Depressive disorders are characterized by persistent low mood, loss of interest and enjoyment and reduced energy. They often impair day-to-day functioning.
It is characterized by one of more major depressive episodes for at least 2 weeks

Clinical Features

Typical Symptoms
  • Depressed mood – most characteristic feature. It get worst in early morning or in the evening
  • Loss of interest and enjoyment
  • Reduced energy leading to increased fatigability and diminished activity.

Core Symptoms
  • Reduced concentration and attention
  • Reduced self-esteem and self-confidence
  • Ideas of guilt and unworthiness
  • Pessimistic views of future
  • Ideas and acts of self-harm or suicide
  • Disturbed sleep
  • Diminished appetite

Somatic Symptoms
  • Diurnal mood variation
  • Loss of emotional reactivity
  • Anhedonia – inability to feel pleasure in normal pleasurable activities
  • Loss of appetite and weight
  • Early morning wakening
  • Loss of libido
  • Psychomotor retardation

Psychotic Symptoms
  • Delusion
  • Hallucination
  • Depressive stupor

Clinically Significant Depressive Episodes (Minimum Criteria)

Presence of at least 2 typical symptoms + at least 2 core symptoms
  • Mild – 2 typical symptoms + 2 core symptoms
  • Moderate - 2 typical symptoms + 3 core symptoms
  • Severe - 3 typical symptoms + 4 core symptoms


  • No specific treatment. Exclude other treatable or secondary cause (eg – loss of appetite, alcohol misuse)
  • Standard tests such as CBC, ESR, Vit B12 and folate, LFT, TFT, glucose, Calcium
  • Others – Thyroid antibody, antinuclear antibody, syphilis serology, EEG, HIV test, Dexamethasone suppression test


  • It depends on need of patient, general health status, other medication taking, types of depression illness and side effects of the drugs.
  • Cyclic antidepressant – Imipramine, Amitryptyline, Desipramine, Nortriptyline, Mianserin
  • Selective Serotonin Reuptake Inhibitors (SSRIs) – Fluoxetine, Paroxetine, Fluvoxamine

Electroconvulsive Therapy (ECT) – Only indicated in selected situations such as those with high risk of suicide, depression stupor, psychotic symptoms and when antidepressants are ineffective.

Psychosocial Treatment
  • Cognitive behavior therapy
  • Interpersonal therapy
  • Group therapy
  • Family and marital therapy
  • Nursing Management