Depression diagnosis

[lasek]

I have to write a short write-up on a patient, and was curious, if a patient says he is diagnosed with depression, but he has a lot of medical conditions (diabetes, COPD, CHF, cataracts, renal failure, kidney stones) and is on several meds (none of which are known to cause depression), does he fit the criteriea for depression? One of the criteriea for depression is that "symptoms are not due to the direct physiologic effects of a substance or a general medical conditions." Having all those illnesses for a long time will probably make you deppressed, but does it constitute a "direct physiologic effect?"

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[Mumpu]

Does the patient actually fit a DSM-IV diagnosis (major depression, dysthymia, schizoaffective, etc.). It's possible to be depressed without a specific DSM-IV mood disorder diagnosis (i.e. depression NOS on axis I with all the diseases on axis III and chronic illness on axis IV).

And always remember to rule out bipiloar/cyclothymic d/o in depressed patients.

 

[doc05]

Check out your dsm-IV. Consider Mood disorder due to general medical condition, depressed type.

 

[lasek]

I didn't consider mood disorder secondary to medical condition. Psych was never my strong point.

All I have about his mood is "mild depression" listed in his PMH, and a vague reference to it in the social history (...is frustrated and depressed of his multiple medical conditions but is compliant of the treatments.) so I cant say anything about the specific criteriea he meets. Presumably, since it's barely mentioned anywhere it is not a major part of his life.

Now to propose a treatment plan for this guy...

Thank you.

 

[Samoa]

There are multiple points where you can start. But whatever you do, be sure to treat the underlying disease with the goal of returning the patient as close to his previous level of functioning as possible. You can also treat the depression, if it's interfering with the patient's ability to function while the disease is still inadequately treated. But don't substitute treating the depression for aggressive therapy of the underlying problem. If you treat the underlying disease, the depression becomes less of a problem. And if you treat the depression, the disease becomes less troubling to the patient. But either without adequate treatment of the other may result in a poorer outcome.

 

[Mumpu]

Your patients deserve thorough care. Screen for depression with a standardized questionnaire like PHQ-9 or run the DSM-IV criteria (SIGECAPS, etc.) and treat appropriately.