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SIGECAPS is your screening tool for depression. And with as high as a disease prevalence as seen with depression, this one must be kept in your back pocket.

It’s short - it’s sweet. It’s easy to remember, and it’s most useful both in test taking and patient care.

We will begin by breaking down the mnemonic, and finish with the value add: what we know about exactly how the USMLE tests, as well as your clinic and hospital patients, will present with this diagnosis.

Breaking Down the SIGECAPS Mnemonic for Diagnosing Depression

Sleep changes: Can happen in either direction; either spend all day in bed or anxiety/mania keeping a patient awake. Patients often wake up earlier than desired and cannot fall back to sleep.

Interest (loss of): The question here is, “Do you still find enjoyment in doing the things you like?” When the avid fisherman can’t be bothered to pick up his rod and reel, think of depression. Also known as “anhedonia.”

Guilt: Self-explanatory; blaming oneself for interpersonal or larger problems that are not one’s fault

Energy: Usually a lack of energy. If the energy cup runneth over, consider mania/bipolar disorder.

Concentration: Loss of some cognitive abilities, like memory and focus.

Appetite: Can swing in either direction, with binge eating or anorexia.

Psychomotor changes: Again, either direction - a general slowing or anxious increase in speed

Suicidal ideation: A spectrum from self-harm to suicide

How to use SIGECAPS for the USMLE and in the clinic

Now, what can we tell you about how this will present on your exam and with your patients? It will be rare that you will have to count out each and every one of the five out of nine symptoms (score a free point for “depressed mood”).

Your vignette should pitch you a pretty straightforward picture of a depressed patient.

But here’s where they can trip you up. Oftentimes you will have to tease away the diagnosis of “major depressive disorder” from other similar diagnoses.

For instance, if drug intoxication is to blame, then you are likely dealing with substance abuse disorder instead of “major depressive disorder (MDD).”

If the patient is experiencing manic episodes as well, it’s bipolar disorder, and not mere MDD.

If the sadness is in reaction to a major life event, it might be grief/bereavement (loss of spouse), or adjustment disorder (new job in a new city with high levels of stress and anxiety).

Diagnosing Depression in the Elderly Population

Be careful in the elderly population! Many times, depression can present as a form of dementia, sometimes referred to as “pseudo-dementia.” Depression presents differently in everyone, and in the elderly patient population, it can look just like classic cognitive decline.

Make sure your octogenarian’s difficulty concentrating, slow movements, and weight loss can’t be chalked up to a mood change before you label them as having dementia.

Depression Treatments

As far as treatments, the low hanging fruit is the SSRI. These drugs are well-tolerated, and almost always are the first-line choice for treatment. Be very familiar with the side effects (e.g., GI upset, sexual dysfunction). Your patient’s best shot at clinical improvement is combining pharmacotherapy with some sort of talk therapy, like cognitive behavioral therapy.

It is your responsibility as a clinician to suss out any suicidal (or homicidal) ideation that your patient might be having, and ensure they are not a danger to him or herself or others.

Photo by Sasha Freemind on Unsplash

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Brian Radvansky

Brian Radvansky

Brian believes that excellence comes from never taking "no" for an answer, and putting as much work into organizing one's studying as into studying itself. After producing an incredibly average MCAT score, he decided he was going to quadruple his efforts in preparing for Step 1. His greatest successes have brought students who were going to drop out of medicine altogether for fear of not matching to matching into their specialties of choice. He reminds students the importance of performing well on a single test, or even learning how to sell themselves can make an extreme difference in their futures. Students can rely on Brian to hold them accountable and make sure that they don't sabotage themselves with excuses. He can help them to totally reevaluate their approach to USMLE questions in a methodical, protocolized way that ultimately leads to more correct answers and a higher score. With his help, you will trim the excesses, and put all of your collective efforts into only the work that will improve your score. Through his residency admissions consulting, Brian has consistently revamped students applications by helping them to highlight their best (and sometimes hidden) characteristics, and get them to match into the programs they had ranked number one. He can help you to master your personal statement, and craft the story as to why your program of choice needs to have you as a resident. Brian will help you find that all too difficult balance of being proud of and selling your accomplishments, without coming forth as someone who is merely checking boxes to bolster their application.
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