A 52-year-old woman presents to her physician with a complaint of loss of libido and interest in life since being fired from her job 7 weeks ago. She feels tired all day which she attributes to the fact that she wakes up 3 hours earlier than usual. She has also been putting on weight recently and has difficulty concentrating on doing daily house chores and activities and lays in bed most of the time.
D) Tranylcypromine
Major depressive disorder is characterized by the presence of at least 5 out of 9 SIG E CAPS symptoms along with patient reported depressed mood or anhedonia, lasting 2 weeks. The SIGECAPS mnemonic helps us remember these 9 symptoms (depressed mood is obligatory to be included):
- S - Sleep disturbances
- I - Loss of Interest (anhedonic or depressed)
- G - Guilt
- E - Lack of Energy
- C - Lack of Concentration
- A - Appetite/weight changes
- P - Psychomotor retardation or agitation
- S - Suicidal thoughts
Answer choice A: Adjustment disorder, is incorrect. Adjustment disorder is not to be confused with generalized anxiety disorder. In adjustment disorder, emotional symptoms develop within 3 months of an identifiable stressor lasting < 6 months once the stressor has ended.
Answer choice B: Atypical depression, is incorrect. Atypical depression is the most common subtype of depression and is characterized by atypical features such as mood reactivity, leaden paralysis (heavy feeling in the limbs), reversed vegetative symptoms like hyperphagia or hypersomnia, and longstanding interpersonal rejection sensitivity. MAO inhibitors can be used to treat atypical depression but are not first-line therapy.
Answer choice C: Generalized anxiety disorder, is incorrect. Generalized anxiety disorder is anxiety lasting > 6 months in the absence of a stressor (contrast this with adjustment disorder).
Answer choice E: Post traumatic stress disorder (PTSD), is incorrect. Patients with PTSD have a prior history of trauma such as a war memory, witnessing the death of a loved one, or a rape. These patients have persistent hyperarousal, avoid associated stimuli, repeatedly reexperience the event (nightmares), and have changes in cognition of mood, all lasting > 1 month.
Key Learning Point
Major depression is characterized by the presence of at least 5 out of 9 SIG E CAPS symptoms, with patient reported depression lasting > 2 weeks.
