Depressive Disorders

Diagnostic Specifiers

  • 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
    • 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
    • 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)
    • Sometimes called seasonal affective disorder.
    • Result of phase-delayed circadian misalignment, meaning that the patient’s circadian rhythm is misaligned with the environmental day-night cycle
    • May be treated effectively with light therapy

Onset and Duration

  • Rare in childhood
  • Risk increases in adolescence and young adulthood, decreases in middle adulthood, increases again in old age (U-shaped pattern)
  • Depressive episodes are variable in length
    • Usually last several months untreated, but may last several years

Grief

  • 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