Major Depressive Episode

A good diagnostic evaluation will include a complete history of symptoms, i.e., when they started,
how long they have lasted, how severe they are, whether the patient had them before and, if so, whether the symptoms were treated and what treatment was given. The doctor should ask about alcohol and drug use, and if the patient has thoughts about death or suicide. Further, a history
should include questions about whether other family members have had a depressive illness and, if treated, what treatments they may have received and which were effective.

Last, a diagnostic evaluation should include a mental status examination to determine if speech or thought patterns or memory have been affected, as sometimes happens in the case of a depressive
or manic-depressive illness.

Treatment choice will depend on the outcome of the evaluation. There are a variety of antidepressant medications and psychotherapies that can be used to treat depressive disorders. Some people with milder forms may do well with psychotherapy alone. People with moderate to severe depression
most often benefit from antidepressants. Most do best with combined treatment: medication to gain relatively quick symptom relief and psychotherapy to learn more effective ways to deal with life's problems, including depression. Depending on the patient's diagnosis and severity of symptoms, the therapist may prescribe medication and/or one of the several forms of psychotherapy that have
proven effective for depression.

Diagnosis of Major Depressive Disorder. Diagnostic Criteria

A. The person experiences a single major depressive episode:

1.- For a major depressive episode a person must have experienced at least five of the nine symptoms below for the same two weeks or more, for most of the time almost every day, and this is a change from his/her prior level of functioning. One of the symptoms must be either (a) depressed mood, or (b) loss of interest.

a) Depressed mood. For children and adolescents, this may be irritable mood.

b) A significantly reduced level of interest or pleasure in most or all activities.

c) A considerable loss or gain of weight (e.g., 5% or more change of weight in a month when not dieting). This may also be an increase or decrease in appetite. For children, they may not gain an expected amount of weight.

d) Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia).

e) Behavior that is agitated or slowed down. Others should be able to observe this.

f) Feeling fatigued, or diminished energy.

g) Thoughts of worthlessness or extreme guilt (not about being ill).

h) Ability to think, concentrate, or make decisions is reduced.

i) Frequent thoughts of death or suicide (with or without a specific plan), or attempt of suicide.

2.- The persons' symptoms do not indicate a mixed episode.

3.- The person's symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas.

4.- The person's symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder.

5.- The person's symptoms are not due to normal grief or bereavement over the death of a loved one, they continue for more than two months, or they include great difficulty in functioning, frequent thoughts of worthlessness, thoughts of suicide, symptoms that are psychotic, or behavior that is slowed down (psychomotor retardation).

B. Another disorder does not better explain the major depressive episode.

C. The person has never had a manic, mixed, or a hypomanic Episode (unless an episode was due to a medical disorder or use of a substance).

Bipolar Disorder (Diagnostic Criteria: Bipolar I, Bipolar II)

There are two types of bipolar disorder:

• Bipolar I Disorder is diagnosed when a person has had at least one manic or mixed episode, often along with a major depressive episode.

• Bipolar II Disorder is diagnosed when a person has had a major depressive episode along with at least one hypomanic episode.

Diagnosis of Bipolar I Disorder

A. A person experiences a current or recent episode that is manic, hypomanic, mixed, or depressed.

1.- To be a manic episode, for at least one week a person's mood must be out of the ordinary and continuously heightened, exaggerated, or irritable.

2.- At least three of the following seven symptoms have been significant and enduring. If the mood is only irritable, then four symptoms are required.

a) Self-esteem is excessive or grandiose.

b) The need for sleep is greatly reduced.

c) Talks much more than usual.

d) Thoughts and ideas are continuous and without a pattern or focus.

e) Easily distracted by unimportant things.

f) An increase in purposeful activity or productivity, or behaving and feeling agitated.

g) Reckless participation in enjoyable activities that create a high risk for negative consequences (e.g., extensive spending sprees, sexual promiscuity).

 

3.- The persons' symptoms do not indicate a mixed episode.

4.- The person's symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas. Or, the symptoms require the person to be hospitalized to protect the person from harming himself/herself or others. Or, the symptoms include psychotic features (hallucinations, delusions).

5.- The person's symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder.

B. Unless this is a first single manic episode there has been at least one manic, mixed, hypomanic, or depressive episode.

1.- For a major depressive episode a person must have experienced at least five of the nine symptoms below for the same two weeks or more, for most of the time almost every day, and this is a change from his/her prior level of functioning. One of the symptoms must be either (a) depressed mood, or (b) loss of interest.

a) Depressed mood. For children and adolescents, this may be irritable mood.

b) A significantly reduced level of interest or pleasure in most or all activities.

c) A considerable loss or gain of weight (e.g., 5% or more change of weight in a month when not dieting). This may also be an increase or decrease in appetite. For children, they may not gain an expected amount of weight.

d) Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia).

e) Behavior that is agitated or slowed down. Others should be able to observe this.

f) Feeling fatigued, or diminished energy.

g) Thoughts of worthlessness or extreme guilt (not about being ill).

h) Ability to think, concentrate, or make decisions is reduced.

i) Frequent thoughts of death or suicide (with or without a specific plan), or attempt of suicide.

2.- The persons' symptoms do not indicate a mixed episode.

3.- The person's symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas.

4.- The person's symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder.

5.- The person's symptoms are not due to normal grief or bereavement over the death of a loved one, they continue for more than two months, or they include great difficulty in functioning, frequent thoughts of worthlessness, thoughts of suicide, symptoms that are psychotic, or behavior that is slowed down (psychomotor retardation).

C. Another disorder does not better explain the episode.

 

Dysthymic Disorder (Diagnostic Criteria)

Diagnosis of Dysthymic Disorder

A. A person has depressed mood for most the time almost every day for at least two years. Children and adolescents may have irritable mood, and the time frame is at least one year.

B. While depressed, a person experiences at least two of the following symptoms:

1.- Either overeating or lack of appetite.

2.- Sleeping to much or having difficulty sleeping.

3.- Fatigue, lack of energy.

4.- Poor self-esteem.

5.- Difficulty with concentration or decision making.

6.- Feeling hopeless.

C. A person has not been free of the symptoms during the two-year time period (one-year for children and adolescents).

D. During the two-year time period (one-year for children and adolescents) there has not been a major depressive episode.

E. A person has not had a manic, mixed, or hypomanic episode.

F. The symptoms are not present only during the presence of another chronic disorder.

G. A medical condition or the use of substances (i.e., alcohol, drugs, medication, toxins) do not cause the symptoms.

H. The person's symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas.

Cyclothymic Disorder (Diagnostic Criteria)

Diagnosis of Cyclothymic Disorder

A. A person has experienced many periods of depressive symptoms (not a full depressive episode), and periods of hypomanic symptoms for a minimum of two years. For children and adolescents, the time frame is a minimum of one year.

B. The person has not been free of the hypomanic or depressive symptoms for more than two months at a time.

C. Throughout the first two years of the illness the person has not had a manic, mixed, or major depressive episode.

D. Another disorder does not better explain the episode.

E. The person's symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder.

F. The symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas.

 

Mood Disorder Due to a General Medical Condition (Diagnostic Criteria)

Diagnosis of Mood Disorder Due to a General Medical Condition

A. A person has significant disturbance in mood that includes either (or both):
Depressed mood or significantly reduced level of interest or pleasure in most or all activities.
Mood that is euphoric, heightened, or irritable.

B. The person's symptoms are directly related to the presence of a medical condition.

C. Another disorder does not better explain the mood disturbance.

D. The mood condition is not present only when a person is delirious.

E. The symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas.

 

Diagnosis of Substance-Induced Mood Disorder

A. A person has significant disturbance in mood that includes either (or both):
Depressed mood or significantly reduced level of interest or pleasure in most or all activities.
Mood that is euphoric, heightened, or irritable.

B. The person's symptoms develop during (or within four weeks of) intoxication or withdrawal, or are caused by medication use.

C. Another disorder does not better explain the mood disturbance.

D. The mood condition is not present only when a person is deleterious.

E. The symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas.

Summarized from the Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition