MANAGEMENT OF MAJOR DEPRESSIVE DISORDER (MDD)

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CH Lim, B Baizury, on behalf of Development Group Clinical Practice Guidelines Management of Major Depressive Disorder

A. Introduction

Major depressive disorder (MDD) is a significant mental health problem that disrupts a person’s mood and affects his psychosocial and occupational functioning. It is often under-recognised and 30-50% of MDD cases in primary care and medical settings are not detected. Suicide occurs in up to 15% of hospitalised patients with severe MDD.

B. Screening

The routine use of screening instruments to identify depression is not recommended. However, the following two initial questions may be used to screen for depression:

  1. “During the past month, have you often been bothered by feeling down, depressed or hopeless?”
  2. “During the past month, have you often been bothered by having little interest or pleasure in doing things?”

If the answer is “Yes” to one or both questions, assess the patient for depression.

For this Two-Question Case-Finding Instrument, the reported sensitivity is 96% and specificity 57%, at a prevalence rate of 18%. Clinicians are encouraged to screen for at least these two core symptoms of depression, especially in high risk groups e.g. those with physical health problems causing disability, a past history of depression, a family history of depression and those with other mental health problems such as substance abuse or dementia.

C. Diagnosis

The diagnosis of MDD is made using internationally accepted diagnostic criteria i.e. either the 10th Revision of the International Classification of Diseases (refer Table 1) or the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders IV.

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