Depression

Types of Depressive Disorders

There are four main types of Depressive Disorders

1) Major Depressive Disorder

2) Persistent Depressive Disorder or Dysthymia (a milder but chronic for of depression) 

3) Disruptive Mood Dysregulation

4) Premenstrual Dysphoric Disorder. All of which can and typically do occur simultaneously with anxiety disorders.

Depression is a condition in which people feel discouraged, sad, hopeless, unmotivated, or disinterested in life in general. Such feelings can be normal but should not be confused with a case of the ‘blues’ where they last a short period of time. This is not a case of depression but it is very commonly described as depression. Depression is more than a case of the ‘blues’ which all experience from time to time.

Major Depressive Disorder

Depression is a serious condition in which someone may feel discouraged, sad, hopeless, unmotivated, or disinterested. When such feelings last more than two weeks and interfere with daily activities such, then it’s very likely a major depressive episode.

The DSM-5 criteria for Major Depressive Disorder are:

Experiencing at least 5 depressive symptoms from symptoms listed below for at least at least a two week period, and one of these five has to be either 1) depressed mood or 2) loss of interest or pleasure in usual activities.

A) 1. Depressed mood most of the day, almost every day, indicated by your own subjective report or by the report of others. This mood might be characterized by sadness, emptiness, or hopelessness.

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.

4. Inability to sleep or oversleeping nearly every day.

5. Psychomotor agitation or retardation nearly every day.

6. Fatigue or loss of energy nearly every day.

7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day.

8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

B. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

C. The episode is not due to the effects of a substance or to a medical condition

D. The occurrence is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders

E. There has never been a manic episode or a hypomanic episode

Do you think that you or someone you know are suffering from Major Depressive Disorder?

Complete the following quiz: Free Depression Test

Persistent Depressive Disorder

Persistent depressive disorder, or PDD, (formerly called dysthymia) is a form of depression that usually continues for at least two years. Although it is less severe than major depression, individual will experience many of the same symptoms as major depression.

Individuals with persistent depressive disorder describe their mood as sad or “down in the dumps.” During periods of depressed mood, at least two of the following six symptoms are present.

  • Poor appetite or overeating

  • Insomnia or hypersomnia

  • Low energy or fatigue

  • Low self-esteem

  • Poor concentration or difficulty making decisions

  • Feelings of hopelessness

 

In children and adolescents, the mood can be irritable and it must have lasted at least one year.

In order to be diagnosed with Persistent Depressive Disorder, there must never have been a Manic Episode, a Mixed Episode, or a Hypomanic Episode in the first 2 years, and criteria for Cyclothymic Disorder must have never been met.

The symptoms must not be due to the use or abuse of a substance (for instance, alcohol, drugs, or medications) or a general medical condition (e.g., cancer or a stroke). The symptoms must also cause significant distress or impairment in social, occupational, educational or other important areas of functioning.

Disruptive Mood Dysregulation Disorder

The DSM-V criteria for Disruptive Mood Dysregulation Disorder are:

A) The disorder is characterized by severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation.

  1. The temper outbursts are manifest verbally and/or behaviorally, such as in the form of verbal rages or physical aggression towards people or property.

  2. The temper outbursts are inconsistent with developmental level.

B) Frequency: The temper outbursts occur, on average, three or more times per week.

C) Mood between temper outbursts:

  1. Nearly every day, most of the day, the mood between temper outbursts is persistently irritable or angry.

  2. The irritable or angry mood is observable by others (e.g., parents, teachers, peers).

D) Duration: Criteria A-C have been present for 12 or more months. Throughout that time, the person has not had 3 or more consecutive months when they were without the symptoms of Criteria A-C.

*The disorder must also be present in 2 or more settings (just like ADHD), and the symptoms must appear between the ages of 6 and 10 (I guess 2 to 5 year olds simply can’t be diagnosed). The diagnosis cannot be made in adults.*

Premenstrual Dysphoric Disorder

The defining characteristics of Premenstrual Dysphoric Disorder (PMDD) is the expression of mood lability, irritability, dysphoria and anxiety symptoms that occur repeatedly during the premenstrual phase of the cycle and remit around the onset of menses or shortly thereafter.

The prevalence of Premenstrual Dysphoric Disorder is between 2 and 6 percent.

The DSM-V criteria for Premenstrual Dysphoric Disorder are:

1) In the majority of menstrual cycles, at least 5 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 after menses.

2) One or more of the following symptoms must be present:

  • Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or increased sensitivity to rejection).

  • Marked irritability or anger, or increased interpersonal conflicts.

  • Marked depressed mood, feelings of hopelessness, or self-depcrecating thoughts.

  • Marked anxiety, tension, and/or feelings of being keyed up or on edge.

3) One or more of the following symptoms must additionally be present, to reach a total of 5 symptoms when combined with the symptoms from #2 above:

  • Decreased interest in usual activities (e.g., work, school, friends, hobbies).

  • Subjective difficulty in concentration.

  • Leghargy, easily fatigued, or marked lack of energy.

  • Marked change in appetite; overeating; or specific food cravings.

  • Hypersomnia or insomnia.

  • A sense of being overwhelmed or out of control.

  • Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating” or weight gain.

The above symptoms must have been met for most menstrual cycles that occurred in the preceding year.

4) 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).

5) The disturbance is not merely an exacerbation of the symptoms of another disorder such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia), or a personality disorder (although it may co-occur with any of these disorders).

6) The first criteria (#1) should be confirmed by prospective daily ratings during at least two symptomatic cycles.

7) The symptoms are not attributable to the physiological effects of a substance or another medical condition.

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