It is a mood disorder characterised by at least 2 weeks of depressed mood and/or diminished interest and pleasure in activities. It is associated with impairment in level of functioning in different areas including social and occupational.
Diagnostic Criteria
Psychological symptoms
- Depressed mood
- Feeling of worthlessness
- Guilt
- Diminished concentration
- Thoughts of death and suicide
Somatic symptoms
- Change in appetite
- Sleep disturbances
- Agitation
- Retardation
- Loss of energy
Non-Pharmacological Treatment
Effective psychotherapies include:
- Cognitive Behavioural Therapy
- Interpersonal psychotherapy
- Stress management / coping skills
- Marital and family issues
Pharmacological Treatment Adults:
A: Amitriptyline (PO) 50–75 mg daily at night, increase gradually to a maximum of 150 mg daily. Elderly: Initially 25–50 mg. Max. 75mg
OR
S: Fluoxetine (PO) 20mg daily (preferably in the morning), may increase up to 60mg/day)
OR
S: Fluvoxamine (PO) initially 50–100mg daily
OR
D: Citalopram (PO) 20mg daily in the morning or evening increase if necessary to a maximum of 60mg daily (Elderly maximum 40mg daily)
Referral
Refer to the next level in the following situations:
- Suicidal ideation
- Major depression with psychotic features
- Failure to respond to available antidepressants
- Patients with concomitant medical illness, e.g. heart disease, epilepsy
- Poor social support systems
- Pregnancy and lactation