What are the indications for major depressive disorder (MDD)?

From the Guidelines

The indications for Major Depressive Disorder (MDD) include persistent feelings of sadness, loss of interest in activities, changes in appetite or sleep, fatigue, feelings of worthlessness or guilt, and recurrent thoughts of death, as defined by the American Psychiatric Association 1. Treatment is recommended for individuals experiencing at least five of these symptoms for two weeks or more.

Symptoms of MDD

The symptoms of MDD include:

• Depressed mood most of the day, nearly every day
• Markedly diminished interest or pleasure in all, or nearly all, activities most of the day, nearly every day
• Significant weight loss or gain, or increased or decreased appetite nearly every day
• Insomnia or hypersomnia nearly every day
• Psychomotor agitation or retardation nearly every day
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness or excessive or inappropriate guilt nearly every day
• Diminished ability to think or concentrate, or indecisiveness, nearly every day
• Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt, or a specific plan to commit suicide, as outlined in the diagnostic criteria 1.

Treatment Approaches

Various treatment approaches can be used to manage MDD, including:

• Pharmacotherapy: Medications such as selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (20mg daily) or sertraline (50mg daily) are often prescribed for at least six months to a year, as recommended by the American College of Physicians 1.
• Psychotherapy: Cognitive-behavioral therapy (CBT) or interpersonal therapy (IPT) is also recommended, either alone or in combination with medication, for at least 12-16 sessions over 3-4 months, as suggested by the American College of Physicians 1.
• Complementary and Alternative Medicine (CAM): CAM treatments, such as acupuncture, meditation, ω-3 fatty acids, S-adenosyl-l-methionine (SAMe), St. John's wort, and yoga, may be considered, as mentioned in the guideline 1.
• Exercise: Exercise, including a broad range of activities, can be done for varying durations, in classes, individually, or in informal groups, as recommended by the American College of Physicians 1.

Treatment-Resistant Depression

In cases of treatment-resistant depression, augmentation with atypical antipsychotics like quetiapine (150-300mg daily) or mood stabilizers like lithium (600-1200mg daily) may be necessary, as suggested by the American College of Physicians 1. Electroconvulsive therapy (ECT) is considered for severe, life-threatening depression, or when other treatments have failed, typically involving 6-12 sessions over 2-4 weeks, as recommended by the American College of Physicians 1.

From the FDA Drug Label

Prozac is indicated for the treatment of major depressive disorder. Adult — The efficacy of Prozac was established in 5– and 6–week trials with depressed adult and geriatric outpatients (≥18 years of age) whose diagnoses corresponded most closely to the DSM–III (currently DSM–IV) category of major depressive disorder Pediatric (children and adolescents) — The efficacy of Prozac in children and adolescents was established in two 8– to 9–week placebo–controlled clinical trials in depressed outpatients whose diagnoses corresponded most closely to the DSM–III–R or DSM–IV category of major depressive disorder

The indications for major depressive disorder (MDD) are:

• Treatment of MDD in adults (≥18 years of age)
• Treatment of MDD in pediatric patients (children and adolescents) Key points to consider:
• The efficacy of fluoxetine was established in clinical trials with outpatients whose diagnoses corresponded to the DSM-III or DSM-IV category of MDD 2

From the Research

Indications for Major Depressive Disorder (MDD)

The indications for Major Depressive Disorder (MDD) include:

• Depressed mood
• Loss of interest or pleasure in activities
• Recurrent thoughts of death
• Physical and cognitive symptoms 3, 4
• At least five of the following symptoms in the past 2 weeks, with at least one being depressed mood or loss of interest or pleasure:
  • Depressed mood
  • Diminished interest or pleasure in activities
  • Significant weight loss or gain, or decreased or increased appetite
  • Insomnia or hypersomnia
  • Psychomotor agitation or retardation
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Poor concentration or indecisiveness
  • Recurrent thoughts of death or suicidal ideation, plan, or attempt 3

Screening and Diagnosis

Screening for MDD is recommended in the general adult population when resources are available for diagnosis, management, and follow-up 3. Several screening tools are available, including:

• Patient Health Questionnaire-9 (PHQ-9)
• Beck Depression Inventory for Primary Care (BDI-PC) 3 Laboratory tests may be considered to assess for significant comorbidities, differential diagnoses, or contraindications to treatment 3.

Treatment

Treatment for MDD commonly involves:

• Pharmacological therapy with antidepressant medications
• Psychotherapy
• Combination of both 4, 5 First-line treatments include specific psychotherapies and antidepressant medications, with cognitive therapy, behavioral activation, problem-solving therapy, interpersonal therapy, brief psychodynamic therapy, and mindfulness-based psychotherapy showing medium-sized effects in symptom improvement over usual care without psychotherapy 5. Antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs), are often the first choice for treatment due to their efficacy and tolerability profile 6.