SIGECAPS

Major depressive disorder (MDD) is a mood disorder that causes a persistent depressed, or low, mood and reduced interest in daily activities. MDD is different from normal changes in mood because it significantly impacts daily life. The signs and symptoms of depression include sleep disturbances, reduced interest in daily activities, guilt, decreased energy, difficulty concentrating, appetite changes, psychomotor changes, and suicidal ideation. MDD is more common in genetic females than genetic males and individuals with a first-degree relative with MDD have an increased risk of developing MDD during their lifetime. Although MDD can occur amongst all age groups, it is most common to have the initial episode in children, teenagers, and young adults. 

Healthcare professionals may use the patient health questionnaire (PHQ-9) to assist in making the diagnosis of MDD. This questionnaire is designed to quantify symptoms of depression and monitor severity. Professionals may also use the mnemonic SIGECAPS, which outlines the symptoms associated with MDD, during the exam to assess their risk.  

There are several different treatment options for MDD. This can range from a variety of medication therapies, cognitive behavioral therapy (CBT), or different types of brain stimulation therapy. For those with treatment-resistant major depressive disorder, neurostimulation may be appropriate. Electroconvulsive therapy (ECT), a type of neurostimulation, uses electric pulses to stimulate a seizure while under anesthesia. While the mechanism of action is unclear, it is a safe treatment option for those who have not responded to more traditional methods. It can also be used when depression exists alongside psychosis (e.g., delusions, hallucinations); or those who have attempted suicide and are not responding to medication. Its success rate ranges between 58% to 70%. Repetitive transcranial magnetic stimulation (RTMS) is another form of neurostimulation that uses magnetic fields to stimulate an electric current throughout the brain. Unlike ETC, RTMS does not require anesthesia. Vagal nerve stimulation is a less commonly used method, which requires a neurosurgical procedure to stimulate the vagal nerve.  

Light therapy is also used for those with seasonal affective disorder, a form of depression related to how much sunlight a person is exposed to. During periods of darkness, like during winter or fall, individuals may develop symptoms of major depressive disorder that resolve as the seasons change. Thirty minutes of white light exposure per day may be recommended during these darker months. 

The “A” in SIGECAPS means appetite changes, which can refer to either a significant reduction or an increase in appetite. Individuals may report that they are not hungry and no longer eat consistent meals throughout the day or they may find that they now binge eat. 

The second “S” in SIGECAPS refers to suicidal ideation. Individuals with suicidal ideation may talk about wanting to die, feelings of hopelessness, feelings of being a burden to others, guilt, or express how they would kill themselves. Studies have shown that those with MDD have a 2 to 15% rate of suicide completion and genetic males have double the rate of suicide compared to genetic females. Suicide is the second leading cause of death amongst 15- to 34-year-old individuals.  

The P4 screening questionnaire may be used to assess the risk of suicide in a person. This survey has four questions asking, “Have you ever attempted to harm yourself in the past?”, “Have you thought about how you might hurt yourself?”, “How likely are you to act on these thoughts about hurting yourself or ending your life?”, and “Is there anything that would prevent or keep you from harming yourself?”  If one expresses suicidal ideation, it is important to ask about their access to weapons, such as guns, because that is one of the highest risk factors for completing a suicide attempt. Those with active suicidal plans may require hospitalization.