Depressive Disorder

DEPRESSIVE DISORDER

INTRODUCTION

        In the field of mental health, the term depressive disorder is generally characterized as a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings and sense of well-being. They may also experience a lack of interest and pleasure in daily activities, significant weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt and recurrent thoughts of death or suicide.

        Most individuals experience depressed feelings sometime in life for short periods, often as the result of negative or unhealthy life events or simply, as Freud said, "everyday misery." The painful feelings that accompany these events are usually appropriate, normal and temporary, and can even present an opportunity for personal growth and improvement. However, when sadness persists and impairs daily life, it may indicate a depressive disorder. Severity, duration, and the presence of other symptoms are the factors that distinguish normal sadness from clinical depression.

        Mental health researchers and practitioners have come to recognize that depressive disorders exists in many forms, with variations in origin and severity. The American Psychiatric Association (APA), in its Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), identifies Depressive Disodrers which includes disruptive mood dysregulation disorder, major depressive disorder (including major depressive episode), persistent depressive disorder (dysthymia), premenstrual dysphoric disorder, substance/medication-induced depres­sive disorder, depressive disorder due to another medical condition, other specified de­pressive disorder, and unspecified depressive disorder. Unlike in DSM-IV, this chapter "Depressive Disorders" has been separated from the previous chapter "Bipolar and Re­lated Disorders." The common feature of all of these disorders is the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that signifi­ cantly affect the individual's capacity to function. What differs among them are issues of duration, timing, or presumed etiology. However, for the sake of brivety and clarity, this journal shall deal only with Major Depressive Disorder.

DSM-5 CRITERIA REQUIRED FOR DIAGNOSIS :

MAJOR DEPRESSIVE EPISODE

        To qualify for a diagnosis of major depressive episode, the patient must meet criteria A through E:

A. Five (or more) of the following symptoms have been present during the same 2-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.

1. Depressed mood most of the day, nearly every day, as indicated by either subjec­tive report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., 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 (e.g., 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 delu­ sional) nearly every day (not merely self-reproach or guilt about being sick).

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

 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation with­ out a specific plan, or a suicide attempt or a specific plan for committing suicide.

B. The symptoms cause clinically significant distress or impairment in social, occupa­ tional, or other important areas of functioning.

 C. The episode is not attributable to the physiological effects of a substance or to another medical condition. Note: Criteria A-C represent a major depressive episode.

D. 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. E. There has never been a manic episode or a hypomanie 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.

CODING AND RECORDING PROCEDURE

        The diagnostic code for major depressive disorder is based on whether this is a single or recurrent episode, current severity, presence of psychotic features, and remission status. Current severity and psychotic features are only indicated if full criteria are currently met for a major depressive episode. Remission specifiers are only indicated if the full criteria are not currently met for a major depressive episode. Codes are as follows:

Severity/course specifier Single episode Recurrent episode*

Mild (p. 188) 296.21 (F32.0) 296.31 (F33.0)

Moderate (p. 188) 296.22 (F32.1) 296.32 (F33.1)

Severe (p. 188) 296.23 (F32.2) 296.33 (F33.2)

With psychotic features** (p. 186) 296.24 (F32.3) 296.34 (F33.3)

In partial remission (p. 188) 296.25 (F32.4) 296.35 (F33.41)

In full remission (p. 188) 296.26 (F32.5) 296.36 (F33.42)

Unspecified 296.20 (F32.9) 296.30 (F33.9)

        *For an episode to be considered recurrent, there must be an interval of at least 2 consecutive months between separate episodes in which criteria are not met for a major depressive episode. The defini­ tions of specifiers are found on the indicated pages. **If psychotic features are present, code the "with psychotic features" specifier irrespective of epi­sode severity. In recording the name of a diagnosis, terms should be listed in the following order: major depressive disorder, single or recurrent episode, severity/psychotic/remission specifiers, followed by as many of the following specifiers without codes that apply to the current episode.

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