Assessing and Managing Major Depressive Disorder

Diagnostic Criteria and Assessment

The American College of Physicians recommends that Major Depressive Disorder (MDD) requires at least 5 symptoms present during a 2-week period, with at least one being either depressed mood or loss of interest/pleasure (anhedonia), causing functional impairment 1, 2
The diagnostic criteria for MDD include depressed mood or anhedonia, significant weight change or appetite disturbance, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive/inappropriate guilt, diminished concentration or indecisiveness, and recurrent thoughts of death or suicidal ideation 1

The American Psychiatric Association recommends using structured diagnostic interviews based on DSM-5 criteria, such as the Mini International Neuropsychiatric Interview or Structured Clinical Interview, to establish the diagnosis of MDD 2
The Patient Health Questionnaire-9 (PHQ-9) or Hamilton Depression Rating Scale (HAM-D) should be implemented to quantify baseline severity and monitor treatment response in patients with MDD 1, 2

The American College of Physicians recommends classifying the severity of MDD based on symptom count, intensity, and degree of functional impairment, with classifications including mild, moderate, and severe 2, 4
For mild MDD, cognitive behavioral therapy (CBT) alone is recommended as first-line treatment, while for moderate to severe MDD, either CBT or second-generation antidepressants (SGAs) should be initiated 4, 5, 2

The American Psychiatric Association recommends assessing response to treatment within 1-2 weeks of initiation and monitoring for therapeutic effects, adverse effects, and suicidality in patients with MDD 2
Treatment should be continued for 4-9 months after satisfactory response for first episodes, and for ≥1 year for recurrent episodes 2