Major Depression — DSM Criteria + Treatment

DSM-5: ≥ 5 symptoms for ≥ 2 weeks (must include #1 or #2) SIG E CAPS: 1. Sleep disturbance (insomnia or hypersomnia) 2. Interest loss (anhedonia) — must have this OR depressed mood 3. Guilt / worthlessness 4. Energy loss / fatigue 5. Concentration impairment 6. Appetite / weight changes 7. Psychomotor agitation or retardation 8. Suicidal ideation PLUS depressed mood (must have this OR anhedonia) Treatment: • SSRI first-line (sertraline, citalopram, escitalopram, fluoxetine) • SNRI second-line (venlafaxine, duloxetine) • Tricyclics (amitriptyline) — older, more side effects • MAOIs — last resort (food + drug interactions) • Psychotherapy (CBT, IPT) • ECT — severe, refractory, psychotic features, pregnancy Side effects of SSRIs: • Sexual dysfunction (most common) • GI (nausea early) • Sleep changes • Hyponatraemia (SIADH) • Bleeding risk • Discontinuation syndrome