Symptoms Of Major Depressive Disorder Dsm

What Are The Dsm

Major Depressive Disorder | DSM-5 Diagnosis, Symptoms and Treatment

The specific DSM-5 criteria for major depressive disorder are outlined below.

At least 5 of the following symptoms have to have been present during the same 2-week period :

  • Depressed mood: For children and adolescents, this can also be an irritable mood

  • Diminished interest or loss of pleasure in almost all activities

  • Significant weight change or appetite disturbance: For children, this can be failure to achieve expected weight gain

  • Sleep disturbance

  • Fatigue or loss of energy

  • Feelings of worthlessness

  • Diminished ability to think or concentrate indecisiveness

  • Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide

The symptoms cause significant distress or impairment in social, occupational or other important areas of functioning.

The symptoms are not attributable to the physiological effects of a substance or another medical condition.

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

There has never been a manic episode or a hypomanic episode

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Causes Of Major Depressive Disorder

Depression is caused by an imbalance of chemicals, known as neurotransmitters, in the brain.

Certain genetic, biological, psychological, and environmental factors can increase the chances of someone developing depression however, its important to remember that anyone can develop depression.

The potential causes and risk factors for depression include:

Adjustment Disorder With Depressed Mood

Adjustment disorder is a psychological reaction to overwhelming emotional or psychological stress, resulting in depression or other symptoms. Some situations in which an adjustment disorder can occur include divorce, imprisonment of self or a significant other, business or employment failures, or a significant family disturbance. The stressor may be a one-time event or a recurring situation. Because of the turmoil that often occurs around a crisis in substance use patterns, clients in substance abuse treatment may be particularly susceptible to Adjustment Disorders. Some of the common depressive symptoms of an adjustment disorder include tearfulness, depressed mood, and feelings of hopelessness. The symptoms of an adjustment disorder normally do not reach the proportions of a Major Depressive Disorder, nor do they last as long as a Dysthymic Disorder. An acute adjustment disorder normally lasts only a few months, while a chronic adjustment disorder may be ongoing after the termination of the stressor.

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What Is Major Or Clinical Depression

Most people feel sad or low at some point in their lives. But clinical depression is marked by a depressed mood most of the day, sometimes particularly in the morning, and a loss of interest in normal activities and relationships — symptoms that are present every day for at least 2 weeks. In addition, according to the DSM-5 — a manual used to diagnose mental health conditions — you may have other symptoms with major depression. Those symptoms might include:

  • Fatigue or loss of energy almost every day
  • Feelings of worthlessness or guilt almost every day
  • Impaired concentration, indecisiveness
  • Insomnia or hypersomnia almost every day
  • Restlessness or feeling slowed down
  • Recurring thoughts of death or suicide
  • Significant weight loss or gain

Depression Is Different From Sadness Or Grief/bereavement


The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such situations. Those experiencing loss often might describe themselves as being depressed.

But being sad is not the same as having depression. The grieving process is natural and unique to each individual and shares some of the same features of depression. Both grief and depression may involve intense sadness and withdrawal from usual activities. They are also different in important ways:

  • In grief, painful feelings come in waves, often intermixed with positive memories of the deceased. In major depression, mood and/or interest are decreased for most of two weeks.
  • In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness and self-loathing are common.
  • In grief, thoughts of death may surface when thinking of or fantasizing about joining the deceased loved one. In major depression, thoughts are focused on ending ones life due to feeling worthless or undeserving of living or being unable to cope with the pain of depression.

Grief and depression can co-exist For some people, the death of a loved one, losing a job or being a victim of a physical assault or a major disaster can lead to depression. When grief and depression co-occur, the grief is more severe and lasts longer than grief without depression.

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Comorbidity With Other Disorders

Many researchers believe that depressive personality disorder is so highly comorbid with other depressive disorders, manic-depressive episodes and dysthymic disorder, that it is redundant to include it as a distinct diagnosis. Recent studies however, have found that dysthymic disorder and depressive personality disorder are not as comorbid as previously thought. It was found that almost two thirds of the test subjects with depressive personality disorder did not have dysthymic disorder, and 83% did not have early-onset dysthymia.

The comorbidity with Axis I depressive disorders is not as high as had been assumed. An experiment conducted by American psychologists showed that depressive personality disorder shows a high comorbidity rate with major depression experienced at some point in a lifetime and with any mood disorders experienced at any point in a lifetime. A high comorbidity rate with these disorders is expected of many diagnoses. As for the extremely high comorbidity rate with mood disorders, it has been found that essentially all mood disorders are comorbid with at least one other, especially when looking at a lifetime sample size.

How Is Depression Treated

Depression is among the most treatable of mental disorders. Between 80% and 90% percent of people with depression eventually respond well to treatment. Almost all patients gain some relief from their symptoms.

Before a diagnosis or treatment, a health professional should conduct a thorough diagnostic evaluation, including an interview and a physical examination. In some cases, a blood test might be done to make sure the depression is not due to a medical condition like a thyroid problem or a vitamin deficiency . The evaluation will identify specific symptoms and explore medical and family histories as well as cultural and environmental factors with the goal of arriving at a diagnosis and planning a course of action.

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Other Psychiatric Conditions In Which Depression Can Be A Primary Symptom

Sometimes depression is symptomatic of another mental disorder. This is particularly true when the nature of the mental disorder causes excessive distress to the individual. While, in this context, the depression is a symptom, it is still important to recognize its impact on the person and his or her ability to respond to substance abuse treatment.

Some of the psychiatric disorders in which depression can play a major role include:

Life Expectancy And The Risk Of Suicide

Major Depressive Disorders in the DSM 5 TR

Depressed individuals have a shorter life expectancy than those without depression, in part because people who are depressed are at risk of dying of suicide. Up to 60% of people who die of suicide have a mood disorder such as major depression, and the risk is especially high if a person has a marked sense of hopelessness or has both depression and borderline personality disorder. About 2รข8% of adults with major depression die by suicide, and about 50% of people who die by suicide had depression or another mood disorder. The lifetime risk of suicide associated with a diagnosis of major depression in the US is estimated at 3.4%, which averages two highly disparate figures of almost 7% for men and 1% for women . The estimate is substantially lower than a previously accepted figure of 15%, which had been derived from older studies of people who were hospitalized.

Depressed people have a higher rate of dying from other causes. There is a 1.5- to 2-fold increased risk of cardiovascular disease, independent of other known risk factors, and is itself linked directly or indirectly to risk factors such as smoking and obesity. People with major depression are less likely to follow medical recommendations for treating and preventing cardiovascular disorders, further increasing their risk of medical complications.Cardiologists may not recognize underlying depression that complicates a cardiovascular problem under their care.

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What Are The Symptoms Of Major Depressive Disorder

Your doctor or a mental health professional can diagnose major depressive disorder based on your symptoms, feelings, and behaviors.

Typically, youll be asked specific questions or given a questionnaire so health professionals can better determine whether you have MDD or another condition.

To be diagnosed with MDD, you need to meet the symptom criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition . This manual helps medical professionals diagnose mental health conditions.

According to its criteria:

  • you must experience a change in your previous functioning
  • symptoms must occur for a period of 2 or more weeks
  • at least one symptom is either depressed mood or loss of interest or pleasure

You must also experience 5 or more of the following symptoms in the 2-week period:

  • You feel sad or irritable most of the day, nearly every day.
  • Youre less interested in most activities you once enjoyed.
  • You suddenly lose or gain weight or have a change in appetite.
  • You have trouble falling asleep or want to sleep more than usual.
  • You experience feelings of restlessness.
  • You feel unusually tired and have a lack of energy.
  • You feel worthless or guilty, often about things that wouldnt usually make you feel that way.
  • You have difficulty concentrating, thinking, or making decisions.
  • You think about harming yourself or suicide.

Symptoms parents should be aware of in their teens include the following:

What Is Major Depressive Disorder According To The Dsm 5

Major depressive disorder is a common but serious mood disorder that is characterized by a low mood and negative emotions that last for most of the day.

Individuals who struggle with MDD have persistent feelings of sadness, hopelessness, and lose interest in people and their surroundings. MDD is commonly referred to as depression.

Below are a few MDD statistics to be aware of.

  • Approximately 3 million people each year will be diagnosed with major depressive disorder. Experts suggest this number is larger as there are people who go undiagnosed due to the stigma that comes with mental health disorders.
  • The condition is more prevalent in women than in men.
  • It is three times more likely for people between the ages of 18-29 to experience depression as compared to adults 60 and over.
  • MDD frequently occurs with other medical or psychological conditions like substance abuse, anxiety, hypothyroidism and diabetes.
  • People who have experienced cancer, a heart attack, post-traumatic stress disorder or Parkinsons Disease are likely to be diagnosed with MDD.

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How To Get Help

MDD is treatable! People suffering from MDD illness may be treated in the overwhelming majority of cases if they seek expert treatment.

Several conventional methods are successful, including:

  • Therapy treatment
  • Alternative treatment
  • Transcranial Magnetic Stimulation

Severe depression may need a stay in a hospital or an outpatient treatment program until you start to feel better.

Most depressed individuals benefit from medication and counseling. Your doctor or psychiatrist may prescribe medications. The benefits of visiting a mental health expert are many.

Major Depressive Disorder Dsm 5 Indicators

Major Depression In Primary Care Making The Diagnosis Smj

Here is the basic major depressive disorder DSM 5 criteria:

  • Major depressive disorder DSM 5 is defined as having five of these symptoms during the same 2-week period:
  • Feeling depressed for long periods of the day every day, as indicated by subjective report or observation made by others
  • Significantly reduced interest or pleasure in activities previously enjoyed
  • Considerable weight loss or weight gain, defined as a change of more than 5% of body weight in a month or a noticeable decrease in the persons appetite
  • Insomnia or hypersomnia on daily basis
  • Psychomotor agitation or retardation
  • Ongoing fatigue or loss of energy
  • Feelings of worthlessness or guilt on a daily basis
  • Ongoing difficulty concentrating, or persistent indecisiveness
  • Recurrent thoughts of suicide or premature death

Its important to keep in mind when evaluating whether or not a person can be suspected of having major depressive disorder DSM 5 that they do not have to have ALL of these indicators in order to be evaluated as possibly being depressed. However, there will be a need to see more than just one or two of them.

Again, however, the only person who can make an accurate and reliable diagnosis is a physician. If you suspect that you or anyone in your family is beginning to experience depression then it is important that you see a doctor, or that they do.

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Changes To Depression In The Dsm

While the DSM-5 doesn’t introduce any new diagnostic tests for depression, it does promote a new integrated approach for clinicians to diagnose mental health disorders.

Clinicians who were used to using the older methods for diagnosing depression didn’t have to completely change how they approached the process with the DSM-5, as the new integrated approach is compatible with previous assessment tools.

New Specifiers For Depression

The DSM-5 added new specifiers to further clarify depression diagnoses when applicable: with mixed features and with anxious distress.

  • With mixed features: This new specifier allows for the presence of manic symptoms within a diagnosis of depression for patients who do not meet the full criteria for a hypomanic or manic episode .
  • With anxious distress: This specifier was added to account for the presence of anxiety, tension, or restlessness with the potential to impact prognosis and treatment choices.

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Can Major Depression Be Prevented

Once you have had an episode of major depression, you are at high risk of having another. The best way to prevent another episode of depression is to be aware of the triggers or causes of major depression and to continue taking the prescribed medication to avoid relapse. It is also important to know what the symptoms of major depression are and to talk with your doctor early if you have any of these symptoms.

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Diagnostic Criteria For Major Depressive Disorder

Depression Explained (Major Depressive Disorder)

If youre feeling low and think you may have major depressive disorder, contact a mental healthcare provider. Or, visit your primary care doctorthey may be able to diagnose your condition or refer you to a specialist who can.

The diagnostic process for major depressive disorder may involve:

  • A detailed personal, social, substance use, and family medical history
  • Questions about your symptoms, including how theyre making you feel and affecting your daily life
  • Other routine tests such as blood tests, lab work, or physical or psychological examinations to rule out other health conditions that can cause similar symptoms
  • Use of a screening tool such as the Patient Health Questionnaire-9 , Hamilton Rating Scale for Depression , Montgomery-Asberg Depression Rating Scale , Beck Depression Inventory , Zung Self-Rating Depression Scale, and other questionnaires

Your healthcare provider will determine whether or not your symptoms meet the diagnostic criteria for major depressive disorder, which includes:

  • Feeling depressed or irritable almost all the time and losing interest in most things
  • Having at least five symptoms of depression
  • Experiencing symptoms every day for most of the day
  • Experiencing symptoms for at least two weeks
  • Not being able to function as you were able to before, due to the symptoms

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What Is Considered A Major Depressive Disorder

There is only one major depressive disorder, though multiple depressive disorders exist within the classification system of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition , published by the American Psychiatric Society. Depression disorders are also classified more broadly as mood disorders. In addition to MDD, the depression disorders are as follows:

  • Persistent depressive disorder , formerly known as dysthymia, which is chronic depression lasting at least two years in adults or at least one year in children and adolescents.
  • Disruptive mood dysregulation disorder, which is a childhood condition characterized by extreme irritability and anger.
  • Premenstrual dysphoric disorder, which is a more severe form of premenstrual syndrome .
  • Substance/medication-induced depressive disorder, which can be caused by certain sedatives, alcohol, steroids, antihypertensives, anticonvulsants, and more.
  • Depressive disorder due to another medical condition, which can be caused by some metabolic disturbances, nutritional deficiencies, infectious diseases, and more.
  • Unspecified depressive disorder, which is diagnosed when someones depression doesnt meet the criteria for any of the above disorders.

Is Major Depressive Disorder Considered A Serious Mental Illness

Major depressive disorder is a serious mental health condition that has a high prevalence and carries an elevated risk of mortality. Its also a leading cause of disease burden in the world, meaning it contributes significantly to health loss and disability in global populations. This makes MDD a critical public health priority.

Clinical depression affects all races and socioeconomic classes equally. Its more prevalent among women, in rural areas, and in people who lack social support.

On an individual level, depression can wipe out everything that seemed good in the world, all your hope for the future, all the things you liked about yourself. It can destroy relationships, cause you to lose your livelihood, and even drive you to extremes of self-harm. So its very serious. But that doesnt mean its not treatable, and that you wont recover.

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