  17. Weissman MM, Leckman JF, Merikangas KR, Gammon GD, Prusoff BA. Depression and anxiety disorders in parents and children. Results from the Yale family study. Arch Gen Psychiatry. Sep 1984;41(9):845-52. [Medline].

  18. Nobile M, Begni B, Giorda R, Frigerio A, Marino C, Molteni M, et al. Effects of serotonin transporter promoter genotype on platelet serotonin transporter functionality in depressed children and adolescents. J Am Acad Child Adolesc Psychiatry. Nov 1999;38(11):1396-402. [Medline].

  19. Birmaher B, Kaufman J, Brent DA, Dahl RE, Perel JM, al-Shabbout M, et al. Neuroendocrine response to 5-hydroxy-L-tryptophan in prepubertal children at high risk of major depressive disorder. Arch Gen Psychiatry. Dec 1997;54(12):1113-9. [Medline].

  20. Blazer DG. Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci. Mar 2003;58(3):249-65. [Medline].

  21. Uhr M, Tontsch A, Namendorf C, Ripke S, Lucae S, Ising M, et al. Polymorphisms in the drug transporter gene ABCB1 predict antidepressant treatment response in depression. Neuron. Jan 24 2008;57(2):203-9. [Medline].

  22. Bishop JR, Moline J, Ellingrod VL, Schultz SK, Clayton AH. Serotonin 2A -1438 G/A and G-protein Beta3 subunit C825T polymorphisms in patients with depression and SSRI-associated sexual side-effects. Neuropsychopharmacology. Oct 2006;31(10):2281-8. [Medline].

  23. McMahon FJ, Buervenich S, Charney D, Lipsky R, Rush AJ, Wilson AF, et al. Variation in the gene encoding the serotonin 2A receptor is associated with outcome of antidepressant treatment. Am J Hum Genet. May 2006;78(5):804-14. [Medline]. [Full Text].

  24. Bruce ML. Psychosocial risk factors for depressive disorders in late life. Biol Psychiatry. Aug 1 2002;52(3):175-84. [Medline].

  25. O'Hara MW, Neunaber DJ, Zekoski EM. Prospective study of postpartum depression: prevalence, course, and predictive factors. J Abnorm Psychol. May 1984;93(2):158-71. [Medline].

  26. Frodl T, Reinhold E, Koutsouleris N, Donohoe G, Bondy B, Reiser M, et al. Childhood stress, serotonin transporter gene and brain structures in major depression. Neuropsychopharmacology. May 2010;35(6):1383-90. [Medline]. [Full Text].

  27. Karg K, Burmeister M, Shedden K, Sen S. The Serotonin Transporter Promoter Variant (5-HTTLPR), Stress, and Depression Meta-analysis Revisited: Evidence of Genetic Moderation. Arch Gen Psychiatry. May 2011;68(5):444-54. [Medline].

  28. De Bellis MD, Dahl RE, Perel JM, Birmaher B, al-Shabbout M, Williamson DE, et al. Nocturnal ACTH, cortisol, growth hormone, and prolactin secretion in prepubertal depression. J Am Acad Child Adolesc Psychiatry. Sep 1996;35(9):1130-8. [Medline].

  29. Krishnan KR. Biological risk factors in late life depression. Biol Psychiatry. Aug 1 2002;52(3):185-92. [Medline].

  30. Hammen C, Burge D, Adrian C. Timing of mother and child depression in a longitudinal study of children at risk. J Consult Clin Psychol. Apr 1991;59(2):341-5. [Medline].

  31. Wickramaratne P, Gameroff MJ, Pilowsky DJ, Hughes CW, Garber J, Malloy E, et al. Children of depressed mothers 1 year after remission of maternal depression: findings from the STAR*D-Child study. Am J Psychiatry. Jun 2011;168(6):593-602. [Medline].

  32. Thomas AJ, Kalaria RN, O'Brien JT. Depression and vascular disease: what is the relationship?. J Affect Disord. Apr 2004;79(1-3):81-95. [Medline].

  33. Klerman GL. The current age of youthful melancholia. Evidence for increase in depression among adolescents and young adults. Br J Psychiatry. Jan 1988;152:4-14. [Medline].

  34. Gershon ES, Hamovit JH, Guroff JJ, Nurnberger JI. Birth-cohort changes in manic and depressive disorders in relatives of bipolar and schizoaffective patients. Arch Gen Psychiatry. Apr 1987;44(4):314-9. [Medline].

  35. Current depression among adults---United States, 2006 and 2008. MMWR Morb Mortal Wkly Rep. Oct 1 2010;59(38):1229-35. [Medline].

  36. Helgason T. Epidemiology of mental disorders in Iceland. A psychiatric and demographic investigation of 5395 Icelanders. Acta Psychiatr Scand. 1964;40:SUPPL 173:1+. [Medline].

  37. Jablensky A, Sartorius N, Gulbinat W, Ernberg G. Characteristics of depressive patients contacting psychiatric services in four cultures. A report from the who collaborative study on the assessment of depressive disorders. Acta Psychiatr Scand. Apr 1981;63(4):367-83. [Medline].

  38. Murphy JM, Laird NM, Monson RR, Sobol AM, Leighton AH. Incidence of depression in the Stirling County Study: historical and comparative perspectives. Psychol Med. May 2000;30(3):505-14. [Medline].

  39. Copeland JR, Beekman AT, Dewey ME, Hooijer C, Jordan A, Lawlor BA, et al. Depression in Europe. Geographical distribution among older people. Br J Psychiatry. Apr 1999;174:312-21. [Medline].

  40. Kashani JH, Sherman DD. Childhood depression: Epidemiology, etiological models, and treatment implications. Integr Psychiatry. 1988;6:1-8.

  41. Lewinsohn PM, Hops H, Roberts RE, Seeley JR, Andrews JA. Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. J Abnorm Psychol. Feb 1993;102(1):133-44. [Medline].

  42. Garrison CZ, Waller JL, Cuffe SP, McKeown RE, Addy CL, Jackson KL. Incidence of major depressive disorder and dysthymia in young adolescents. J Am Acad Child Adolesc Psychiatry. Apr 1997;36(4):458-65. [Medline].

  43. Hankin BL, Abramson LY, Moffitt TE, Silva PA, McGee R, Angell KE. Development of depression from preadolescence to young adulthood: emerging gender differences in a 10-year longitudinal study. J Abnorm Psychol. Feb 1998;107(1):128-40. [Medline].

  44. Siegel JM, Aneshensel CS, Taub B. Adolescent depressed mood in a multiethnic sample. J Youth Adolesc. 1998;27.

  45. Tohen M, Khalsa HM, Salvatore P, et al. Two-year outcomes in first-episode psychotic depression The McLean-Harvard first-episode project. J Affect Disord. Jan 2012;136(1-2):1-8. [Medline].

  46. Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. AACAP. J Am Acad Child Adolesc Psychiatry. Oct 1998;37(10 Suppl):63S-83S. [Medline].

  47. Pine DS, Cohen E, Cohen P, Brook J. Adolescent depressive symptoms as predictors of adult depression: moodiness or mood disorder?. Am J Psychiatry. Jan 1999;156(1):133-5. [Medline].

  48. Lespérance F, Frasure-Smith N. Depression and heart disease. Cleve Clin J Med. Feb 2007;74 Suppl 1:S63-6. [Medline].

  49. Millard PH. Depression in old age. Br Med J (Clin Res Ed). Aug 6 1983;287(6389):375-6. [Medline]. [Full Text].

  50. Alexopoulos GS, Chester JG. Outcomes of geriatric depression. Clin Geriatr Med. May 1992;8(2):363-76. [Medline].

  51. Geda YE, Knopman DS, Mrazek DA, Jicha GA, Smith GE, Negash S, et al. Depression, apolipoprotein E genotype, and the incidence of mild cognitive impairment: a prospective cohort study. Arch Neurol. Mar 2006;63(3):435-40. [Medline].

  52. Modrego PJ, Ferrández J. Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: a prospective cohort study. Arch Neurol. Aug 2004;61(8):1290-3. [Medline].

  53. Katon W, Lyles CR, Parker MM, Karter AJ, Huang ES, Whitmer RA. Association of depression with increased risk of dementia in patients with type 2 diabetes: the diabetes and aging study. Arch Gen Psychiatry. Apr 2012;69(4):410-7. [Medline].

  54. Li G, Wang LY, Shofer JB, et al. Temporal Relationship Between Depression and Dementia: Findings From a Large Community-Based 15-Year Follow-up Study. Arch Gen Psychiatry. Sep 2011;68(9):970-7. [Medline].

  55. Gotlib I, Hammen C. (2002). Handbook of Depression. New York: Guilford Press; 2002.

  56. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). Available at http://www.cdc.gov/ncipc/wisqars. Accessed March 19, 2010.

  57. Conwell Y, Duberstein PR, Caine ED. Risk factors for suicide in later life. Biol Psychiatry. Aug 1 2002;52(3):193-204. [Medline].

  58. Elovainio M, Shipley MJ, Ferrie JE, Gimeno D, Vahtera J, Marmot MG, et al. Obesity, unexplained weight loss and suicide: the original Whitehall study. J Affect Disord. Aug 2009;116(3):218-21. [Medline].

  59. Friedman RA, Leon AC. Expanding the black box - depression, antidepressants, and the risk of suicide. N Engl J Med. Jun 7 2007;356(23):2343-6. [Medline].

  60. [Medline].

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

  62. 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.

  63. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder, Text Revision. 4th Edition. Washington, DC: American Psychiatric Association; 2000.

  64. Kendell RE, Chalmers JC, Platz C. Epidemiology of puerperal psychoses. Br J Psychiatry. May 1987;150:662-73. [Medline].

  65. SIGN. Postnatal Depression and Puerperal Psychosis: A National Clinical Guideline. Scottish Intercollegiate Guidelines Network. 2002;32.

  66. USPSTF. Screening for depression in adults: U.S. preventive services task force recommendation statement. Ann Intern Med. Dec 1 2009;151(11):784-92. [Medline].

  67. ACOG Committee Opinion No. 343: psychosocial risk factors: perinatal screening and intervention. Obstet Gynecol. Aug 2006;108(2):469-77. [Medline].

  68. Peindl KS, Wisner KL, Hanusa BH. Identifying depression in the first postpartum year: guidelines for office-based screening and referral. J Affect Disord. May 2004;80(1):37-44. [Medline].

  69. Wisner KL, Parry BL, Piontek CM. Clinical practice. Postpartum depression. N Engl J Med. Jul 18 2002;347(3):194-9. [Medline].

  70. Beck CT. Postpartum depression: it isn't just the blues. Am J Nurs. May 2006;106(5):40-50; quiz 50-1. [Medline].

  71. Imsiragic AS, Begic D, Martic-Biocina S. Acute stress and depression 3 days after vaginal delivery--observational, comparative study. Coll Antropol. Jun 2009;33(2):521-7. [Medline].

  72. Scrandis DA, Sheikh TM, Niazi R, Tonelli LH, Postolache TT. Depression after delivery: risk factors, diagnostic and therapeutic considerations. ScientificWorldJournal. Oct 22 2007;7:1670-82. [Medline].

  73. Spinelli MG. Antepartum and postpartum depression. J Gend Specif Med. Oct-Nov 1998;1(2):33-6. [Medline].

  74. ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists number 92, April 2008 (replaces practice bulletin number 87, November 2007). Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol. Apr 2008;111(4):1001-20. [Medline].

  75. Earls, Marian, MD. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. Nov 2010;126(5):1032-9. [Medline].

  76. Pignone MP, Gaynes BN, Rushton JL, Burchell CM, Orleans CT, Mulrow CD, et al. Screening for depression in adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. May 21 2002;136(10):765-76. [Medline].

  77. Vogelzangs N, Beekman AT, Boelhouwer IG, et al. Metabolic depression: a chronic depressive subtype? findings from the InCHIANTI study of older persons. J Clin Psychiatry. May 2011;72(5):598-604. [Medline].

  78. Ko DT, Hebert PR, Coffey CS, Sedrakyan A, Curtis JP, Krumholz HM. Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction. JAMA. Jul 17 2002;288(3):351-7. [Medline].

  79. Luijendijk HJ, van den Berg JF, Hofman A, Tiemeier H, Stricker BH. ß-blockers and the risk of incident depression in the elderly. J Clin Psychopharmacol. Feb 2011;31(1):45-50. [Medline].

  80. Portella MJ, de Diego-Adeliño J, Ballesteros J, Puigdemont D, Oller S, Santos B, et al. Can we really accelerate and enhance the selective serotonin reuptake inhibitor antidepressant effect? A randomized clinical trial and a meta-analysis of pindolol in nonresistant depression. J Clin Psychiatry. Jul 2011;72(7):962-9. [Medline].

  81. U.S. Preventive Services Task Force. Screening for Depression. May 2002. Available at http://www.uspreventiveservicestaskforce.org/uspstf/uspsdepr.htm#summary. Accessed February 21, 2012.

  82. Mitchell AJ, Coyne JC. Do ultra-short screening instruments accurately detect depression in primary care? A pooled analysis and meta-analysis of 22 studies. Br J Gen Pract. Feb 2007;57(535):144-51. [Medline]. [Full Text].

  83. Arroll B, Khin N, Kerse N. Screening for depression in primary care with two verbally asked questions: cross sectional study. BMJ. Nov 15 2003;327(7424):1144-6. [Medline]. [Full Text].

  84. Tutus A, Kibar M, Sofuoglu S, Basturk M, Gönül AS. A technetium-99m hexamethylpropylene amine oxime brain single-photon emission tomography study in adolescent patients with major depressive disorder. Eur J Nucl Med. Jun 1998;25(6):601-6. [Medline].

  85. Pampallona S, Bollini P, Tibaldi G, Kupelnick B, Munizza C. Combined pharmacotherapy and psychological treatment for depression: a systematic review. Arch Gen Psychiatry. Jul 2004;61(7):714-9. [Medline].

  86. Ishak WW, Ha K, Kapitanski N, Bagot K, Fathy H, Swanson B, et al. The impact of psychotherapy, pharmacotherapy, and their combination on quality of life in depression. Harv Rev Psychiatry. Dec 2011;19(6):277-89. [Medline].

  87. [Guideline] Qaseem A, Snow V, Denberg TD, Forciea MA, Owens DK. Using second-generation antidepressants to treat depressive disorders: a clinical practice guideline from the American College of Physicians. Ann Intern Med. Nov 18 2008;149(10):725-33. [Medline]. [Full Text].

  88. APA. Practice Guideline for the Treatment of Patients with Major Depressive Disorder (3rd edition). American Psychiatric Association. Available at http://www.psychiatryonline.com/pracGuide/pracGuideTopic_7.aspx. Accessed May 3, 2011.

  89. US Food and Drug Administration. Celexa (citalopram hydrobromide): Drug safety communication – abnormal heart rhythms associated with high doses. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm269481.htm. Accessed August 24, 2011.

  90. Celexa (citalopram hydrobromide) [package insert]. St. Louis, Missouri: Forest Pharmaceuticals, Inc; August, 2011. [Full Text].

  91. Rush AJ, Trivedi MH, Stewart JW, et al. Combining Medications to Enhance Depression Outcomes (CO-MED): Acute and Long-Term Outcomes of a Single-Blind Randomized Study. Am J Psychiatry. Jul 2011;168(7):689-701. [Medline].

  92. 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 March 22, 2010.

  93. Zisook S, Lesser IM, Lebowitz B, Rush AJ, Kallenberg G, Wisniewski SR, et al. Effect of antidepressant medication treatment on suicidal ideation and behavior in a randomized trial: an exploratory report from the Combining Medications to Enhance Depression Outcomes Study. J Clin Psychiatry. Oct 2011;72(10):1322-32. [Medline].

  94. Fournier JC, DeRubeis RJ, Hollon ST, et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA [serial online]. Accessed March 22, 2010. Available at http://jama.ama-assn.org/content/303/1/47.full.

  95. Hollon SD, Ponniah K. A review of empirically supported psychological therapies for mood disorders in adults. Depress Anxiety. Oct 2010;27(10):891-932. [Medline]. [Full Text].

  96. Areán PA, Cook BL. Psychotherapy and combined psychotherapy/pharmacotherapy for late life depression. Biol Psychiatry. Aug 1 2002;52(3):293-303. [Medline].

  97. Pinquart M, Duberstein PR, Lyness JM. Treatments for later-life depressive conditions: a meta-analytic comparison of pharmacotherapy and psychotherapy. Am J Psychiatry. Sep 2006;163(9):1493-501. [Medline].

  98. Mufson L, Fairbanks J. Interpersonal psychotherapy for depressed adolescents: a one-year naturalistic follow-up study. J Am Acad Child Adolesc Psychiatry. Sep 1996;35(9):1145-55. [Medline].

  99. Lieverse R, Van Someren EJ, Nielen MM, Uitdehaag BM, Smit JH, Hoogendijk WJ. Bright light treatment in elderly patients with nonseasonal major depressive disorder: a randomized placebo-controlled trial. Arch Gen Psychiatry. Jan 2011;68(1):61-70. [Medline].

  100. Wirz-Justice A, Bader A, Frisch U, Stieglitz RD, Alder J, Bitzer J, et al. A randomized, double-blind, placebo-controlled study of light therapy for antepartum depression. J Clin Psychiatry. Jul 2011;72(7):986-93. [Medline].

  101. Krogh J, Nordentoft M, Sterne JA, Lawlor DA. The effect of exercise in clinically depressed adults: systematic review and meta-analysis of randomized controlled trials. J Clin Psychiatry. Apr 2011;72(4):529-38. [Medline].

  102. Kennedy SH, Giacobbe P, Rizvi SJ, et al. Deep brain stimulation for treatment-resistant depression: follow-up after 3 to 6 years. Am J Psychiatry. May 2011;168(5):502-10. [Medline].

  103. 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].

  104. Rush AJ. Star-D: lessons learned and future implications. Depress Anxiety. Jul 2011;28(7):521-4. [Medline].

  105. Berman RM, Marcus RN, Swanink R, McQuade RD, Carson WH, Corey-Lisle PK, et al. 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].

  106. [Best Evidence] Marcus RN, McQuade RD, Carson WH, Hennicken D, Fava M, Simon JS, et al. 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].

  107. Berman RM, Fava M, Thase ME, Trivedi MH, Swanink R, McQuade RD, et al. Aripiprazole augmentation in major depressive disorder: a double-blind, placebo-controlled study in patients with inadequate response to antidepressants. CNS Spectr. Apr 2009;14(4):197-206. [Medline].

  108. March JS, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, et al. The Treatment for Adolescents With Depression Study (TADS): long-term effectiveness and safety outcomes. Arch Gen Psychiatry. Oct 2007;64(10):1132-43. [Medline].

  109. Hughes CW, Emslie GJ, Crismon ML, Posner K, Birmaher B, Ryan N, et al. Texas Children's Medication Algorithm Project: update from Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder. J Am Acad Child Adolesc Psychiatry. Jun 2007;46(6):667-86. [Medline].

  110. Brent DA. The treatment of SSRI-resistant depression in adolescents (TORDIA): in search of the best next step. Depress Anxiety. 2009;26(10):871-4. [Medline].

  111. Leonard HL, March J, Rickler KC, Allen AJ. Pharmacology of the selective serotonin reuptake inhibitors in children and adolescents. J Am Acad Child Adolesc Psychiatry. Jun 1997;36(6):725-36. [Medline].

  112. Rey-Sánchez F, Gutiérrez-Casares JR. Paroxetine in children with major depressive disorder: an open trial. J Am Acad Child Adolesc Psychiatry. Oct 1997;36(10):1443-7. [Medline].

  113. Tsapakis EM, Soldani F, Tondo L, Baldessarini RJ. Efficacy of antidepressants in juvenile depression: meta-analysis. Br J Psychiatry. Jul 2008;193(1):10-7. [Medline].

  114. Emslie GJ, Rush AJ, Weinberg WA, Kowatch RA, Hughes CW, Carmody T, et al. A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression. Arch Gen Psychiatry. Nov 1997;54(11):1031-7. [Medline].

  115. March JS, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, et al. The Treatment for Adolescents With Depression Study (TADS): long-term effectiveness and safety outcomes. Arch Gen Psychiatry. Oct 2007;64(10):1132-43. [Medline].

  116. Cassels C. FDA Suicide Warnings Change Antidepressant Prescribing Patterns, but Physicians Ignore Monitoring Recommendations. Medscape Today. Available at http://www.medscape.com/viewarticle/715952. Accessed March 22, 2010.

  117. Cassels C. FDA Suicide Warnings About Antidepressants Cut Rates of Depression Diagnosis and Treatment. Medscape Today. Available at http://www.medscape.com/viewarticle/704235. Accessed March 22, 2010.

  118. Leon AC, Solomon DA, Li C, et al. Antidepressants and risks of suicide and suicide attempts: a 27-year observational study. J Clin Psychiatry. May 2011;72(5):580-6. [Medline].

  119. Carlsten A, Waern M, Ekedahl A, Ranstam J. Antidepressant medication and suicide in Sweden. Pharmacoepidemiol Drug Saf. Oct-Nov 2001;10(6):525-30. [Medline].

  120. Hall WD, Mant A, Mitchell PB, Rendle VA, Hickie IB, McManus P. Association between antidepressant prescribing and suicide in Australia, 1991-2000: trend analysis. BMJ. May 10 2003;326(7397):1008. [Medline]. [Full Text].

  121. Olfson M, Marcus SC, Druss B, Pincus HA. National trends in the use of outpatient psychotherapy. Am J Psychiatry. Nov 2002;159(11):1914-20. [Medline].

  122. March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, et al. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA. Aug 18 2004;292(7):807-20. [Medline].

  123. Simon GE, Savarino J, Operskalski B, Wang PS. Suicide risk during antidepressant treatment. Am J Psychiatry. Jan 2006;163(1):41-7. [Medline].

  124. Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. Oct 2010;67(10):1012-24. [Medline].

  125. Chambers CD, Hernandez-Diaz S, Van Marter LJ, Werler MM, Louik C, Jones KL, et al. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med. Feb 9 2006;354(6):579-87. [Medline]. [Full Text].

  126. Occhiogrosso M, Omran SS, Altemus M. Persistent pulmonary hypertension of the newborn and selective serotonin reuptake inhibitors: lessons from clinical and translational studies. Am J Psychiatry. Feb 2012;169(2):134-40. [Medline].

  127. FDA drug safety communication: Selective serotonin reuptake inhibitor (SSRI) antidepressant use during pregnancy and reports of a rare heart and lung condition in newborn babies. US Food and Drug Administration. Available at http://www.fda.gov/Drugs/DrugSafety/ucm283375.htm. Accessed December 14, 2011.

  128. Levinson-Castiel R, Merlob P, Linder N, Sirota L, Klinger G. Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediatr Adolesc Med. Feb 2006;160(2):173-6. [Medline].

  129. di Scalea TL, Wisner KL. Pharmacotherapy of postpartum depression. Expert Opin Pharmacother. Nov 2009;10(16):2593-607. [Medline]. [Full Text].

  130. Yonkers KA, Wisner KL, Stewart DE, Oberlander TF, Dell DL, Stotland N, et al. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Obstet Gynecol. Sep 2009;114(3):703-13. [Medline].

  131. Wisner KL, Perel JM, Peindl KS, Hanusa BH, Piontek CM, Findling RL. Prevention of postpartum depression: a pilot randomized clinical trial. Am J Psychiatry. Jul 2004;161(7):1290-2. [Medline].

  132. Weissman AM, Levy BT, Hartz AJ, Bentler S, Donohue M, Ellingrod VL, et al. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry. Jun 2004;161(6):1066-78. [Medline].

  133. Andreescu C, Lenze EJ, Mulsant BH, Wetherell JL, Begley AE, Mazumdar S, et al. High worry severity is associated with poorer acute and maintenance efficacy of antidepressants in late-life depression. Depress Anxiety. 2009;26(3):266-72. [Medline]. [Full Text].

  134. Cooper C, Katona C, Lyketsos K, et al. A systematic review of treatments for refractory depression in older people. Am J Psychiatry. Jul 2011;168(7):681-8. [Medline].

  135. Fabian TJ, Amico JA, Kroboth PD, Mulsant BH, Corey SE, Begley AE, et al. Paroxetine-induced hyponatremia in older adults: a 12-week prospective study. Arch Intern Med. Feb 9 2004;164(3):327-32. [Medline].

  136. King RA, Segman RH, Anderson GM. Serotonin and suicidality: the impact of acute fluoxetine administration. I: Serotonin and suicide. Isr J Psychiatry Relat Sci. 1994;31(4):271-9. [Medline].

  137. Teicher MH, Glod CA, Cole JO. Antidepressant drugs and the emergence of suicidal tendencies. Drug Saf. Mar 1993;8(3):186-212. [Medline].

  138. Pan A, Okereke OI, Sun Q, Logroscino G, Manson JE, Willett WC, et al. Depression and incident stroke in women. Stroke. Oct 2011;42(10):2770-5. [Medline]. [Full Text].

  139. Pan A, Sun Q, Okereke OI, Rexrode KM, Hu FB. Depression and risk of stroke morbidity and mortality: a meta-analysis and systematic review. JAMA. Sep 21 2011;306(11):1241-9. [Medline]. [Full Text].

  140. Baldessarini RJ, Tondo L, Ghiani C, Lepri B. Illness risk following rapid versus gradual discontinuation of antidepressants. Am J Psychiatry. Aug 2010;167(8):934-41. [Medline].

  141. Nelson JC, Papakostas GI. Atypical antipsychotic augmentation in major depressive disorder: a meta-analysis of placebo-controlled randomized trials. Am J Psychiatry. Sep 2009;166(9):980-91. [Medline].

  142. Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med. Nov 27 2006;166(21):2314-21. [Medline].

  143. Kroll L, Harrington R, Jayson D, Fraser J, Gowers S. Pilot study of continuation cognitive-behavioral therapy for major depression in adolescent psychiatric patients. J Am Acad Child Adolesc Psychiatry. Sep 1996;35(9):1156-61. [Medline].

  144. Harris EC, Barraclough B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry. Mar 1997;170:205-28. [Medline].

  145. Steingard RJ, Renshaw PF, Yurgelun-Todd D, Appelmans KE, Lyoo IK, Shorrock KL, et al. Structural abnormalities in brain magnetic resonance images of depressed children. J Am Acad Child Adolesc Psychiatry. Mar 1996;35(3):307-11. [Medline].

 
Previous
Next
 
Media file 1: From 1991-2006, the suicide rate was consistently higher among males. Suicide rates declined among both sexes from 1991-2000; the rate among males decreased from 24.64 to 20.67 suicides per 100,000 and 5.48 to 4.62 suicides per 100,000 among females. From 2000-2006, however, the suicide rates gradually increased among females. Note: All rates are age-adjusted to the standard 2000 population. Rates based on less than 20 deaths are statistically unreliable. Source: Centers for Disease Control and Prevention. National suicide statistics at a glance: Trends in suicide rates among persons ages 10 years and older, by sex, United States, 1991-2006. Available at: http://www.cdc.gov/violenceprevention/suicide/statistics/trends01.html. Accessed: May 5, 2010.
Media file 2: Geriatric Depression Scale.
Media file 3: Geriatric Depression Scale-Short.
Media file 4: Hamilton Depression Scale.
Media file 5: Center for Epidemiologic Studies Depression Scale.
Media file 6: Cornell Scale for Depression in Dementia.
Media file 7: Suicide rate by age and gender. 2004 data compiled from CDC. The mean suicide rate for the entire population was 12.8/100,000/year.
Table 1. Treatment Response Over Time in the Treatment of Adolescents with Depression Study
Treatment Response Rate (%)
Week 12Week 18Week 36
Fluoxetine626981
Cognitive-behavioral therapy (CBT)486581
Fluoxetine plus CBT738586
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.