Differential Diagnosis

Major depressive episodes also occur in patients with bipolar disorder. Persons with bipolar disorder also experience manic, hypomanic, and/or mixed episodes (see Chap. 39) during the course of their illness, whereas persons with MDD do not.

The presence of a significant medical disorder can produce depressive symptoms via either psychological or physiological mechanisms. Examples include hypo-

thyroidism, neoplasms, anemia, infections, electrolyte disturbances, cardiovascular diseases, neurologic disorders, and many others.9 Various psychiatric conditions, such as substance-use disorders and anxiety disorders, have been associated with depression as well.9 The use of CNS depressants, such as benzodiazepines and narcotics,

is associated with increased propensity for depression. Drugs that reportedly cause depressive symptoms or depressive-like side effects include corticosteroids, contraceptives, gonadotropin-releasing hormone agonists, interferon-a, interleukin-2, mefloquine, isotretinoin, propranolol, and sotalol.14

Table 38-1 Diagnostic Criteria for Major Depressive Episode

At least five of the following symptoms have been present during the same 2-week period and represent a change from previous functioning:

• Depressed mooda

• Markedly diminished interest or pleasure in usual activities0

• Increase or decrease in appetite or weight

• Increase or decrease in amount of sleep

• Increase or decrease in psychomotor activity

• Fatigue or loss of energy

• Feelings of worthlessness or guilt

• Diminished ability to think, concentrate, or make decisions

• Recurrent thoughts of death, suicidal ideation, or suicide attempt

The symptoms cause clinically significant distress or impairment in functioning

The symptoms are not due to the direct physiological effects of a substance or medical condition a One of these two symptoms must be present. From Ref. 3.

Dysthymia is a condition that must be differentiated from depression. Many of the symptoms of dysthymia are similar to those of depression, but in dysthymia, symptoms are chronic and milder. Symptoms of dysthymia must be present for at least 2

years and may include sleep and appetite disturbances, a loss of energy, a lack of interest in things that would usually be enjoyable, and poor self-image. Patients with dysthymia often have family members with a history of depression or dysthymia. It occurs more frequently in women, and patients with dysthymia are more likely to develop major depression than the general population.

Do Not Panic

Do Not Panic

This guide Don't Panic has tips and additional information on what you should do when you are experiencing an anxiety or panic attack. With so much going on in the world today with taking care of your family, working full time, dealing with office politics and other things, you could experience a serious meltdown. All of these things could at one point cause you to stress out and snap.

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