Psychiatry

At least 5 of 9 symptoms (including depressed mood or anhedonia) present for ≥2 weeks, causing functional impairment. SIG-E-CAPS: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidality.

An SSRI (e.g., sertraline, escitalopram) combined with psychotherapy. ECT is reserved for refractory, psychotic, pregnant, severely suicidal, or catatonic patients.

Treatment-refractory depression, psychotic depression, severe suicidality, catatonia, pregnancy, or when rapid response is needed. It is highly effective and safe in pregnancy.

Suicide risk. Always directly ask about suicidal ideation, plan, intent, and access to means; this guides disposition (hospitalization vs outpatient).

≥1 week of elevated/irritable mood plus ≥3 symptoms: Distractibility, Impulsivity/Indiscretion, Grandiosity, Flight of ideas, Activity increase, decreased Sleep need, Talkativeness. Causes marked impairment or requires hospitalization.

Mood stabilizers (lithium, valproate, lamotrigine) or atypical antipsychotics (quetiapine, olanzapine). Lithium reduces suicide risk; lamotrigine is good for bipolar depression.