Fast Five Quiz: Mood Disorders

Stephen Soreff, MD

Disclosures

October 01, 2019

According to DSM-5 criteria for major depressive disorder, at least five of the following symptoms must be present during the same 2-week period (and at least one of the symptoms must be diminished interest/pleasure or depressed mood):

  • Depressed mood: For children and adolescents, this can also be an irritable mood

  • Diminished interest or loss of pleasure in almost all activities (anhedonia)

  • Significant weight change or appetite disturbance: For children, this can be failure to achieve expected weight gain

  • Sleep disturbance (insomnia or hypersomnia)

  • Psychomotor agitation or retardation

  • Fatigue or loss of energy

  • Feelings of worthlessness

  • Diminished ability to think or concentrate; indecisiveness

  • Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide

The symptoms must cause significant distress or impairment in social, occupational, or other important areas of functioning. The key is impairment. Many individuals have moments of depression; however, in mood disorder, patients cannot function vocationally or socially.

The symptoms must not be attributable to the physiologic effects of a substance (eg, a drug of abuse, a medication) or another medical condition. For example, patients with hypothyroidism may demonstrate the above symptoms. However, once the thyroid condition has been treated, the patient returns to normal functioning.

The disturbance must not be better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorders. The patient must not have a history of a manic episode or hypomanic episode.

Depressive disorders can be rated as mild, moderate, or severe. The disorder can also occur with psychotic symptoms, which can be mood congruent or incongruent. Depressive disorders can be determined to be in full or partial remission.

The DSM-5 further notes the importance of distinguishing between normal sadness and grief from a major depressive disorder. Although bereavement can induce great suffering, it does not typically induce a major depressive disorder. When the two are simultaneously present, the symptoms and functional impairment are more severe, and the prognosis is worse compared with bereavement alone. A diagnosis of major depressive disorder after a significant loss requires clinical judgment based on the individual's history and the cultural context for expression of grief.

Read more about major depressive disorder.

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