Depression and psychiatric disease associated with outcomes after anterior cruciate ligament reconstruction

Table 1 Diagnostic criteria of major depressive disorder¹

DSM-V	Diagnostic Criteria
Major depressive disorder	Patient reports at least five of nine of the following depressive symptoms most of the day or almost every day for at least two weeks: (1) Depressed mood that may be characterized by sadness, emptiness or hopelessness; (2) Markedly diminished interest or pleasure in all or almost all activities; (3) Significant unexpected weight loss; (4) Inability to sleep or oversleeping; (5) Psychomotor agitation or retardation; (6) Fatigue or loss of energy; (7) Feelings of worthlessness or inappropriate guilt; (8) Diminished ability to think, concentrate or make decisions; (9) Recurrent thoughts of death, suicidal ideation without a specific plan or a specific suicide attempt or specific plan for committing suicide
	Symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning
	The episode is not due to the effects of substance or to a medical condition
	The occurrence is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders
	There has never been a manic episode or a hypomanic episode

¹Adapted from the DSM-V guidelines.

Table 2 Systemic effects of clinical depression on immune system and hypothalamic-pituitary-adrenal axis

Target system	Effect
Immunologic system	Increased interleukin-1 Increased interleukin-6 Increased tumor necrosis factor-α
Musculoskeletal system	Decreased bone formation Increased bone resorption (likely 2/2 increased interleukin-1 and subsequent osteoclast activity)
Hypothalamic-pituitary-adrenal axis	Increased cortisol

Table 3 Patient Health Questionnaire 2¹

Over the past 2 wk, how often have you been bothered by any of the following problems?	Not at all	Several days	More than half the days	Nearly every day
Litter interest or pleasure in doing things	02	12	22	32
Feeling down, depressed, or hopeless	02	12	22	32

¹Adapted from Arroll et al[86];

²Sum points from both questions (range 0-6). A score of 3 or higher is considered positive and should be further evaluated by Patient Health Questionnaire-9.

Table 4 Diagnostic criteria for major depressive disorder utilizing SIGECAPS mnemonic¹

Sleep	Insomnia or hypersomnia nearly every day
Interest	Markedly diminished interest or pleasure in nearly all activities most of the time
Guilt	Excessive or inappropriate feelings of guilt or worthlessness most of the time
Energy	Loss of energy or fatigue most of the time
Concentration	Diminished ability to think or concentrate; indecisiveness most of the time
Appetite	Increase or decrease in appetite
Psychomotor	Observed psychomotor agitation/retardation
Suicide	Recurrent thoughts of death/suicidal ideation

¹Adapted from the Diagnostic and Statistical Manual of Mental Disorder, 4^th ed.