psychiatric disorders
Depressive Disorders
Key Points
Depression is a common disorder that involves depressed mood and/or near-complete loss of interest or pleasure in activities that were previously enjoyed; somatic (eg, weight change, sleep disturbance) and cognitive manifestations (eg, difficulty concentrating) are common. Depression may markedly impair the ability to function at work and to interact socially; risk of suicide is significant. Sometimes depressive symptoms are caused by general medical disorders (eg, thyroid or adrenal gland disorders, benign or malignant brain tumors, stroke, AIDS, Parkinson disease, multiple sclerosis) or use of certain medications (eg, corticosteroids, some beta-blockers, interferon, some illicit drugs). Diagnosis is based on clinical criteria; general medical disorders must be ruled out by clinical evaluation and selected testing (eg, CBC; electrolyte, TSH, B12 and folate levels). Treatment involves psychotherapy and usually medications; SSRIs are usually tried first, and if they are ineffective, other medications that affectserotonin,norepinephrineand/ordopaminemay be tried. 