Depressive Disorders

Specifier:

Additional diagnostic label used by clinicians to convey extra information about symptoms

Specifiers are not

mandatory; only assigned if appropriate

Psychotic features specifier

Major depressive episodes which also include some psychotic features

Psychotic features

hallucinations

delusions

Hallucinations:

Sensory experience in the absence of sensory input

Delusions:

Strongly held inaccurate beliefs

Anxious distress specifier

Depression is accompanied by several significant symptoms of anxiety

Anxious distress specifier predicts

poorer outcome

Mixed features specifier

Depressive episodes which also include several manic symptoms

Melancholic features specifier

Major depressive episode accompanied by additional severe symptoms such as early morning awakenings, lack of reactivity to positive stimuli

Catatonic features specifier:

Extremely rare muscular symptoms such as remaining in a still stupor, “waxy” limbs that remain in place when manipulated, repetitive or purposeless movement

Atypical features specifier:

Presence of several symptoms less common in depression, including oversleeping and overeating

Peripartum onset specifier:

Depression occurring around the time of giving birth

Seasonal pattern specifier:

Depression occurring primarily in certain seasons (usually winter)

Seasonal pattern specifier is also known as

seasonal affective disorder

Seasonal pattern specifier is a result of

phase-delayed circadian misalignment, meaning that the patient’s circadian rhythm is misaligned with the environmental day-night cycle

Seasonal pattern specifier may be treated effectively with

light therapy

Depressive disorders are rare in

childhood

Risk increases in

adolescence and young adulthood

Risk decreases in

middle adulthood, increases again in old age (U-shaped pattern)

Depressive episodes are variable in

length

Depressive episodes usually last

several months untreated, but may last several years

In previous editions of the DSM, depression could not be diagnosed during

periods of mourning

Now recognized that major depression may occur as

part of the grieving process

Acute grief:

Occurs immediately after loss

Integrated grief:

Eventual coming to terms with meaning of the loss

Complicated grief:

Persistent acute grief and inability to come to terms with loss