Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Related articles

Unipolar depression in adults: Assessment and diagnosis

INTRODUCTION

Most adults with clinically significant depression visit a primary care physician rather than a psychiatrist [1-3], and the diagnosis is missed in a substantial number of depressed primary care patients. A meta-analysis of 41 studies (n >50,000 primary care patients) found that among all of the patients with a depressive disorder, the general practitioners identified depression in approximately 50 percent [4]. Another meta-analysis (36 studies) found that nonpsychiatric physicians did not diagnose depression in over 50 percent of their depressed patients [5]. In addition, primary care clinicians may over-diagnose depression in patients who do not have a depressive disorder; meta-analyses estimate that the rate of false positives is 15 to 20 percent [4,5]. However, these findings should be interpreted with recognition of the primary care approach to diagnosis over several office visits, the complexity of diagnosing depression in the context of chronic general medical illnesses, and that depressed patients who present to primary care practices may be less severely ill than patients who present to psychiatric practices.

This topic reviews the assessment and diagnosis of depression in adults. The clinical features, epidemiology, neurobiology, treatment, and prognosis of depression in adults are discussed separately, as are the clinical features and diagnosis of depression in pediatric and elderly patients:

(See "Unipolar depression in adults: Clinical features".)

(See "Unipolar depression in adults: Epidemiology, pathogenesis, and neurobiology".)

(See "Unipolar major depression in adults: Choosing initial treatment".)

                                 

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Mar 2014. | This topic last updated: Mar 31, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Mojtabai R, Olfson M. National patterns in antidepressant treatment by psychiatrists and general medical providers: results from the national comorbidity survey replication. J Clin Psychiatry 2008; 69:1064.
  2. Marcus SC, Olfson M. National trends in the treatment for depression from 1998 to 2007. Arch Gen Psychiatry 2010; 67:1265.
  3. Harman JS, Veazie PJ, Lyness JM. Primary care physician office visits for depression by older Americans. J Gen Intern Med 2006; 21:926.
  4. Mitchell AJ, Vaze A, Rao S. Clinical diagnosis of depression in primary care: a meta-analysis. Lancet 2009; 374:609.
  5. Cepoiu M, McCusker J, Cole MG, et al. Recognition of depression by non-psychiatric physicians--a systematic literature review and meta-analysis. J Gen Intern Med 2008; 23:25.
  6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
  7. Zimmerman M, Galione JN, Chelminski I, et al. Validity of a simpler definition of major depressive disorder. Depress Anxiety 2010; 27:977.
  8. Andrews G, Slade T, Sunderland M, Anderson T. Issues for DSM-V: simplifying DSM-IV to enhance utility: the case of major depressive disorder. Am J Psychiatry 2007; 164:1784.
  9. Zimmerman M, Galione JN, Chelminski I, et al. A simpler definition of major depressive disorder. Psychol Med 2010; 40:451.
  10. Zimmerman M, Chelminski I, McGlinchey JB, Young D. Diagnosing major depressive disorder X: can the utility of the DSM-IV symptom criteria be improved? J Nerv Ment Dis 2006; 194:893.
  11. The ICD-10 Classification of Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines. http://www.who.int/classifications/icd/en/bluebook.pdf (Accessed on December 04, 2013).
  12. Regier DA, Narrow WE, Clarke DE, et al. DSM-5 field trials in the United States and Canada, Part II: test-retest reliability of selected categorical diagnoses. Am J Psychiatry 2013; 170:59.
  13. Uher R, Payne JL, Pavlova B, Perlis RH. MAJOR DEPRESSIVE DISORDER IN DSM-5: IMPLICATIONS FOR CLINICAL PRACTICE AND RESEARCH OF CHANGES FROM DSM-IV. Depress Anxiety 2013.
  14. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, American Psychiatric Association, Washington, DC, 2000.
  15. McCullough JP Jr, Klein DN, Keller MB, et al. Comparison of DSM-III-R chronic major depression and major depression superimposed on dysthymia (double depression): validity of the distinction. J Abnorm Psychol 2000; 109:419.
  16. McCullough JP Jr, Klein DN, Borian FE, et al. Group comparisons of DSM-IV subtypes of chronic depression: validity of the distinctions, part 2. J Abnorm Psychol 2003; 112:614.
  17. Klein DN, Shankman SA, Lewinsohn PM, et al. Family study of chronic depression in a community sample of young adults. Am J Psychiatry 2004; 161:646.
  18. Yang T, Dunner DL. Differential subtyping of depression. Depress Anxiety 2001; 13:11.
  19. Zimmerman M, Ruggero CJ, Chelminski I, Young D. Clinical characteristics of depressed outpatients previously overdiagnosed with bipolar disorder. Compr Psychiatry 2010; 51:99.