From the Guidelines
Depression symptoms include persistent sadness, loss of interest in activities, changes in sleep and appetite, fatigue, difficulty concentrating, feelings of worthlessness, and thoughts of death or suicide, and treatment typically involves a combination of psychotherapy and medication, with the most recent evidence suggesting that clinicians should select between either cognitive behavioral therapy or second-generation antidepressants to treat patients with major depressive disorder after discussing treatment effects, adverse effect profiles, cost, accessibility, and preferences with the patient 1.
Symptoms of Depression
The symptoms of depression can be categorized into several key areas, including:
- Persistent sadness or feelings of emptiness
- Loss of interest in activities that were once enjoyable
- Changes in sleep patterns, such as insomnia or hypersomnia
- Changes in appetite, leading to weight loss or gain
- Fatigue or loss of energy
- Difficulty concentrating or making decisions
- Feelings of worthlessness or excessive guilt
- Recurrent thoughts of death or suicide
Treatment Options
Treatment for depression typically involves a combination of psychotherapy and medication. Some common treatment options include:
- Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, 20-80mg daily) or sertraline (Zoloft, 50-200mg daily)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor XR, 75-225mg daily) or duloxetine (Cymbalta, 30-60mg daily)
- Cognitive-behavioral therapy (CBT), which helps individuals identify and change negative thought patterns and develop coping strategies
- Lifestyle changes, such as regular exercise, maintaining social connections, establishing sleep routines, and reducing alcohol consumption
Recommendations
Based on the most recent evidence, clinicians should select between either cognitive behavioral therapy or second-generation antidepressants to treat patients with major depressive disorder after discussing treatment effects, adverse effect profiles, cost, accessibility, and preferences with the patient 1. Medications usually take 2-6 weeks to show full effects and should be continued for at least 6-12 months after symptoms improve to prevent relapse. Psychotherapy approaches like CBT typically involve weekly sessions for 12-16 weeks. For severe depression, treatments may include electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS). Depression is believed to result from a combination of genetic factors, brain chemistry imbalances, and environmental stressors, which is why a multi-faceted treatment approach is most effective.
From the FDA Drug Label
A major depressive episode implies a prominent and relatively persistent depressed or dysphoric mood that usually interferes with daily functioning (nearly every day for at least 2 weeks); it should include at least 4 of the following 8 symptoms: change in appetite, change in sleep, psychomotor agitation or retardation, loss of interest in usual activities or decrease in sexual drive, increased fatigue, feelings of guilt or worthlessness, slowed thinking or impaired concentration, and a suicide attempt or suicidal ideation.
The symptoms of depression include:
- Change in appetite
- Change in sleep
- Psychomotor agitation or retardation
- Loss of interest in usual activities or decrease in sexual drive
- Increased fatigue
- Feelings of guilt or worthlessness
- Slowed thinking or impaired concentration
- Suicide attempt or suicidal ideation Treatment options for depression include the use of antidepressants such as venlafaxine 2. However, it is essential to monitor patients for the emergence of suicidality and other symptoms, especially during the initial few months of treatment 2.
From the Research
Symptoms of Depression
- 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
- Changes in affect, cognition, behavior, and physical functioning 4
- Minor depression symptoms include depressed mood, diminished interest, weight change, sleep disturbance, psychomotor changes, fatigue, feelings of worthlessness, poor concentration, and recurrent thoughts of death 5
Treatment Options for Depression
- Psychotherapy
- Pharmacotherapy, including selective serotonin reuptake inhibitors 3
- Antidepressant psychotropic medications, such as tricyclics and MAO inhibitors 4
- Lithium carbonate for bipolar disorder 4
- Electroconvulsive therapy 4
- Exercise regimens 6
- Cognitive-behavioral therapy 5
- Mechanism-based prescribing for personalized medicine, targeting specific symptom domains such as fatigue, sleep/wake disturbance, and cognitive dysfunction 7
Diagnosis and Management
- Screening for major depressive disorder (MDD) is recommended in the general adult population when resources are available for diagnosis, management, and follow-up 3
- Laboratory tests may be considered to assess for significant comorbidities, differential diagnoses, or contraindications to treatment 3
- Referral to a psychiatrist or other mental health clinician should be considered when the diagnosis is in question or when symptoms do not improve with standard treatment 3
- Nursing care of hospitalized depressed persons involves careful monitoring of clients' status and the effectiveness of treatments, focusing on immediate, short-term, and long-term needs 4