Depressive Disorders

What is the common feature of all depressive disorders?

Presence of sad, empty, or irritable mood with somatic and cognitive changes that significantly impair functioning.

What primarily differentiates depressive disorders from one another?

Duration, timing, and presumed etiology.

Which disorders are included in the depressive disorders chapter?

• Disruptive Mood Dysregulation Disorder (DMDD)

• Major Depressive Disorder (MDD)

• Persistent Depressive Disorder (PDD)

• Premenstrual Dysphoric Disorder (PMDD)

Why was DMDD added to DSM-5?

To reduce overdiagnosis of bipolar disorder in children with chronic irritability.

Core feature of DMDD?

Severe recurrent temper outbursts grossly out of proportion to the situation.

Frequency requirement for DMDD outbursts?

3 or more times per week.

Mood between DMDD outbursts?

Persistently irritable or angry most of the day, nearly every day.

DMDD Duration requirement?

≥12 months, with no 3-month symptom-free period.

DMDD Settings requirement?

Present in at least 2 settings; severe in at least 1.

DMDD Age requirements?

• Diagnosis not before age 6 or after 18

• Onset before age 10

Can DMDD coexist with ODD?

No. If both criteria met, diagnose DMDD only.

DMDD - Exclusion related to mania?

No history of manic or hypomanic episode.

Minimum duration of a Major Depressive Episode (MDE)?

2 weeks.

How many symptoms required for MDD?

5 or more (one must be depressed mood or loss of interest/pleasure).

The 9 symptoms of MDD?

• Depressed mood

• Anhedonia

• Weight/appetite change

• Sleep disturbance

• Psychomotor agitation/retardation

• Fatigue

• Worthlessness/guilt

• Poor concentration/indecisiveness

• Suicidal ideation/behavior

Bipolar exclusion for MDD?

No history of manic or hypomanic episode.

Can MDD be single episode?

Yes, but most cases are recurrent.

How does bereavement differ from MDD?

Grief may resemble depression but typically does not produce full MDD; MDD involves more severe impairment and worse prognosis.

Minimum PDD duration in adults?

2 years.

Minimum PDD duration in children/adolescents?

1 year.

PDD Core symptom?

Depressed mood most of the day, more days than not.

How many additional symptoms required for PDD?

2 or more (appetite, sleep, energy, self-esteem, concentration, hopelessness).

Maximum symptom-free period allowed for PDD?

No more than 2 months.

Can MDE occur during PDD?

Yes — specify intermittent or persistent major depressive episodes.

When do symptoms occur for PMDD?

Final week before menses, improve after onset, minimal postmenses.

Minimum number of symptoms for PMDD?

5 total.

At least one PMDD symptom must be from which category?

Mood symptoms (affective lability, irritability, depressed mood, anxiety).

Confirmation requirement for PMDD?

Prospective daily ratings for at least 2 cycles.

Examples of other specified depressive disorder

• Recurrent brief depression

• Short-duration depressive episode

• Insufficient symptoms

Minimum number of anxiety symptoms required for w/anxious distress specifier?

2.

Why is anxious distress specifier clinically important?

Associated with higher suicide risk and poorer treatment response.

How many manic/hypomanic symptoms required for mixed features specifier?

3 or more.

Clinical significance of mixed features specifier?

Risk factor for later bipolar disorder.

Core distinguishing feature of melancholic features?

Loss of pleasure or lack of mood reactivity.

Additional required symptoms for melancholic specifier?

3 or more (early awakening, worse in morning, psychomotor changes, etc.).

Hallmark of atypical features?

Mood reactivity.

Other common atypical symptoms?

Hypersomnia, increased appetite, leaden paralysis, rejection sensitivity.

What must be specified for psychotic features?

Mood-congruent vs. mood-incongruent.

Peripartum Onset window?

During pregnancy or within 4 weeks postpartum.

Minimum duration seasonal pattern required?

2 years of seasonal episodes without nonseasonal episodes during that period.

2 weeks vs 2 years — which diagnoses?

2 weeks = MDD
2 years = PDD

Irritability + temper outbursts in child under 10?

DMDD

Depression linked to menstrual cycle?

PMDD

Depression directly caused by hypothyroidism?

Depressive Disorder Due to Another Medical Condition

Depression during cocaine withdrawal?

Substance-Induced Depressive Disorder