Depression manifests in various forms. There can be a single episode or many episodes. Depression can be mild, moderate, or severe. It can occur seasonally, from grief, after a sudden life change, or maybe just because. Depression does not discriminate, it can impact an individual at any age, from any cultural background. Depression, though, is different than just feeling sad for a day or two. Clinical depression is typically diagnosed when symptoms occur for at least two-weeks. These are the common depressive related disorders and their symptoms:
(The following disorders and criteria are from the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders set forth by the American Psychiatric Association)
Major Depressive Disorder
At least 5 of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either depressed mood, or loss of interest or pleasure. Symptoms are also not attributable to another medical condition that could better explain their presence.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (sadness, emptiness, hopeless) or observation made by others (appearing tearful)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
3. Significant weight loss when not dieting or weight gain; or decrease/increase in appetite nearly every day (change of more than 5% of body weight in a given month)
4. Insomnia or hypersomnia nearly every day
5. Feelings of restlessness or being slowed down (psychomotor agitation)
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt
8. Decreased ability to think or concentrate, indecisiveness, nearly every day
9. Recurrent thoughts of death, recurrent suicidal ideation, or attempt, or plan for committing suicide
** Symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning
Disruptive Mood Dysregulation Disorder
Diagnostic criteria for this disorder consists of:
1. Severe recurrent temper outbursts manifested verbally and/or behaviorally that are grossly out of proportion in intensity or duration to the situation or provocation (verbal rages, physical aggression towards people or property)
2. The temper outbursts are inconsistent with developmental level
3. The temper outbursts occur about 3 or more times per week
4. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others
5. These criteria have been occurring for 12 or more months. During that time, the individual cannot have had more than 3 months symptom free
6. Criteria are present in at least two of three settings (home, school, with peers) and is severe in at least 1 of these
7. This diagnosis should not be made for the first time before age 6 or after the age of 18
8. Age of onset is typically before the age of 10
9. This diagnosis is viable if the behaviors cannot be better explained by another mental disorder (autism spectrum disorder, PTSD, separation anxiety disorder)
10. This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder
Persistent Depressive Disorder (Dysthymia)
Diagnostic criteria consists of:
1. Depressed mood for most of the day, for more days than not, lasting for at least 2 years
2. Presence, while depressed, of 2 or more of the following:
· Poor appetite or overeating
· Insomnia or hypersomnia
· Low energy or fatigue
· Low self-esteem
· Poor concentration or difficulty making decisions
· Feelings of hopelessness
** Symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.
Premenstrual Dysphoric Disorder
In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post menses. One or more of the following symptoms must be present:
1. Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or increased sensitivity to rejection).
2. Marked irritability or anger or increased interpersonal conflicts.
3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
4. Marked anxiety, tension, and/or feelings of being keyed up or on edge.
One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from above.
5. Decreased interest in usual activities (e.g., work, school, friends, hobbies).
6. Subjective difficulty in concentration.
7. Lethargy, easily fatigued or marked lack of energy.
8. Marked change in appetite; overeating; or specific food cravings.
9. Hypersomnia or insomnia.
10. A sense of being overwhelmed or out of control.
11. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.
** The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home).
Seasonal Affective Disorder
Symptoms typically occur during the winter months. These symptoms only occur during this certain time of year and dissipate when warmer/sunnier months occur. This disorder is classified as major depressive disorder, with seasonal pattern. Symptoms include:
1. Low mood (similar symptoms as major depressive disorder)
2. Sleepiness
3. Weight gain
SAD is said to occur because there is a disturbance in the normal circadian rhythm of the body. The lack of light in the winter months affects the circadian rhythm leading to depression.
Postpartum Depression
Postpartum depression occurs during pregnancy or following the birth of a child when a significant hormonal shift takes place. This is classified as depression with peripartum onset. There can be common mood changes or anxiety after giving birth that last up to two weeks, however, more severe and longer-lasting symptoms warrant the diagnosis of postpartum depression. Symptoms include:
1. Low mood (feelings of sadness)
2. Severe mood swings
3. Social withdrawal
4. Difficulty bonding with baby
5. Appetite changes
6. Feelings of hopelessness and helplessness
7. Loss of interest in things previously enjoyed
8. Feelings of inadequacy or worthlessness
9. Anxiety/panic attacks
10. Thoughts of harming the baby or yourself
**Postpartum psychosis- a condition where a mood episode is accompanied by confusion, hallucinations, or delusions
The next post will feature different treatments for some of these depressive disorders. Look out for this post on Thursday, 12/12!
-Kelsey Ruffing, MA, MS, LCPC
References
https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml
Diagnostic and Statistical Manual of Mental Disorders: Dsm-5. Arlington, VA: American Psychiatric Association, 2013. Print.
https://www.nami.org/learn-more/mental-health-conditions/depression
https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007