Fast Five Quiz: Holidays and Mental Health

Stephen Soreff, MD


December 14, 2020

Patients with major depressive disorder may not initially present with a complaint of low mood, anhedonia, or other typical symptoms. In the primary care setting, where many of these patients first seek treatment, the presenting complaints often can be somatic (eg, fatigue, headache, abdominal distress, weight change). Patients may complain more of irritability or difficulty concentrating than of sadness or low mood.

The specific DSM-5 criteria for major depressive disorder are outlined below. 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 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 cause significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not attributable to the physiologic effects of a substance (eg, a drug of abuse, a medication) or another medical condition. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorders. There has never been a manic episode or a hypomanic episode; experience of one of these episodes suggests bipolar disorder.

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. Symptoms of major depression may also occur in persons with bipolar disorder or SAD.

Read more about the diagnosis of major depressive disorder.


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