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Depression Background Pathophysiology โข The monoamine theory of depression is that it results from a central deficit in the monoamine neurotransmitters serotonin (5-HT) and norepinephrine. โข Other reported physiological features include โcortisol and a blunted TSH response. โข However, there is no widely accepted and definitively proven biological model of depression. Epidemiology โข Time course: for most it is an episodic illness, but for other it follows a more chronic course. โข Incidence: 5% annual risk, 20% lifetime risk. Presentation DSM and NICE criteria These are based on DSM-4, though DSM-5 does not significantly differ. Major depressive disorder is โฅ2 weeks of low mood and/or anhedonia, and at least 4 symptoms out of: โข โEnergy or fatigue. โข โConcentration โข โWeight/appetite. โข Disturbed sleep, which commonly includes early waking. Diurnal pattern to symptoms also seen, with symptoms often worse in the morning. โข Slowing of thought and movements (psychomotor slowing) or agitation. โข Ideas of worthlessness or guilt. โข Recurrent thoughts of death or suicide. โข All but the last 2 are considered 'biological' symptoms.
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