Clinical Meaning
The NP approaches major depressive disorder (MDD) through systematic diagnostic formulation, differential diagnosis, and evidence based pharmacotherapy selection.
The NP approaches major depressive disorder (MDD) through systematic diagnostic formulation, differential diagnosis, and evidence-based pharmacotherapy selection. DSM-5-TR requires ≥5 of 9 symptoms for ≥2 weeks, with at least one being depressed mood or anhedonia. The nine criteria (SIG E CAPS): Sleep disturbance, Interest loss (anhedonia), Guilt/worthlessness, Energy loss, Concentration impairment, Appetite/weight change, Psychomotor agitation or retardation, Suicidal ideation. The NP must differentiate MDD from bipolar depression (screen with MDQ — Mood Disorder Questionnaire — before starting antidepressants, as SSRIs can precipitate mania), persistent depressive disorder (dysthymia — depressed mood more days than not for ≥2 years), adjustment disorder with depressed mood (symptoms within 3 months of identifiable stressor, not meeting full MDD criteria), and medical causes of depression (hypothyroidism, Cushing syndrome, vitamin D deficiency, anemia, medication-induced from beta-blockers, corticosteroids, interferon). Treatment-resistant depression (TRD) is defined as failure to respond to ≥2 adequate antidepressant trials (adequate dose for ≥6-8 weeks). The STAR*D trial demonstrated that after first SSRI failure, switching classes (SNRI) or augmenting (with bupropion, lithium, or atypical antipsychotic) are evidence-based strategies. Esketamine nasal spray (Spravato) is FDA-approved for...
