Depression, also known as major depressive disorder or clinical depression, is a serious and common mood disorder. Those who suffer from depression experience persistent feelings of sadness and hopelessness and lose interest in activities they once enjoyed. In addition to emotional problems caused by depression, people may also have a physical symptom, such as chronic pain or digestive problems. Changes in appetite, including increased appetite or decreased appetite, are also common symptoms of major depressive disorder. Other DSM-5 symptoms include decreased concentration, psychomotor agitation, and weight gain. To be diagnosed with depression, symptoms must be present for at least two weeks. The DSM-5 criteria for major depressive disorder are specific and require that the person experience a depressed mood most of the day, for more days than not, for at least two weeks. Individuals may report that they ‘feel sad’ or may be observed to ‘appear tearful’ during clinical assessment.
The symptom must be new or clearly worsened compared to the person’s pre-episode state and should persist most of the day, every day, for at least 2 weeks in a row. In children and adolescents, depressive symptoms may present as an irritable mood rather than a depressed mood, and symptoms such as failure to gain weight should be considered. Exclude symptoms that are clearly due to a general medical condition, delusions incongruous with mood, or hallucinations incongruous with mood. Clinicians must also rule out delusional disorder, schizoaffective disorder, schizophreniform disorder, other psychotic disorders, and unspecified schizophrenia spectrum disorders as possible explanations for the symptoms. A mixed episode is characterized by the symptoms of a major depressive episode and a manic episode that occur almost daily for at least a period of 1 week. It is important to distinguish between depressive episodes, hypomanic episodes, hypomanic like episodes, and manic like episodes, as well as identifying substance induced mood symptoms. Ruling out a hypomanic episode or manic or hypomanic episode is essential to distinguish major depressive disorder from bipolar disorder. When grief and depression coincide, grief is more severe and lasts longer than grief without depression. Pain and depression can coexist for some people, the death of a loved one, losing a job, or being the victim of physical assault or serious disaster can lead to depression. Family history, multiple adverse childhood experiences, stressful life events, and a lack of close interpersonal relationships all increase the risk for major depressive disorder. When assessing symptoms, clinicians should consider the individual’s history and cultural norms to ensure accurate diagnosis. A discriminant analysis was conducted to examine whether the DSM-5 criteria accurately distinguished between non-depressed, moderately depressed and severely depressed groups as defined by the 17-item HAMD scores.
As expected, all DSM-5 symptoms were found to be more frequent in the groups with severe depression and moderate depression compared to the control group (not depressed). Mild or moderate depression and mild episodes generally have a better prognosis and fewer complications. In the context of suicidal ideation and risk, a history of suicide attempt is a critical factor in assessment, and fear and self reproach are common emotional experiences in major depressive disorder, but the disorder encompasses not just fear but a broader range of emotional distress. It is important to evaluate for suicidal ideations in individuals with major depressive disorder. Individuals with major depressive disorder are at high risk for self destructive behavior, and untreated depression can lead to developing self destructive behavior as a maladaptive coping mechanism. In addition to the diagnostic criteria for major depressive disorder, changes published in DSM-5 included the addition of new prescribers and depressive mood disorders. A person with persistent depressive disorder (formerly called dysthymic disorder) has a depressed mood most of the day, for more days than not, for at least two years.
Major depression should be differentiated from other forms of depression for accurate diagnosis and treatment planning. Anxiety disorder frequently co-occurs with major depressive disorder and should be considered in diagnostic evaluations. Some individuals with major depressive disorder may experience psychotic symptoms, which can influence prognosis and treatment. Medical conditions such as multiple sclerosis can also cause depressive symptoms and should be considered in the differential diagnosis. Early diagnosis and reducing stigma associated with mental illness are important for improving outcomes. Individuals are encouraged to seek treatment for depression as early intervention can improve prognosis. The goal of treatment is to relieve depression and improve daily functioning. Neurobiological mechanisms, including mood regulation, play a significant role in major depressive disorder.
Pharmacological treatments for major depressive disorder include monoamine oxidase inhibitors, tricyclic antidepressants, atypical antidepressants, serotonin norepinephrine reuptake inhibitors, and selective serotonin reuptake inhibitors. Electroconvulsive therapy is an option for severe or treatment-resistant cases. Talk therapy is also effective for major depressive disorder. Adjunctive therapies, such as mood-stabilizers or antipsychotics, may be used to enhance antidepressant effects in treatment-resistant cases.
Introduction to Major Depressive Disorder
Major Depressive Disorder (MDD) is a serious mental disorder that affects millions of people worldwide. Characterized by a persistent and overwhelming sense of sadness, hopelessness, and a loss of interest in daily activities, MDD can disrupt every aspect of a person's life. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association, is the primary reference used by mental health professionals to diagnose mental disorders, including major depressive disorder. According to the statistical manual, MDD is classified as a mood disorder and is defined by the occurrence of a major depressive episode—a period of at least two weeks marked by depressive symptoms that are noticeably different from the individual's usual functioning. Unlike bipolar disorder, which includes episodes of mania or hypomania, major depressive disorder is characterized solely by depressive episodes. Understanding the diagnostic criteria for MDD is essential for accurate diagnosis and effective treatment of this and other mental disorders.
Definition and Diagnostic Criteria
The DSM-5 outlines specific diagnostic criteria for Major Depressive Disorder to ensure accurate identification and treatment. To meet the criteria for MDD, an individual must experience at least five depressive symptoms during the same two-week period, and these symptoms must represent a clear change from previous functioning. One of the symptoms must be either a depressed mood or a marked loss of interest or pleasure in most activities. Additional symptoms can include significant weight loss or gain, insomnia or hypersomnia, persistent fatigue or loss of energy, feelings of excessive guilt or worthlessness, and recurrent suicidal ideation. These symptoms must cause clinically significant distress or impairment in important areas of daily life, such as work, school, or relationships. It is also crucial to exclude symptoms that are due to the direct physiological effects of a substance, medication, or another medical condition. The DSM-5 emphasizes that the presence of these symptoms must not be better explained by another disorder, ensuring that the diagnosis of major depressive disorder is both accurate and specific.
Differential Diagnosis
Accurately diagnosing major depressive disorder requires a careful process known as differential diagnosis. Because many mental disorders can present with similar depressive symptoms, a mental health professional must conduct a comprehensive psychiatric evaluation and review the individual’s medical history. The diagnostic and statistical manual (DSM-5) provides clear guidelines to help clinicians distinguish major depressive disorder from other depressive disorders, such as persistent depressive disorder, as well as from other mental health conditions like bipolar disorder, schizoaffective disorder, and anxiety disorders.
During the evaluation, the mental health professional will assess the duration, severity, and pattern of depressive symptoms, as well as any history of mood elevation or manic episodes, which could indicate bipolar disorder rather than major depressive disorder. Persistent depressive disorder, for example, is characterized by a chronic, less severe depressed mood lasting for at least two years, while schizoaffective disorder involves both mood symptoms and psychotic features. Anxiety disorders can also overlap with depressive symptoms, making it essential to differentiate between primary anxiety and depressive disorder.
The process of differential diagnosis is crucial for developing an effective treatment plan and ensuring that individuals receive the most appropriate care for their specific mental health needs. By following the criteria outlined in the statistical manual and conducting a thorough psychiatric evaluation, clinicians can accurately identify major depressive disorder and rule out other potential causes of depressive symptoms.
Depressive Symptoms and Suicidal Ideation
Depressive symptoms in major depressive disorder can be severe and wide-ranging, often including a persistently depressed mood, diminished interest in activities, and overwhelming feelings of guilt or worthlessness. Among these, recurrent suicidal ideation is one of the most serious symptoms and requires immediate clinical attention. The DSM-5 highlights the importance of assessing for suicidal thoughts and behaviors as part of the diagnostic assessment for MDD. This involves not only recognizing the presence of suicidal ideation through the individual's subjective report but also evaluating any history of suicide attempts or the development of a specific plan. The American Psychiatric Association recommends a comprehensive approach to treatment, which may include medication, psychotherapy, or a combination of both, to address both depressive symptoms and the risk of suicide. Early identification and intervention are critical in reducing the risk of suicide and improving outcomes for individuals experiencing major depressive episodes.
