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STEP 5: Determine type of depressive disorder
Types of Depression
➤ Major Depressive Disorder (MDD): Symptoms are experienced most
days and last for at least two weeks.
➤ Dysthymia: Symptoms of dysthymia are similar to MDD but are less
severe and last longer – at least two years.
➤ Bipolar disorder: Periods of depression and periods of mania with
normal mood in between.
➤ Melancholic depression: Severe form of depression characterized by
a near-complete absence of the capacity for pleasure, psychomotor
agitation or retardation, neurocognitive impairment, significant
weight loss or anorexia, interrupted sleep, and a diurnal variation
(mood and energy worse in the morning).
Types of Grief
➤ Grief: Grief after the death of a loved one is a normal reaction to loss
and generally does not require treatment.
➤ Complicated grief: Lasts a very long time (6-12 months) or/and is
severe and may require treatment.
STEP 4: Perform a medical evaluation
➤ When evaluating depression in older adults, consider checking blood
count, glucose level, thyroid-stimulating hormone and vitamin B12/
folate.
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➤ Cognitive assessment should be included in evaluation since
depression in older adults is also associated with cognitive
impairment. Refer to Table 7 in Dementia section.
➤ Evaluate for common medications which can induce or worsen
depressive symptoms or cause depression itself.
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➤ Evaluate for substance use (i.e., alcohol, illicit drugs).
• Anti-arrythmic medications
• Anticonvulsants
• Barbiturates
• Benzodiazepines
• Bromocriptine
• Calcium-channel blockers
• Carbidopa-levodopa
• Certain beta-adrenergic blockers
(e.g. propranolol)
• Clonidine
• Cytokines / Interferon alfa
• Digoxin
• Fluoroquinolone antibiotics
• Opioids
