Tuesday, September 20, 2011

Major Depressive Disorder (MDD)

MDD is characterized by one or more major depressive episodes & no history of manic, hypomanic or mixed episodes.  MDD can begin at any age but most often onsets in the mid-20s.  The course can be quite variable.  Some people may have isolated episodes of depression with remissions of many years; others may have clusters of episodes with brief remissions.  You can use specifiers to indicate the course of the disorder, such as the specifier “With Full Interepisode Recovery” or “Without Full Interepisode Recovery.”

The criteria:
  • Presence of a single major depressive episode (see previous post)
  • Episode is not better accounted for by schizoaffective disorder & is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified.
  • There has never been a manic, mixed or hypomanic episode unless that episode is substance or treatment induced or due to a general medical condition.

  • If the full criteria are met at the current time for a major depressive episode, specify its current clinical status and/or features:
    • Mild (with 5 – 6 symptoms of a major depressive episode), moderate (between mild & severe), severe with psychotic features (with most symptoms of a depressive episode and psychosis) or severe without psychotic features (with most of the symptoms & no psychosis)
    • Chronic – full criteria have been met for a major depressive episode for at least the previous 2 years
    • With catatonic features – with 2 of the following
      • Motor immobility as evidenced by muscular rigidity or stupor
      • Excessive motor activity that serves no evident purpose & is not influenced by external stimuli
      • Extreme negativism (resistance to instructions with no evident motive or maintenance of a rigid posture against attempts to be moved) or mutism
      • Peculiarities of voluntary movement such as posturing (assuming bizarre or inappropriate postures), stereotyped movements, prominent mannerisms or prominent grimacing
      • Echolalia (repeating what you say) or echopraxia (imitating your physical movements)
    • With melancholic features – defined by
      • Either loss of pleasure in nearly all activities or lack of reactivity to usually pleasurable stimuli at the most severe point of the episode.
      • Three or more of the following symptoms:
        • Distinct quality of depressed mood
        • Depression regularly worse in the morning
        • Early morning awakening (at least 2 hours before usual time of awakening)
        • Marked psychomotor retardation or agitation
        • Significant anorexia or weight loss
        • Excessive or inappropriate guilt
    • With atypical features
      • Mood reactivity – mood improves in response to positive events
      • Two or more of the following:
        • Significant weight gain/increased appetite
        • Hypersomnia
        • Leaden paralysis – a heavy, leaden feeling in extremities
        • Long standing pattern of sensitivity to interpersonal rejection that results in significant social/occupational impairment
      • Criteria are not met for melancholic or catatonic features during the same episode
    • With postpartum onset – episode onsets within 4 weeks postpartum

1 comment:

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