Depressive Disorders, Depression

Depressive Disorders are characterised by the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function. Here are the key types and their criteria:

Major Depressive Disorder (MDD):

• Symptoms: At least five symptoms present during the same 2-week period, representing a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
• Common Symptoms: Depressed mood most of the day, nearly every day; markedly diminished interest or pleasure in all, or almost all, activities; significant weight loss when not dieting or weight gain; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthlessness or excessive or inappropriate guilt; diminished ability to think or concentrate, or indecisiveness; recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
• Exclusion Criteria: The episode is not attributable to the physiological effects of a substance or another medical condition. Not better explained by another mental disorder.

Persistent Depressive Disorder (Dysthymia):

• Symptoms: Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least two years.
• Additional Criteria: Presence, while depressed, of two (or more) of the following: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness.
• Chronicity: Symptoms have persisted for two years with no more than two months symptom-free.
• Exclusion Criteria: The disturbance is not better explained by another mental disorder and is not attributable to the physiological effects of a substance or another medical condition.

Other Depressive Disorders:

• Disruptive Mood Dysregulation Disorder: Severe recurrent temper outbursts and persistent irritable or angry mood.
• Premenstrual Dysphoric Disorder: Mood swings, irritability, depression, or anxiety occurring in the week before menstruation and improving after onset of menses.
• Substance/Medication-Induced Depressive Disorder: Depression directly caused by a substance (drug of abuse, medication) or another medical condition.
• Depressive Disorder Due to Another Medical Condition: Depression directly attributable to the physiological effects of another medical condition.
• Other Specified Depressive Disorder: Used when symptoms characteristic of a depressive disorder cause clinically significant distress or impairment in social, occupational, or other important areas of functioning, but do not meet the full criteria for any of the disorders in the depressive disorders diagnostic class.
• Unspecified Depressive Disorder: Used when the clinician chooses not to specify the reason that the criteria are not met for a specific depressive disorder, and includes presentations in which there is insufficient information to make a more specific diagnosis.

Criteria Breakdown Major Depressive Disorder:

Certainly, the DSM-5 outlines specific criteria for Major Depressive Disorder (MDD) which are integral for its diagnosis. These criteria are detailed and include various factors, but for simplification, they can be divided into an A, B, C format:

1. Criterion A (Major Depressive Episode): This involves at least five of the following symptoms during the same 2-week period, representing a change from previous functioning; at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.

• Depressed mood most of the day, nearly every day.
• Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
• Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
• Insomnia or hypersomnia nearly every day.
• Psychomotor agitation or retardation nearly every day (observable by others).
• Fatigue or loss of energy nearly every day.
• Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
• Diminished ability to think or concentrate, or indecisiveness, nearly every day.
• Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

1. Criterion B (Clinical Significance): The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
2. Criterion C (Exclusion Criteria): The episode is not attributable to the physiological effects of a substance or another medical condition. Also, the occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.

Additionally, for a diagnosis of Major Depressive Disorder, there should never have been a manic or hypomanic episode, as these would indicate a bipolar disorder.

Criteria Breakdown for Persistent Depressive Disorder:

1. Criterion A (Depressed Mood): Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least two years.
2. Criterion B (Additional Symptoms): Presence, while depressed, of two (or more) of the following:

• Poor appetite or overeating.
• Insomnia or hypersomnia.
• Low energy or fatigue.
• Low self-esteem.
• Poor concentration or difficulty making decisions.
• Feelings of hopelessness.

1. Criterion C (Duration): During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than two months at a time.
2. Criterion D (Major Depressive Episode): Criteria for a major depressive episode may be continuously present for two years.
3. Criterion E (No Manic or Hypomanic Episode): There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.
4. Criterion F (Not Better Explained): The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorders.
5. Criterion G (Substance/Medical Exclusion): The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism).
6. Criterion H (Significant Distress): The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Like other disorders in the DSM-5, these criteria for Persistent Depressive Disorder are used by healthcare professionals for accurate diagnosis and treatment planning. It’s important for these diagnoses to be made by qualified healthcare professionals who can interpret these criteria in the context of a comprehensive clinical assessment.