USMLE (Fach) / Psychiatry (Lektion)

Vorderseite Major depressive disorder
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Episodes characterized by at least 5 of the 9 diagnostic symptoms lasting ≥2 weeks (symptoms must include patient-reported depressed mood or anhedonia). Screen for history of manic episodes to rule out bipolar disorder.

Diagnostic symptoms:- Depressed mood- Sleep disturbances- Anhedonia (loss of interest)- Guilt or feelings of worthlessness- Energy loss and fatigue- Concentration problems- Appetite/weight changes- Psychomotor retardation or agitation- Suicidal ideations

Patients typically have the following sleep changes:- ↓ slow-wave sleep, ↓ REM latency- ↑ REM early in sleep cycle, ↑ total REM sleep- Repeated nighttime and early-morning awakenings (terminal insomnia)

Treatment: CBT and SSRIs are first line. SNRIs, mirtazapine, bupropion can also be considered. Electroconvulsive therapy (ECT) in treatment-resistant patients.

Persistent depressive disorder (dysthymia) – often milder, ≥2 depressive symptoms lasting ≥2 years, with no more than 2 months without depressive symptoms.

MDD with seasonal pattern – formerly known as seasonal affective disorder. Lasting ≥2 years with ≥2 major depressive episodes associated with seasonal pattern and absence of nonseasonal depressive episodes. Atypical symptoms common (eg, hypersomnia, hyperphagia, leaden paralysis).

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