from docx import Document
from docx.shared import Pt, Inches, RGBColor
from docx.enum.text import WD_ALIGN_PARAGRAPH
from docx.enum.table import WD_TABLE_ALIGNMENT
from docx.oxml.ns import qn
from docx.oxml import OxmlElement

doc = Document()

style = doc.styles["Normal"]
style.font.name = "Calibri"
style.font.size = Pt(11)

NAVY = RGBColor(0x1F, 0x3A, 0x5F)
ACCENT = RGBColor(0x2E, 0x74, 0xB5)

def set_cell_shading(cell, color_hex):
    tcPr = cell._tc.get_or_add_tcPr()
    shd = OxmlElement('w:shd')
    shd.set(qn('w:val'), 'clear')
    shd.set(qn('w:color'), 'auto')
    shd.set(qn('w:fill'), color_hex)
    tcPr.append(shd)

def heading(text, level=1):
    h = doc.add_heading(text, level=level)
    for run in h.runs:
        run.font.color.rgb = NAVY
    return h

def bullet(text, bold_lead=None):
    p = doc.add_paragraph(style="List Bullet")
    if bold_lead:
        r = p.add_run(bold_lead)
        r.bold = True
        p.add_run(text)
    else:
        p.add_run(text)
    return p

def subbullet(text, bold_lead=None):
    p = doc.add_paragraph(style="List Bullet 2")
    if bold_lead:
        r = p.add_run(bold_lead)
        r.bold = True
        p.add_run(text)
    else:
        p.add_run(text)
    return p

def note(text):
    p = doc.add_paragraph()
    r = p.add_run(text)
    r.italic = True
    r.font.size = Pt(9.5)
    r.font.color.rgb = RGBColor(0x60, 0x60, 0x60)
    return p

# ---------------- TITLE PAGE ----------------
title = doc.add_paragraph()
title.alignment = WD_ALIGN_PARAGRAPH.CENTER
run = title.add_run("DEPRESSION (MAJOR DEPRESSIVE DISORDER)")
run.bold = True
run.font.size = Pt(26)
run.font.color.rgb = NAVY

sub = doc.add_paragraph()
sub.alignment = WD_ALIGN_PARAGRAPH.CENTER
r2 = sub.add_run("Study Guide: Diagnostic Criteria, Symptoms, Clinical Features & Treatment")
r2.font.size = Pt(14)
r2.font.color.rgb = ACCENT

src = doc.add_paragraph()
src.alignment = WD_ALIGN_PARAGRAPH.CENTER
r3 = src.add_run("Compiled from Kaplan & Sadock's Comprehensive Textbook of Psychiatry, Kaplan & Sadock's Synopsis of Psychiatry, "
                  "The Maudsley Prescribing Guidelines in Psychiatry, and DSM-5 diagnostic framework")
r3.font.size = Pt(10)
r3.italic = True

doc.add_page_break()

# ---------------- 1. OVERVIEW & DEFINITIONS ----------------
heading("1. Overview and Definitions", level=1)
doc.add_paragraph(
    "Mood disorders are psychiatric syndromes in which pathologic, sustained mood states dominate the clinical "
    "picture, accompanied by vegetative and psychomotor disturbances. Major Depressive Disorder (MDD, unipolar "
    "depression) is the most common mood disorder, presenting as a single episode or as recurrent episodes."
)
bullet("Single-episode course can be protracted (up to 2 years or longer).", "Course: ")
bullet("Roughly 3 of 4 patients with MDD experience recurrence over their lifetime; prognosis for any single acute "
       "episode is generally good, but residual symptoms between episodes are common.", "Recurrence: ")
bullet("A DSM-5 term for the older 'dysthymic disorder' — a low-grade, intermittent, protracted depressive "
       "substrate lasting ≥2 years, from which full MDD episodes often arise. ~40% of MDD patients also meet "
       "criteria for persistent depressive disorder ('double depression'), which carries a poorer prognosis.",
       "Persistent Depressive Disorder (Dysthymia): ")
bullet("Cyclothymic and dysthymic conditions can exist in the community without progressing to full mood "
       "episodes — best considered 'trait' depressive/bipolar conditions.", "Subthreshold states: ")

heading("2. Epidemiology", level=1)
bullet("Point prevalence 12.9%; 1-year prevalence 7.2%; lifetime prevalence 10.8% (pooled meta-analysis, 90 "
       "studies, 30 countries, >1 million participants).", "Global: ")
bullet("1-year prevalence of a major depressive episode = 7.1% (NSDUH/SAMHSA data, DSM-5 criteria) — closely "
       "matching international figures.", "United States: ")
bullet("Depression is one of the most disabling and economically costly disorders, often striking during peak "
       "productive years; roughly 15% of the population experiences a major depressive episode at some point "
       "in life, and 6-8% of primary care outpatients meet criteria at any given time.", "Burden: ")
bullet("Depression is bidirectionally linked with physical illness: prior depression raises risk of heart disease "
       "and diabetes, while cardiovascular disease, stroke, chronic pain, obesity, diabetes, epilepsy, other CNS "
       "disorders, and cancer carry a 2-4x increased risk of MDD.", "Medical comorbidity: ")

doc.add_page_break()

# ---------------- 3. DIAGNOSTIC CRITERIA ----------------
heading("3. Diagnostic Criteria (DSM-5)", level=1)

heading("3.1 Core Criteria for a Major Depressive Episode", level=2)
doc.add_paragraph(
    "Five (or more) of the following nine symptoms present during the same 2-week period, representing a change "
    "from previous functioning; at least one symptom must be (1) depressed mood or (2) anhedonia. Symptoms must "
    "cause clinically significant distress or impairment and not be attributable to a substance, another medical "
    "condition, or better explained by another disorder (e.g., schizoaffective disorder, bereavement)."
)
criteria = [
    "Depressed mood most of the day, nearly every day (subjective report or observation; can be irritable mood in children/adolescents).",
    "Markedly diminished interest or pleasure in almost all activities (anhedonia), most of the day, nearly every day.",
    "Significant weight loss/gain (>5% body weight in a month) or decreased/increased appetite nearly every day.",
    "Insomnia or hypersomnia nearly every day.",
    "Psychomotor agitation or retardation nearly every day (observable by others, not just subjective restlessness/sluggishness).",
    "Fatigue or loss of energy nearly every day.",
    "Feelings of worthlessness or excessive/inappropriate guilt nearly every day.",
    "Diminished ability to think, concentrate, or make decisions nearly every day.",
    "Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, a suicide attempt, or a specific plan for suicide.",
]
for c in criteria:
    bullet(c)
note("Duration threshold: minimum 2 weeks of symptoms is the traditional requirement; in the context of a new "
     "medical diagnosis (e.g., brain tumor), some clinicians prefer to allow at least 1 month before diagnosing "
     "a mood disorder — Kaplan & Sadock's CTP.")

heading("3.2 Specifiers Used to Characterize an Episode", level=2)
subbullet("Involves loss of pleasure and reduced mood reactivity, plus ≥3 of: despair/depressed mood quality, "
          "symptoms worse in the morning, early morning awakening, psychomotor changes, significant appetite/weight "
          "loss, excessive guilt.", "With melancholic features: ")
subbullet("Mood reactivity present, with ≥2 of: weight gain/increased appetite, hypersomnia, leaden paralysis, "
          "long-standing pattern of interpersonal rejection sensitivity.", "With atypical features: ")
subbullet("Mood-congruent or mood-incongruent delusions/hallucinations accompanying the episode.",
          "With psychotic features: ")
subbullet("≥2 of: feeling tense/keyed up, unusual restlessness, difficulty concentrating due to worry, fear that "
          "something awful may happen, fear of losing control.", "With anxious distress: ")
subbullet("Full criteria for a depressive episode are met along with ≥3 manic/hypomanic symptoms not meeting full "
          "manic/hypomanic criteria.", "With mixed features: ")
subbullet("Onset during pregnancy or within 4 weeks postpartum.", "Peripartum onset: ")
subbullet("Regular temporal relationship between episode onset/remission and a particular time of year (e.g., "
          "winter).", "Seasonal pattern: ")
subbullet("Longitudinal course specifiers describe pattern over the prior 2 years: with pure dysthymic syndrome "
          "(criteria for a depressive episode not met over 2 years), with persistent major depressive episode "
          "(full criteria met continuously for 2 years), and with intermittent major depressive episode "
          "(with or without a current episode, and ≥8 symptom-free weeks somewhere in the prior 2 years).",
          "Course specifiers: ")

heading("3.3 Key Differential Diagnoses", level=2)
bullet("Depressive Disorder Due to Another Medical Condition — requires clinical evidence of a prominent, "
       "persistent, socially disruptive mood change occurring in the context of a diagnosed medical condition "
       "(e.g., brain tumor, stroke, hypothyroidism); adjustment disorder with depressed mood and delirium must be "
       "excluded first. Can be specified 'with major depressive-like episode' (full MDE criteria met) or 'with "
       "depressive features' (prominent mood change, full criteria not met).")
bullet("Bipolar I/II Disorder — must screen for any history of manic or hypomanic episodes before labeling a "
       "depressive presentation as unipolar; misdiagnosis is common, especially in Bipolar II.")
bullet("Bereavement/Normal Grief — most bereaved individuals experience intense sadness, but only a minority meet "
       "full DSM-5 criteria for a major depressive episode; grief is fluid, mixes positive and negative emotion, "
       "and is not equivalent to depression, though DSM-5 no longer excludes an MDD diagnosis solely because "
       "symptoms follow a loss.")
bullet("Adjustment Disorder with Depressed Mood — subthreshold symptoms following an identifiable stressor.")
bullet("Depression may also present as marked anhedonia without depressed mood (recognized, for example, in "
       "pituitary tumor and glioma patients) — a distinct clinical picture from the classic sad-mood presentation.")

doc.add_page_break()

# ---------------- 4. SYMPTOMS & CLINICAL FEATURES ----------------
heading("4. Symptoms and Clinical Features", level=1)

heading("4.1 Core Mood and Cognitive Symptoms", level=2)
for t in ["Persistent sad, low, or empty mood (or irritability in youth).",
          "Anhedonia — loss of interest or pleasure in previously enjoyable activities.",
          "Feelings of worthlessness, hopelessness, or excessive/inappropriate guilt.",
          "Difficulty concentrating, indecisiveness, impaired memory.",
          "Recurrent thoughts of death or suicide, with or without a plan or attempt.",
          "A person may meet full criteria for a major depressive episode without a subjectively 'depressed' mood — depression can manifest primarily as decreased capacity for pleasure or interest."]:
    bullet(t)

heading("4.2 Neurovegetative (Somatic) Symptoms", level=2)
for t in ["Sleep disturbance — insomnia (commonly early morning awakening) or hypersomnia.",
          "Appetite/weight change — reduced appetite and weight loss, or increased appetite and weight gain.",
          "Psychomotor changes — observable agitation (restlessness, pacing) or retardation (slowed speech/movement).",
          "Fatigue or loss of energy, even for minor tasks."]:
    bullet(t)

heading("4.3 Presentation in Special / Medically Ill Populations", level=2)
bullet("Diagnosis is complicated because neurovegetative symptoms (appetite loss, fatigue, sleep disturbance, "
       "psychomotor slowing, poor concentration) overlap with disease- or treatment-related symptoms. Diagnosis "
       "leans more heavily on dysphoria, anhedonia, hopelessness, worthlessness, excessive guilt, and suicidal "
       "ideation to distinguish true depression from illness effects. Delirium must be ruled out before "
       "diagnosing a mood disorder in the medically ill.", "Cancer patients: ")
bullet("Pooled prevalence of poststroke depression is ~29% at any time point (cumulative incidence 39-52% within "
       "5 years); risk factors for poststroke suicide include the depression itself, pre-existing mood disorder, "
       "prior stroke, cognitive impairment, and lower education.", "Stroke patients: ")
bullet("MDD is more common in glioma/brain tumor patients than the general population (~11-20% depending on "
       "methodology); a subset shows marked anhedonia without depressed mood, a distinct clinical picture from "
       "classic sad-mood depression.", "Brain tumor patients: ")
bullet("Poor memory and impaired concentration are more likely to be the presenting complaint; hallmark "
       "psychological symptoms (guilt, worthlessness) may be less prominent, and vegetative symptoms may be "
       "misattributed to aging or comorbid illness.", "Older adults: ")

doc.add_page_break()

# ---------------- 5. ETIOLOGY / RISK FACTORS ----------------
heading("5. Etiology and Risk Factors (Brief)", level=1)
bullet("Genetic loading, monoamine (serotonin/norepinephrine/dopamine) dysregulation, HPA-axis hyperactivity, "
       "neuroinflammation, and structural/functional connectivity changes (e.g., in prefrontal-limbic circuits).",
       "Biological: ")
bullet("Prior personal or family history of depression, early adverse experiences, chronic stress, poor social "
       "support, low self-esteem, recent significant loss.", "Psychosocial: ")
bullet("Corticosteroids, interferon, some chemotherapeutic agents (vinblastine, vincristine, procarbazine, "
       "asparaginase), tamoxifen; comorbid cardiovascular disease, stroke, cancer, endocrine disorders "
       "(hypothyroidism), chronic pain, substance use.", "Medical / substance-related: ")
bullet("Anxiety disorders (~60%), substance use disorders (~25%), and impulse control disorders (~30%) are "
       "highly prevalent among patients with lifetime MDD — always screen for comorbidity.", "Psychiatric comorbidity: ")

# ---------------- 6. TREATMENT ----------------
heading("6. Treatment", level=1)

heading("6.1 Foundations of Management", level=2)
bullet("A thorough biopsychosocial assessment (safety/suicidality, comorbid psychiatric and medical conditions, "
       "prior treatment response, family/social history, concurrent medications) underlies quality care; rule out "
       "bipolar disorder before starting an antidepressant.", "Assessment: ")
bullet("Acute-phase goal is remission (≈HAM-D ≤7 or MADRS ≤10), not just response (≥50% symptom reduction) — "
       "failure to reach remission raises recurrence risk. Functional recovery and quality of life are "
       "increasingly prioritized alongside symptom scores.", "Treatment goals: ")
bullet("MDD is typically a disorder of recurrent episodes; treatment planning should address acute, continuation, "
       "and maintenance phases from the outset.", "Course-oriented care: ")

heading("6.2 Pharmacotherapy", level=2)
table = doc.add_table(rows=1, cols=3)
table.style = "Light Grid Accent 1"
table.alignment = WD_TABLE_ALIGNMENT.CENTER
hdr = table.rows[0].cells
hdr[0].text = "Class"
hdr[1].text = "Examples"
hdr[2].text = "Key Notes"
for c in hdr:
    set_cell_shading(c, "1F3A5F")
    for p in c.paragraphs:
        for r in p.runs:
            r.font.color.rgb = RGBColor(255, 255, 255)
            r.bold = True

rows = [
    ("SSRIs", "Sertraline, escitalopram, fluoxetine, paroxetine, citalopram, fluvoxamine",
     "First-line agents worldwide for three decades; favorable safety/tolerability. Fluvoxamine uniquely "
     "FDA-approved for OCD (not MDD) in the US, though it shares the class's antidepressant activity. "
     "Sertraline is often first-line in cardiac patients (SADHART trial) and commonly used first-line in older adults (NICE)."),
    ("SNRIs", "Venlafaxine, duloxetine",
     "Dual serotonin-norepinephrine reuptake inhibition; may produce higher remission rates than SSRIs in some head-to-head studies."),
    ("Atypical agents", "Bupropion, mirtazapine, nefazodone, trazodone",
     "Nefazodone: 5-HT2A antagonism plus 5-HT reuptake inhibition; comparable efficacy to SSRIs with less sleep "
     "disturbance, weight gain, and sexual dysfunction (dose range 300-500 mg/day). Useful for patients "
     "prioritizing avoidance of specific SSRI side effects."),
    ("TCAs", "Imipramine, amitriptyline, nortriptyline",
     "Effective but less favorable side-effect/toxicity profile (anticholinergic, cardiac, overdose lethality); "
     "reserved as alternative when SSRIs are ineffective or not tolerated (e.g., in Parkinson disease when SSRIs worsen motor symptoms)."),
    ("MAOIs", "Phenelzine, tranylcypromine",
     "Effective, particularly in atypical depression; dietary tyramine restriction and drug interaction risk limit routine use."),
    ("Augmentation / other", "Lithium, atypical antipsychotics, esketamine, ECT/TMS (see 6.4)",
     "Used for partial response or treatment-resistant depression (generally defined as inadequate response to ≥2, "
     "often ≥4, adequate antidepressant trials)."),
]
for a, b, c in rows:
    row = table.add_row().cells
    row[0].text = a
    row[1].text = b
    row[2].text = c

doc.add_paragraph()
bullet("SSRIs/SNRIs remain first-line for most adults with moderate-severe MDD due to favorable tolerability, "
       "despite some evidence that dual-action agents (MAOIs, TCAs, venlafaxine, mirtazapine) may achieve higher "
       "remission in head-to-head trials.", "Choosing an agent: ")
bullet("Antidepressants are not recommended as first-line treatment for less severe depression per NICE guidance — "
       "counselling, guided self-help, and CBT are preferred initial options in mild cases.", "Mild depression: ")

heading("6.3 Psychotherapy", level=2)
bullet("Historically arose from psychoanalytic/psychodynamic models (depression as internalized anger from "
       "unconscious conflict, treated via long-term insight-oriented work and interpretation of transference).",
       "Psychodynamic approaches: ")
bullet("Emerged from behavioral theory (depression as loss of reinforcement from reduced engagement in rewarding "
       "activities) and broadened by the 1970s to include cognitive components. Beck's cognitive therapy focuses "
       "on identifying and testing negative automatic thoughts and cognitive distortions, replacing them with "
       "more balanced alternatives; homework assignments reinforce skill generalization to daily life.",
       "Cognitive-Behavioral Therapy (CBT): ")
bullet("Time-limited, evidence-based, addresses interpersonal disputes, role transitions, grief, and social "
       "skill deficits linked to depressive episodes.", "Interpersonal Therapy (IPT): ")
bullet("CBT and other structured psychotherapies are comparably effective to antidepressants for mild-moderate "
       "MDD and are often combined with medication for moderate-severe or recurrent depression; combination "
       "therapy generally outperforms either modality alone for more severe or chronic presentations.",
       "Comparative efficacy: ")

heading("6.4 Somatic / Procedural Treatments (Treatment-Resistant or Severe Depression)", level=2)
bullet("Most effective treatment for severe, psychotic, or treatment-resistant depression and for cases requiring "
       "rapid response (e.g., high suicide risk, catatonia, pregnancy); requires anesthesia and induces a "
       "generalized seizure.", "Electroconvulsive Therapy (ECT): ")
bullet("Noninvasive option for treatment-resistant depression in patients who prefer to avoid ECT or medication "
       "side effects.", "Transcranial Magnetic Stimulation (TMS): ")
bullet("Rapid-acting options for treatment-resistant depression and acute suicidality, used as an adjunct to "
       "standard antidepressants.", "Ketamine / Esketamine: ")

doc.add_page_break()

# ---------------- 7. COURSE & PROGNOSIS ----------------
heading("7. Course and Prognosis", level=1)
bullet("Prognosis for recovery from a single acute episode is favorable for most patients.")
bullet("~75% of patients experience at least one recurrence over their lifetime; residual subthreshold symptoms "
       "between episodes are common and predict relapse.")
bullet("Comorbid persistent depressive disorder ('double depression') predicts a worse overall prognosis.")
bullet("Treatment-resistant depression is generally defined as inadequate response after ≥4 adequate treatment "
       "trials; requires reassessment of diagnosis (e.g., unrecognized bipolarity), adherence, and comorbidities "
       "before escalating to somatic treatments.")
bullet("Ongoing maintenance pharmacotherapy and/or psychotherapy reduces recurrence risk, particularly after "
       "multiple prior episodes.")

# ---------------- 8. QUICK REVIEW ----------------
heading("8. Quick-Review Summary", level=1)
qr_table = doc.add_table(rows=1, cols=2)
qr_table.style = "Light Grid Accent 1"
hdr2 = qr_table.rows[0].cells
hdr2[0].text = "Domain"
hdr2[1].text = "Key Point to Remember"
for c in hdr2:
    set_cell_shading(c, "1F3A5F")
    for p in c.paragraphs:
        for r in p.runs:
            r.font.color.rgb = RGBColor(255, 255, 255)
            r.bold = True

qr_rows = [
    ("Diagnosis", "≥5 of 9 symptoms, ≥2 weeks, must include depressed mood or anhedonia, causes impairment."),
    ("Core symptoms", "Depressed mood, anhedonia, guilt/worthlessness, poor concentration, suicidal ideation."),
    ("Somatic symptoms", "Sleep, appetite/weight, energy, and psychomotor changes."),
    ("Specifiers", "Melancholic, atypical, psychotic, anxious distress, mixed features, peripartum, seasonal."),
    ("First-line drug", "SSRI (or SNRI); reserve TCA/MAOI for non-response or specific indications."),
    ("First-line therapy", "CBT or IPT; comparable to medication for mild-moderate MDD."),
    ("Treatment goal", "Remission (not just response) to minimize recurrence risk."),
    ("Severe/resistant cases", "ECT, TMS, ketamine/esketamine, or augmentation (lithium, atypical antipsychotic)."),
    ("Recurrence risk", "~75% lifetime recurrence; maintenance treatment reduces relapse."),
]
for a, b in qr_rows:
    row = qr_table.add_row().cells
    row[0].text = a
    row[1].text = b

doc.add_paragraph()
note("Sources: Kaplan & Sadock's Comprehensive Textbook of Psychiatry (Depressive Disorders, Mood Disorders "
     "epidemiology/definitions, Pharmacotherapy for MDD, Psychotherapy for Depression, poststroke/cancer "
     "depression chapters); Kaplan & Sadock's Synopsis of Psychiatry; The Maudsley Prescribing Guidelines in "
     "Psychiatry, 15th ed.; DSM-5 diagnostic framework. This guide consolidates textbook content with standard "
     "DSM-5 criteria for study purposes and is not a substitute for the full text or clinical guidelines.")

doc.save("/tmp/workspace/depression-study-guide/Depression_Study_Guide.docx")
print("saved")