SLIDE 3 10/18/2017 3
Epidemiology of major depressive disorder
- Lifetime prevalence (10 countries)
~ 3% to 17%
- Annual prevalence rate US 6.7%
- Lifetime prevalence rate US 16.5%
- Women (2x as high as men)
- Younger adults
- Frequently undetected in the absence
- f screening
- ~ 10% to 47% of cases undetected
Andrade et al. Int J Methods Psychiatr Res 2003 Kessler et al. Arch Gen Psychiatry 2005 Pignone et al. Ann Intern Med 2002
RISK FACTORS
- Prior depressive episode
- Family history
- Female gender
- Childbirth
- Childhood trauma
- Stressful life events
- Poor social support
- Serious medical illness
- Dementia
- Substance abuse
0% 2% 4% 6% 8% 1991/1992 2001/2002 POINT PREVALENCE in US
Depression: diagnosis and natural history
- Untreated depression
- Poorer quality of life
- Increased risk of suicide
- Poorer outcomes when co-
- ccurring w/ medical conditions
- Few patients discuss depressive
symptoms – more often present w/ somatic symptoms
- Estimated 50% of patients w/
major depression are identified
DMS-5, Major Depression Tylee and Gandhi. Prim Care Companion J Clin Psychiatry 2005 Simon et al. NEJM 1999 Mitchell et al. Lancet 2009
5 symptoms present most of the day nearly every day at least 2 weeks
- Depressed mood*
- Loss of interest or pleasure in most
- r all activities*
- Insomnia or hypersomnia
- Change in appetite or weight
- Psychomotor retardation or agitation
- Low energy
- Poor concentration
- Thoughts of worthlessness or guilt
- Recurrent thoughts about death or
suicide
Hormones and depression
- Over-production of corticotropin releasing
hormone excess activity of HPA axis
- Higher concentration of inflammatory
markers
- Abnormal functioning of neurotransmitters
(serotonin, norepi, dopamine, GABA, glutamate)
- Estrogen modulates serotonergic function
- Progestins with low androgenicity may be
more favorable with mood symptoms
Joffe et al. Biol Psychiatry 1998 Schaffir et al. Eur J Contraception Reprod Health Care 2016
Etiology of depression
Wittenborn et al. Psychological Medicine 2015
