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DSM-IV Signs & Symptoms Major Depressive Disorder | Major Depressive Disorder |
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THE DIAGNOSTIC CRITERIA FOR MAJOR DEPRESSIVE DISORDER In order for a diagnosis of major depressive disorder to be made according to the DSM-IV criteria, the patient must meet the criteria for a major depressive episode. In addition, this episode must not be better accounted for by another psychiatric diagnosis, and the patient must never have had a manic, mixed or hypomanic episode. The diagnostic criteria for a major depressive episode state that the patient must have a predominantly depressed mood or loss of interest and pleasure nearly every day over a 2-week period. In addition, four of the following criteria must be met over the same 2-week period: significant change in body weight or a change in appetite; sleep disturbances nearly every day; psychomotor retardation or agitation nearly every day that is observable by others; fatigue or loss of energy nearly every day; feelings of worthlessness or excessive or inappropriate guilt nearly every day; difficulty thinking or concentrating nearly every day; recurrent thoughts of death or suicide. The symptoms must cause clinically significant distress or functional impairment. In addition, there must be no episodes of mania or hypomania, and the symptoms must not be due to the effects of a substance or to a general medical illness or must not be better accounted for by bereavement. Single-episode major depressive disorder is used to describe the occurrence of one such episode. In recurrent major depressive disorder, there are two or more distinct episodes. Symptoms and signs The clinical features are as described in the DSM-IV criteria. Subtypes of depression There are a number of subtypes of depression that are sometimes described: psychotic depression, which is accompanied by delusions or hallucinations that may be mood-congruent (related to depressive themes) or mood-incongruent (not related to typical depressive themes, such as delusions of external control); atypical depression, in which the mood improves with positive events, or in which there is a reversal of the usual neurovegetative signs seen in depression (e.g. hypersomnia, increased appetite), leaden paralysis, or long-standing pattern of sensitivity to interpersonal rejection; seasonal affective disorder, in which there is a regular occurrence of depressive episodes during a particular season (usually autumn or winter) for at least 2 years, with complete remission between episodes; chronic depression, in which the depressive episode meets the full criteria for major depressive disorder continuously for at least 2 years; catatonic depression, in which the patient displays immobility or excessive motor activity, negativism, mutism, bizarre posturing or stereotypes; echolalia or echopraxia (parroting by the patient of another's words or actions); melancholic depression, in which there is a total loss of pleasure or reactivity to pleasurable stimuli. (from PsychiatryMatters.MD) Last update: 07-12-2005 06:18
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