The Diagnosis of Depression

Doctors are Trained to Diagnose and Treat Depression
A Doctor Can Help Manage Depression
If You Feel Depressed See a Doctor

Do I Have Depression?

Depression Diagnosis Begins With Understanding the Types of Depression

A depression diagnosis should be made by a doctor. However, you need to recognize the signs of depression to know to seek help. Many people have moments of feeling down, but they can function and take care of themselves and others. Feeling down for a few days without major impairment is not depression. We are all human, and we all feel down sometimes.

Depression in adults is a strong feeling of sadness that lasts several days or longer, causing significant impairment in daily functioning, accompanied by one or more other severe symptoms. There are several types of depression as defined by the DSM-V that share a commonality, namely the presence of sad, empty, or irritable mood along with physical or mental changes that create significant impairment in daily living. They differ from one another by duration, timing, and cause. A depression diagnosis requires skill and experience to make accurately. Depressive disorders include:

Major Depressive Disorder (including Major Depressive Episode)

Minor Depressive Disorder (Minor Depression)

Persistent Depressive Disorder (Dysthymia)

Disruptive Mood Dysregulation Disorder (seen in children under 10)

Premenstrual Dysphoric Disorder

Substance or Medication-induced Depressive Disorder

Depressive Disorder Due to Another Medical Condition

Recurrent Brief Depression

Short Duration Depressive Episode

Depressive Episode with Insufficient Symptoms

Double Depression

Bipolar Depression

If you are feeling depressed then please consult your doctor. This website cannot diagnose depression and does not try to do so, but it can act as a starting point for understanding the signs and symptoms of the different forms of depression.

Major Depressive Disorder

Major Depressive Disorder is present when a person experiences a Major Depressive Episode in the absence of a psychotic disorder, and in the absence of a Manic, Mixed, or Hypomanic Disorder.

The essential feature of Major Depressive Episode is 2 weeks or more of either depressed mood or loss of interest or pleasure in life. Children and teenagers may report irritability instead of depressed mood. During this 2 week period, five or more of the symptoms also must occur most of the day, nearly every day (with the exception of weight change and suicidal ideation), that cause significant impairment in daily living.

The eight features of Major Depressive Episode:

Significant decrease in interest in activities and pleasure
Insomnia or hypersomnia
Significant weight loss or weight gain or change in appetite
Agitated behavior or slowed behavior observable by others
Low energy and fatigue
Feeling worthless or significant guilt
Poor concentration or indecisiveness
Thoughts of dying or thoughts of suicide with or without a plan

If these symptoms are caused by substance abuse or a medical condition, then the diagnosis may be Substance/medication-Induced Depressive Disorder, or Depressive Disorder due to Another Medical Condition. 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, and there there has never been a manic episode or a hypomanic episode. [1]

If someone with Major Depressive Disorder shows signs of improvement and experiences fewer than five of the above symptoms, then the condition is classified as Major Depression in Partial Remission (instead of minor depression).

Minor Depressive Disorder

Minor Depressive Disorder refers to depression lasting two or more weeks with four or fewer of the eight features of a major depressive episode. Many patients with minor depression experience crying spells, lack of pleasure in usual activities, or irritability. Patients may also present with symptoms of anxiety such as worry, tenseness, and feeling on edge. Minor depression can also cause impaired concentration, memory, and decision making, as well as thoughts of worthlessness, hopelessness, and helplessness. Many people report insomnia or hypersomnia, increased or decreased appetite, and psychomotor agitation (inability to sit still) or psychomotor retardation (feeling slowed down). Suicidal ideation or behavior may occur in minor depression. Minor depression is associated with increased rates of smoking, lack of physical exercise, poor diet, and obesity. [2,3,4]

Persistent Depressive Disorder (Dysthymia)

The diagnosis of Persistent Depressive Disorder requires depressed mood for most of the day, for more days than not for at least 2 years with two or more of the following (In children and adolescents, mood can be irritable and duration must be at least 1 year):

Insomnia or hypersomnia
Low energy or fatigue
Poor appetite or overeating
Low self-esteem
Feelings of hopelessness
Poor concentration or difficulty making decisions

During the 2 year period, the person has never been without the symptoms for more than 2 months. 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, and there there has never been a manic episode or a hypomanic episode. [1] It is possible for a person to have Dysthymia and Major Depressive Disorder at the same time. This is called Double Depression (see below).

Disruptive Mood Dysregulation Disorder

The signs and symptoms of this depressive disorder appear prior to age 10. This disorder is characterized by children who have severe recurrent temperamental outbursts that are inappropriate for the child’s age, with severe continual irritability between outbursts. “The severe irritability consists of chronic, persistently irritable or angry mood that is present between the severe temper outbursts.” [1] The outbursts occur three or more times a week for 12 or more months. The outbursts linger throughout the day, and happen in two or more different settings (ie. home, school, friend’s house). The diagnosis of disruptive mood dysregulation disorder also requires that during the 12 months or more, the child has not had a period of 3 or more consecutive months without the temper tantrums.

If at any point a child does harm to others or himself/herself, then either call 911 or take the child to the nearest hospital for evaluation immediately. If you suspect your child suffers from any mental disorder, then please take your child to see a doctor.

Premenstrual Dysphoric Disorder

The features of Premenstrual Dysphoric Disorder include mood swings, irritability, unhappiness, and anxiety that begin a week or so prior to menses and diminish a week after menstruation. Five or more symptoms must occur during the menstrual cycles in the past one year with an adverse effect on daily functioning. [1] The total number of symptoms from Groups A and B must add up to five combined, with at least one symptom from each group:

Group A
Mood swings
Significant irritability or anger
Significant depression or hopelessness
Marked anxiety or feeling one edge

Group B
Loss of interest in usual activities
Excessive sleep or poor sleep
Poor concentration
Low energy, feeling tired
Excessive eating or poor appetite
Feeling overwhelmed
Physical symptoms like bloating, weight change, joint or muscle pain.

Substance or Medication-induced Depressive Disorder

This disorder is characterized by persistent depressed mood or lack of interest in activities that develops during or soon after exposure to a drug. This disturbance in mood overwhelms the person and causes significant distress or impairment in daily living. The depressive symptoms are associated with the ingestion, injection, or inhalation of a substance (ie. drug of abuse, toxin, psychotropic medication, other medication), and the mood change continues beyond the expected length of psychological effects for the given drug intoxication or withdrawal. The mood disturbance is not better explained by a depressive disorder that is not substance or medication related. [1]

Depressive Disorder Due to Another Medical Condition

When a clear and established period of depressed mood or significantly diminished interest in daily activities occurs, and there is evidence of a medical condition existing around the same time as the mood change, then the depressive disorder may be due to the medical condition. The mood change causes significant distress or impairment in daily living. [1]

Recurrent Brief Depression

This occurs when a person has significant distress due to depression plus four or more of the eight major depressive episode symptoms lasting:
2 to 13 days a month for at least 12 consecutive months.

The person never had a previous diagnosis of depression or bipolar disorder, and no active or residual psychotic disorder. [1]

Short Duration Depressive Episode

Depressive mood causing significant distress plus four or more of the eight major depressive episode symptoms lasting:
5 to 13 days

The person never had a previous diagnosis of depression or bipolar disorder, and no active or residual psychotic disorder. [1]

Depressive Episode with Insufficient Symptoms

This occurs when a person has significant distress due to depression plus one or more of the eight major depressive episode symptoms lasting:
14 days or more

The person never had a previous diagnosis of depression or bipolar disorder, and no active or residual psychotic disorder and does not meet criteria for mixed anxiety and depressive disorder symptoms. [1]

Double Depression

Double depression is a term that refers to a person experiencing a major depressive episode while having dysthymic disorder. Two studies found that most patients with dysthymic disorder also meet criteria for major depression; approximately 59% to 62% of people with dysthymic disorder have Double Depression. [5,6] The studies also found that dysthymia also seemed to worsen the course of major depression. People who have recovered from double depression have a higher relapse rate of major depression than those people who have recovered from major depression exclusively. [7] (In DSM-5, the formal diagnosis for double depression is persistent depressive disorder with intermittent major depressive episodes [1]).

Bipolar Depression

Bipolar Depression is depression that occurs in the context of Bipolar Disorder when a person’s mood drops into a low phase and causes feelings of sadness or hopelessness, called a depressive episode. The mood of a depressive episode can be characterized as an overly long period of feeling sad or hopeless, and may include loss of interest in enjoyable activities. The behavioral changes may include feeling tired or slowed down, having problems concentrating, remembering, or making decisions, eating more or less often, feeling restless or irritable, and having thoughts of suicide or not wanting to live. This diagnosis is specific to people with Bipolar Disorder. As you can see, a depression diagnosis can be complicated and should be handled by a medical professional. 

If you experience significant mood change, then please see a doctor or visit your nearest hospital.

Last updated 10/01/14



References:

[1] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
[2] “‘Subthreshold’ mental disorders. A review and synthesis of studies on minor depression and other ‘brand names’.” Br J Psychiatry. 1999 Apr;174:288-96.
[3] Wassertheil-Smoller S, Shumaker S, Ockene J, et al. Depression and cardiovascular sequelae in postmenopausal women. The Women’s Health Initiative (WHI). Arch Intern Med 2004; 164:289.
[4] Katon W, Richardson L, Russo J, et al. Depressive symptoms in adolescence: the association with multiple health risk behaviors. Gen Hosp Psychiatry 2010; 32:233.
[5] Klein DN, Shankman SA, Rose S. Ten-year prospective follow-up study of the naturalistic course of dysthymic disorder and double depression. Am J Psychiatry 2006; 163:872.
[6] Keller MB, Klein DN, Hirschfeld RM, et al. Results of the DSM-IV mood disorders field trial. Am J Psychiatry 1995; 152:843.
[7] Klein DN, Schwartz JE, Rose S, Leader JB. Five-year course and outcome of dysthymic disorder: A prospective, naturalistic follow-up study. Am J Psychiatry 2000; 157:931.