Notes on Depressive Disorders

Depressive Disorders Overview

  • Common features across all depressive disorders:
    • Presence of sad, empty, or irritable mood
    • Accompanied by somatic and cognitive changes
    • Significantly affects individual’s capacity to function

1. Disruptive Mood Dysregulation Disorder (DMDD)

  • Criteria:
    • Severe recurrent temper outbursts (e.g., verbal rages or physical aggression).
    • Outbursts are grossly out of proportion to the situation.
    • Inconsistent with developmental level.
    • Occur on average three or more times per week.
    • Mood is persistently irritable or angry most of the day.
  • Duration: Symptoms present for 12 months or more; no period longer than 3 months without symptoms.
  • Settings: Present in at least 2 of 3 settings (home, school, with peers).
  • Age of onset: Before age 10; diagnosis should not be made under age 6 or over age 18.
  • Exclusions: Must not meet full criteria for a manic or hypomanic episode and cannot coexist with bipolar disorder or oppositional defiant disorder.
  • Prevalence: Common in pediatric mental health clinics; higher rates in males and school-age children.
  • Differential Diagnosis: Distinguishable from bipolar disorders by lack of manic episodes.

2. Major Depressive Disorder (MDD)

  • Criteria for diagnosis:
    • At least five symptoms for two weeks that reflect change from previous functioning; one symptom must be either depressed mood or loss of interest or pleasure.
  • Symptoms include:
    1. Depressed mood nearly every day.
    2. Diminished interest or pleasure in most activities.
    3. Significant weight loss/gain or change in appetite.
    4. Insomnia or hypersomnia.
    5. Psychomotor agitation or retardation.
    6. Fatigue/loss of energy.
    7. Feelings of worthlessness or excessive guilt.
    8. Reduced ability to think or concentrate.
    9. Recurrent thoughts of death or suicidal ideation.
  • Clinical significance: Symptoms cause distress or impairment in functioning.
  • Exclusions: Not attributable to substance effects or another medical condition.
  • Grief vs. MDD: Grief involves transient feelings and preserved self-esteem; MDD features persistent mood and feelings of worthlessness.
  • Prevalence: Higher in younger adults (ages 18-29) compared to older adults; more common in females, particularly post-puberty.

3. Persistent Depressive Disorder (Dysthymia)

  • Criteria:
    • Depressed mood for most of the day for more than 2 years (1 year in children/adolescents).
    • Presence of two (or more) of specific symptoms: poor appetite, insomnia/hypersomnia, low energy, low self-esteem, poor concentration, feelings of hopelessness.
  • Continuity of symptoms: Individual has never been free of depressive symptoms for more than 2 months during the 2-year period.
  • Clinical significance: Causes significant distress or impairment.
  • Exclusions: No history of manic/hypomanic episodes.

4. Premenstrual Dysphoric Disorder (PMDD)

  • Criteria:
    • Symptoms occur in the final week before menses, improve after onset, and are minimal/absent in the week post-menses.
    • Must include at least one severe symptom from specified list (e.g., mood swings, irritability, depressed mood).
  • Total of five symptoms needed: Includes symptoms that affect interest, concentration, energy levels, and more.
  • Clinical significance: Causes distress or interference in daily functioning.
  • Differential from PMS: Symptoms are more severe and require five symptoms to meet PMDD criteria.

5. Substance/Medication-Induced Depressive Disorder

  • Criteria:
    • Persistent mood disturbance characterized by depressed mood or diminished interest.
    • Symptoms arise during or after substance intoxication/withdrawal.
    • Must be attributable to overdose, withdrawal, or a medication that affects mood.
  • Clinical significance: Causes significant distress or impairment.

6. Depressive Disorder Due to Another Medical Condition

  • Criteria:
    • Depressed mood or diminished interest due to a medical condition (evidence required).
    • Symptoms cannot be better explained by another mental disorder.
    • Illustrative conditions: Stroke, Cushing's disease, hypothyroidism.

7. Other Specified Depressive Disorder

  • Usage: For clinically significant symptoms that do not meet criteria for another specific depressive disorder.
  • Examples include:
    1. Recurrent brief depression (short episodes under 2 weeks).
    2. Short-duration depressive episode (4-13 days).
    3. Insufficient symptoms for a major depressive episode.

8. Unspecified Depressive Disorder

  • Usage: For presentations lacking sufficient information for a specific diagnosis, often used in emergency settings to indicate depressive symptomatology causing distress or impairment without specific criteria met.