Depression for the American Board of Psychiatry & Neurology (ABPN) Exam
Major Depressive Disorder (MDD)
Diagnostic Criteria:
- Presence of at least five of the following symptoms during the same 2-week period, with at least one being either depressed mood or loss of interest or pleasure:
- Depressed mood most of the day, nearly every day.
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
- Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day.
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
- Diminished ability to think or concentrate, or indecisiveness, nearly every day.
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Treatment:
- Pharmacotherapy: SSRIs, SNRIs, atypical antidepressants, TCAs, and MAOIs. See this tutorial for a review of Antidepressants
- Psychotherapy: Cognitive Behavioral Therapy (CBT), Interpersonal Therapy (IPT), and Psychodynamic Therapy.
- Advanced Therapies: Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), and ketamine infusion therapy for treatment-resistant depression.
Persistent Depressive Disorder (Dysthymia)
- Characteristics:
- Chronic depressive symptoms lasting at least two years in adults (one year in children and adolescents).
- Generally fewer, less severe symptoms than MDD but more chronic and pervasive.
- Treatment:
- Similar to MDD, often requiring a combination of psychotherapy and pharmacotherapy.
- Long-term management strategies are crucial given the chronic nature of the disorder.
Adjustment Disorder with Depressed Mood
- Features:
- Development of emotional or behavioral symptoms in response to an identifiable stressor, occurring within three months of the onset of the stressor.
- Symptoms do not meet the criteria for another mental disorder and are not merely an exacerbation of a preexisting condition.
- Management:
- Typically time-limited; treatment focuses on supportive therapy, stress management techniques, and sometimes short-term use of antidepressants.
Seasonal Affective Disorder (SAD)
- Clinical Presentation:
- Recurrent episodes of depression that occur during specific seasons, most commonly in winter.
- Treatment:
- Light therapy is the first-line treatment.
- Depending on the severity, SSRIs and behavioral therapy may also be recommended.
Comorbid Conditions
- Common Comorbidities: Anxiety disorders, substance use disorders, bipolar disorder, and personality disorders.
- Management Considerations: Requires a comprehensive treatment plan addressing all co-occurring conditions to optimize outcomes.
Special Considerations
- Geriatric Depression: Careful with pharmacotherapy due to increased sensitivity to side effects and potential drug-drug interactions.
- Child and Adolescent Depression: Requires age-appropriate interventions, with a strong emphasis on family involvement and psychotherapy.
High-Yield Topics for ABPN Exam
- Diagnostic Skills: Accurate diagnosis using DSM-5 criteria, differentiating between similar disorders.
- Pharmacological Knowledge: In-depth understanding of drug mechanisms, appropriate selection, and management of side effects.
- Psychotherapy Techniques: Competence in applying evidence-based psychotherapy techniques.
- Ethical and Legal Considerations: Management of high-risk patients, including considerations for involuntary hospitalization and ensuring safety.