DEPRESSION

Ask the following questions:

1. Is there associated headache, papilledema, dementia, or focal neurologic signs? These findings would suggest a space-occupying lesion. This is something the clinician does not want to miss.
2. Are there endocrine changes? A number of endocrinologic diseases may present with depression, including Cushing's disease, myxedema, hyperthyroidism, and menopause.
3. Is there marked loss of appetite, weight, and libido? Endogenous depression, unipolar depression, and the depressive phase of manic-depressive psychosis may present with these findings. On the other hand, neurotic depressive reaction usually is not associated with significant loss of appetite, weight, or libido.

DIAGNOSTIC WORKUP

If the patient is suicidal, one should not hesitate to make a psychiatric referral or plan hospitalization immediately. To rule out organic causes, routine laboratory studies include a CBC, sedimentation rate, chemistry panel, VDRL test, and thyroid profile. If Cushing's syndrome is suspected, a serum cortisol and cortisol suppression test should be done. If menopause is suspected, order a serum FSH and estradiol level. A trial of estrogen therapy may be warranted. A CT scan of the brain should probably be done in all cases to exclude a brain tumor, especially if there is no response to treatment! Office tests to evaluate nonorganic depression include the Beck Depression Inventory and the Hamilton Depression Scale. A referral to a psychiatrist should also be considered early if the depression is severe or if there is suicidal ideation.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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