Major Depressive Disorder
For my first post of 2024, I wanted to do a breakdown of the diagnostic criteria for Major Depressive Disorder. Looking back at the past posts that I’ve done on the blog I realized that I did do a post on depression however it wasn’t a full breakdown of the criteria but more a look at how depression may present in an individual. You can find that post here. Before jumping into the diagnostic criteria, I wanted to give you guys an update on the plan for the blog for this year. As you may have noticed there has been a few posts from a guest writer by the name of Cheryl Conklin from Wellness Mind. Moving forward whenever she sends me a post that she feels may be interesting for you guys, I will continue to edit and post it. As for me, I plan to go through the entire DSM 5 and pinpoint certain diagnoses that you may find interesting to write about and I will do both a post for the breakdown of the diagnostic criteria as presented by the DSM 5 as well as a post discussing how it may present and finding real-life examples of people that have dealt with the same mental health challenges. If you have any questions or suggestions for any diagnoses you want to see a post about, leave a comment under this post and we can go from there.
Criterion A
The first criterion that a person being assessed for major depressive disorder must hit is having 5 or more of the following 9 symptoms over a 2-week period that has shown a change in the previous mode of functioning. It is also noted that at least one of the 5 symptoms must either be depressed mood or loss of interest or pleasure.
Having a depressed mood most of the day, nearly every day either reported by the individual or observed by other people. If assessing children their mood may be irritable and could be a symptom.
One thing that I would like to make a note of when it comes to this specific symptom is that we all have bouts of sadness throughout our life and it doesn’t necessarily mean we are depressed. People tend to throw the term depressed around when it has the potential to be a very debilitating disorder that can negatively impact other parts of a person’s life in ways they never intended. So with any symptom keep in mind that these symptoms create issues within the individual’s life.
Diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day that is either self-reported or observed by others.
So, this is the other symptom that the individual must be experiencing to be properly diagnosed with major depressive disorder. When thinking about diminished interest/lack of pleasure in activities think about your everyday life and the various things that you tend to do. I tend to wake up, provide a therapy session or two, workout, go to my night job and possibly a hookah lounge before I head home to go to bed for the night. Not looking too deeply at how ridiculous my schedule is, if I were to say I have this symptom I would have no interest in doing any of these activities. I would rather lay in bed all day and I probably would do that depending on how severe my case is.
Significant weight loss or gain (they noted a 5% change within a month) OR decrease/increase in appetite nearly every day. If assessing children they may have difficulty reaching their expected weight gain.
This symptom is pretty straightforward. A person is either overeating/undereating or their appetite has made a drastic change over the two-week period of assessment.
Insomnia or hypersomnia every day.
This is another straightforward symptom. A person is either having difficulty sleeping or sleeping too much over a two-week period. With insomnia, it’s important to remember that they have difficulty sleeping even though they are exhausted, and with hypersomnia, they have trouble staying awake even with adequate sleep at night.
Psychomotor agitation or retardation nearly every day. This must also be observed by other people and not mainly reported by the individual.
I’m sure I’ve touched on the definition of psychomotor in the past however for new readers this is basically movements that relate to conscious thought. Psychomotor agitation would be expressed as a form of restlessness while psychomotor retardation would be expressed as a form of slowing down. So an example of agitation would be an inability to sit still while retardation may be a person’s speech slowing down. Again, it is important to note that this has to be observed by another person and the behavior has to be more on the extreme side concerning that person’s assumed regular level of functioning.
Fatigue or loss of energy nearly every day.
For at least a two-week period the individual is experiencing fatigue or loss of energy almost every day. Pretty straightforward.
Feelings of worthlessness or excessive or inappropriate guilt. It is noted that this may be delusional thinking. It is also noted that it isn’t feelings of guilt related to being sick or self-reproach (blame directed to oneself)
Imagine feeling worthless even though there are countless examples of the contrary or guilt where it isn’t warranted. This is what this symptom means.
Diminished ability to think or concentrate or indecisiveness nearly every day. Noted to be self-reported or observed by others.
This symptom, under the diagnosis of depression, it may hard for an individual to think clearly. Their mind may be focused more on the feelings of dread than the tasks that they may have to handle on a day-to-day basis.
Recurrent thoughts of death, recurrent suicidal ideation w/o a specific plan, or suicide attempt with a specific plan to commit suicide. Note that the recurrent thoughts of death are NOT limited to just the fear of dying.
This final symptom is focused on either the thoughts of death or suicidal ideations or attempts.
Criterion B
The identified symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
As with other disorders, these symptoms have to be prevalent enough that they seep into other areas of your life as opposed to a single moment. Whether it be within your interpersonal relationships, employment, etc.
Criterion C
The episode is not attributable to the physiological effects of a substance or another medical condition.
Certain drugs (i.e. alcohol, marijuana, cocaine, etc.) can mimic depressive symptoms and it is important to assess for any drug usage when making this diagnosis. The same can be said for certain medical disorders as well.
Criterion D
The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
This is where some differential diagnosing comes in. You have to assess whether what the person is going through is not better explained by one of the above-identified disorders because they may manifest similar symptoms.
Criterion E
There has never been a manic or hypomanic episode.
It is noted that this specific criteria is not applied if there was a manic or hypomanic episode that is the cause of a substance or medical disorder. Now if there were no drug usage or medical disorder to cause a manic or hypomanic episode yet the individual experienced one then they would more than likely be diagnosed with bipolar disorder as opposed to major depressive disorder.
Now like any other disorder that I have done the criterion breakdown for, for a person to be accurately diagnosed with this disorder, they must hit each criterion. It is noted that if a person only meets the first three criteria they can be diagnosed with a major depressive episode. There is a diagnosis for those who don’t meet all criteria however that will be discussed in a later post.
Treatment
There are different accepted routes of treatment for major depressive disorder. Psychotherapy (i.e. CBT or Behavioral therapy), application of antidepressants or herbal remedies (products made from St. John’s Wort for example), the use of relaxation techniques, yoga, sports/exercise, phototherapy (as discussed for Seasonal Affective Disorder), Sleep Deprivation therapy or Electroconvulsive therapy. However, the proper route of treatment depends on the severity of depression that the individual has.
Conclusion
This post is not intended to tell you how to deal with depression if you have it but how the diagnosis is made. My professional recommendation will be to speak with a medical professional that you trust and work together to find a solution that makes the most sense for you. Unfortunately, mental health is not an exact science and there may be some trial and error until you find something that works for you. For clients that I’ve worked with, I’ve used a mix of CBT with different techniques that focused on the specific symptoms that they’ve identified and I’ve noticed through our sessions that it has worked for them so far. Always remember that you must be an active member in your mental health journey to receive the best results possible. Any questions, concerns, or critiques please feel free to leave a comment and I’ll be sure to reach out to you about it.