Description:

Major depressive disorder is a well-known mental illness that affects how you feel, think, and behave, causing persistent feelings of sadness and loss of interest in previously enjoyed activities. Depression can lead to a variety of emotional and physical problems. It is a chronic illness that usually requires long-term treatment. Bereavement exclusion was a rule in DSM-4 that said if people experience depressive symptoms shortly after the loss of their loved ones, they shouldn’t be diagnosed with Major Depressive Disorder unless the symptoms lasted more than two months or were very severe (e.g., suicidal thoughts). However, this exclusion is removed in DSM-5 because it might lead to missed opportunities for treatment, as intensive grief can sometimes trigger a major depressive episode. The World Health Organization once compared depression to a “black dog”—a heavy, shadowy presence that follows you around, takes away your energy, and distorts how you see the world. But like any dog, with the right care, support, and tools, it can be managed. It’s important to note that depression is a real medical condition, not a weakness or failure of character. Therapy(especially Cognitive behavior therapy, medication, and social support can help.

Diagnosis:

DSM-5-TR diagnostic criteria for a major depressive episode

1. Five (or more) of the following symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

NOTE: Do not include symptoms that are clearly attributable to another medical condition.

1) Depressed mood most of the day, nearly every day, as indicated by either subjective report (eg, feels sad, empty, hopeless) or observations made by others (eg, appears tearful). (NOTE: In children and adolescents, can be irritable mood.)

2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).

3) Significant weight loss when not dieting or weight gain (eg, a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (NOTE: In children, consider failure to make expected weight gain.)

4) Insomnia or hypersomnia nearly every day.

5) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).

6) Fatigue or loss of energy nearly every day.

7) Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).

8) Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by their subjective account or as observed by others).

9) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

1. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
2. The episode is not attributable to the direct physiological effects of a substance or to another medical condition.

NOTE: Criteria A through C represent a major depressive episode.

NOTE: Responses to a significant loss (eg, bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgement based on the individual’s history and the cultural norms for the expression of distress in the context of loss.

1. 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.
2. There has never been a manic or hypomanic episode.

NOTE: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition.

Specify:

With anxious distress

With mixed features

With melancholic features

With atypical features

With psychotic features

With catatonia

With peripartum onset

With seasonal pattern