What are Depressive Disorders?
A low, sad state marked by significant levels of sadness, lack of energy, and low
self-worth, guilt, or related symptoms.
Types of Depressive Disorders
According to DSM-5, the Classification of Depressive Disorders is as follows:
- Major Depressive Disorder
- Disruptive Mood Dysregulation Disorder
- Persistent Depressive Disorder (Dysthymia)
- Premenstrual Dysphoric Disorder
- Substance/Medication-Induced Depressive Disorder
- Depressive Disorder Due to Another Medical Condition
- Other Specific Depressive Disorder
- Depression with Psychotic Features
- Depression with Seasonal Pattern
Major Depressive Disorder
Symptoms of Major Depressive Disorder
Symptoms of Major Depressive Disorder are as follows:
➢ Depressed mood most of the day, nearly every day.
➢ Loss of interest and pleasure.
➢Change of body weight includes 5%
or more than in a month, a decrease or an increase in appetite.
➢ Insomnia or hypersomnia.
➢ Psychomotor agitation or retardation, for example, restlessness or being slowed
down.
➢ Feelings of worthlessness or guilt.
➢ Trouble thinking clearly, focusing, or making decisions
➢ Suicide attempt or recurrent thoughts of death.
Diagnostic Criteria for Major Depressive Disorder
According to DSM-5, the criteria for meeting the Major Depressive
Disorder is as follows:
➢ Five or more of the above-mentioned symptoms have been present during the
same 2-week period and represent a change from previous functioning. At least
one of the symptoms is either depressed mood and loss of interest or pleasure.
➢ The symptoms cause significant distress or impairment in personal, social,
occupational areas of functioning.
➢ These symptoms are not due to the physiological effects of a substance or
other medical condition
Differential Diagnosis for Major Depressive Disorder
Mood disorder due to another medical condition. It should be considered, mood disturbance is not due to a specific medical condition, such as stroke,
hypothyroidism etc.
Substance/medication-induced depressive or bipolar disorder. It should be
carefully clinically evaluated that depressive symptoms are not due to a drug or
medication. For example, depressed mood also occurred due to withdrawal from
cocaine, then it should be diagnosed as cocaine-induced depressive disorder.
Adjustment disorder with depressed mood. Moreover, a major depressive episode that
occurs in response to a psychosocial stressor is distinguished from adjustment
disorder with depressed mood.
Sadness. Often, we experience sadness. Also, these periods of sadness should not
be diagnosed as Major Depression unless criteria are met for severity, duration, and
impairment.
Disruptive Mood Dysregulation Disorder
It is a mental disorder in children and adolescents.
Symptoms of Disruptive Mood Dysregulation Disorder
According to DSM-5, symptoms of Disruptive Mood Dysregulation Disorder
are as follows:
➢ Severe recurrent temper outbursts manifested verbally and behaviorally
➢ The mood is persistently irritable or angry most days, nearly every day
and is observable by others.
Diagnostic Criteria
➢ The temper outbursts occur three or more times per week.
➢ The above-mentioned symptoms have been present for 12 or more months.
➢Symptoms typically appear in at least two out of three settings — at home, at school, or with peers — and are noticeably severe in at least one of them.
➢ Therapist make this diagnosis only between the ages of 6 and 18 — not earlier or later
Differential Diagnosis
Bipolar disorder. Disruptive Mood Dysregulation is characterized by chronic
irritability, whereas irritability in bipolar disorder is episodic.
Oppositional defiant disorder. Both disorders have the symptoms of
irritability and temper outbursts. The difference is that in Disruptive Mood Dysregulation
Disorder outbursts occur three times per week, but only once a week in oppositional
defiant disorder.
Persistent Depressive Disorder (Dysthymia)
Symptoms and Diagnostic Criteria for Dysthymia
➢ Depressed mood most of the day
➢ With depressed mood, at least two of the symptoms of poor appetite or overeating,
insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor
concentration or difficulty making decisions, and feelings of hopelessness.
➢ Duration of depressed mood is two years.
➢ In children and adolescents, the duration of irritable mood must be at least one
year.
➢ During two years of depressed mood and one year in children
and adolescents, the individual must have two of the above-mentioned
symptoms for more than two months at a time.
➢ The symptoms are not due to the physiological effects of a drug or other
medical condition.
➢ The symptoms cause significant impairment in the areas of functioning of
personal, occupational, and social life.
Differential Diagnosis
Major depressive disorder. The diagnosis of the persistent depressive
disorder over major depression is made on the criteria of a year’s duration.
Substance/medication induces depressive or bipolar disorder. A
Substance/medication-induced depressive or bipolar and related disorder is
distinguished from persistent depressive disorder when a substance is judged to be
etiologically related to the mood disturbance.
Psychotic disorders. Depressive symptoms are a common associated feature
of chronic psychotic disorders, for example, schizoaffective disorder, schizophrenia, and
delusional disorder. Therefore, a separate diagnosis of persistent depressive disorder is not made
if the symptoms occur only during the psychotic disorder.
Premenstrual Dysphoric Disorder
Symptoms and Diagnostic Criteria
With reference to DSM-5, the diagnostic criteria and symptoms are as follows:
➢ In most menstrual cycles during the past year, at least five of the following
Symptoms present in the final week before menses and improved within a few days
days of menses onset:
Affective lability
Irritability
Depressed mood, hopelessness, or self-deprecating thoughts
Anxiety
Diminished interest in usual activities
Difficulty concentrating
Lack of energy
Changes in appetite
Sleeping too much or too little
Subjective sense of being overwhelmed or out of control
Physical symptoms such as breast swelling, joint or muscle pain, or bloating
➢ Symptoms lead to significant functional impairment.
➢ Symptoms are not due to the effect of another mood or anxiety disorder or a
personality disorder.
➢ Symptoms are present when oral contraceptives are not being taken.
Differential Diagnosis
Premenstrual syndrome. The criteria for the presence of five symptoms are not
required in premenstrual syndrome.
Dysmenorrhea. It is a syndrome of painful menses. Symptoms of
Dysmenorrhea begins with the onset of menses, but symptoms occur in premenstrual
dysphoric disorder before the onset of the menstrual cycle.
Bipolar, major depressive disorder, and dysthymia. Additionally, symptoms of
Premenstrual disorder can be differentiated from bipolar disorder, major depression, and
Dysthymia, based on the criteria of the onset of the symptoms of this disorder before
menses.
Substance/Medication-Induced Depressive Disorder
Symptoms and Diagnostic Criteria
In DSM-5, symptoms and criteria of this disorder are as follows:
➢ A prominent and persistent disturbance in mood that is characterized by
depressed mood and diminished interest in pleasure and all activities.
➢ There is evidence from the history, physical examination, or laboratory
findings of both of the following:
- Depressed mood is developed during or soon after substance intoxication or
withdrawal or after exposure to a medication. - The involved substance/medication is capable of producing the symptoms of
depressed mood and loss of pleasure and interest in all activities.
➢ The disturbance is not better explained by a depressive disorder that is not
substance/medication-induced.
➢ The symptoms persist for about a duration of one month after the cessation of
acute withdrawal or severe intoxication.
➢ The disturbance does not occur exclusively during a delirium.
➢ The disturbance causes significant distress or impairment in social,
occupational, or other important areas of functioning.
Differential Diagnosis
Substance intoxication and withdrawal. Mood disturbance is more severe
and long-lasting in substance/medication-induced depressive disorder,
Depressive disorder due to another medical condition. It is worth noting that the clinician must
consider the possibility that the mood symptoms are caused by the physiological
consequences of the medical conditions rather than the medication in which
depressive disorder due to another medical condition is diagnosed.
Other Specified Depressive Disorder
Recurrent Brief Depression
Presence of depressed mood and at least four other symptoms of depression
for 2-13 days at least once per month and not associated with the menstrual cycle, for
at least 12 consecutive months in an individual whose symptoms never met the
criteria of any other depressive disorder or bipolar disorder.
Short-duration Depressive Episode (4-13 days)
Depressed mood and at least four of the other eight symptoms of a major
depressive episode for more than 4 days but less than 14 days.
Depressive Episodes with insufficient symptoms
Depressed mood and at least four of the other eight symptoms of a major A
depressive episode for at least two weeks in an individual.
Depression with Psychotic Features
Delusion and hallucinations.
Depression with Seasonal Pattern
There has been a regular temporal relationship between the onset of major
depressive episodes in major depressive disorder, and a particular time of the year for
example in the fall or winter.
In the last two years, two major depressive episodes have occurred that
demonstrate the temporal seasonal relationships defined above, and no nonseasonal
Major depressive episodes have occurred during that same period.
Causes of Depressive Disorders
Biological Causes
➢ A family history of depression. You are more likely to experience symptoms
of depression if others in your family also have depression or another type of
mood disorder.
➢ Certain medical conditions. You may be more likely to experience
depression if you have a chronic illness, sleep disorder, or thyroid
conditions. Depression rates also tend to be higher among people who have
chronic pain, diabetes, multiple sclerosis, and cancer.
➢ Substance use. Having a history of substance use or misuse can also increase
the likelihood of depression.
Psychological Causes
Psychodynamic view. According to the psychodynamic view, certain people
who experience real or imagined losses may regress to an earlier stage of
development, introject feelings for the lost object, and eventually become depressed.
Behavioral views. The behaviorists say that when people experience a large
reduction in their positive regard in life, they may display fewer and fewer positive
behaviors. These responses lead to a still lower rate of positive rewards and eventually
to depression.
The cognitive views. The cognitive school of thought explains that negative
thoughts and hopelessness cause depression. According to Beck’s theory of negative
thinking, maladaptive attitudes, the cognitive triad, errors in thinking, and automatic
thoughts help to produce depression.
Treatment and Management Plan For Depressive Disorders
Intervention goals are set according to the needs of the client, according to the
personality traits of the client, and based on the conditions of the client. Some of the
management techniques or therapies are as follows:
Medications
Antidepressant medication may be prescribed, along with psychological treatments, when a person experiences a moderate to severe episode of depression. Sometimes, antidepressants are prescribed when other treatments have not been successful or when psychological treatments are not possible due to the severity of the condition or a lack of access to the treatment.
Rapport building
Building rapport is the process of establishing that connection. It is usually based on shared experiences or views, including a shared sense of humor. Building rapport tends to be most important at the start of creating rapport at the beginning of a conversation with somebody new will often make the outcome of the conversation more positive. However stressful or nervous you may feel, the first thing you need to do is to try to relax and remain calm. Hence, By becreasing the tension in the situation, communication
becomes easier and rapport grows.
Psychoeducation
Psychoeducation interventions are interventions in which education is offered to individuals with psychological disorders or physical illnesses. Moreover, psychoeducation interventions are less expensive, more easily administered, and potentially more accessible than conventional pharmacological and psychological interventions.
Relaxation Techniques
Relaxation techniques can help to relax the mind and body and also manage some of the symptoms of anxiety and depression. There are many types of relaxation, including breathing exercises, progressive muscle relaxation, and mindfulness, that help to manage the symptoms of depression.
Behavior Activation Therapy
Behavioral activation (BA) is a structured, brief psychotherapeutic approach
that aims to increase engagement in adaptive activities, decrease engagement in
activities that maintain depression or increase risk for depression, and solve
problems that limit access to reward or that maintain or increase aversive control.
In other words, BA is a type of therapeutic intervention (most often used to
treat depression) that focuses on behavioral changes in a client’s daily life. Moreover, BA
Interventions might involve helping the client plan more activities they enjoy
doing, helping the client develop their social skills, or just generally having the client
track their own emotions and activities. Hence, Behavioral Activation is a highly
personalized intervention that targets one’s depression by targeting the behaviors that
feed into that depression.
Cognitive Behavioral Therapy (CBT)
CBT techniques are evidence-based methods to change thoughts, feelings, and behaviors and improve overall life satisfaction and functioning. Some techniques for dealing with depression are as follows:
Cognitive restructuring. It is a cognitive behavior therapy technique aimed at helping people identify thinking patterns responsible for negative moods and ineffective behavior. There are numerous
techniques employed during cognitive restructuring. The most common technique is
tracking dysfunctional thoughts on a thought record form, finding out cognitive
distortions, and devising healthier, more psychologically flexible patterns of thinking.
Activity scheduling. Activity scheduling is a cognitive behavior therapy technique designed to
help people increase behaviors they should be doing more. By identifying and
scheduling helpful behaviors, such as meditating, going for a walk, or working on a
project, it increases the likelihood of them getting done. Additionally, This technique is especially
helpful for people who do not engage in many rewarding activities due to depression.
Interpersonal Therapy (IPT)
Interpersonal Therapy (IPT) uses a structured, goal-oriented approach to help you work through problems in personal relationships and build healthier communication skills. It’s based on the idea that relationship conflicts or changes can deeply impact your emotional well-being — and may even trigger or worsen depression. IPT helps you identify unhelpful patterns in your relationships and gives you tools to break those cycles, reducing your vulnerability to depressive symptoms. Hence, Identifying these
Patterns mean you can focus on improving relationships, coping with grief, and
finding new ways to get along with others.
Mindfulness-Based Cognitive Therapy (MBCT)
It focuses on relapse prevention after successful treatment for recurrent
episodes of major depression. It is based on the assumption that a person becomes
vulnerable to relapse because of repeated associations between sad mood and patterns
of negative thinking. The goal of MBCT is to help clients with depression learning how
to avoid relapses by not engaging in those automatic thought patterns that perpetuate
and worsen depression.
Conclusion
In a nutshell, depression affects more than 300 million people across the globe, touching lives regardless of culture, age, gender, or background. It’s the leading cause of disability worldwide and plays a major role in the global burden of disease. While effective treatments do exist, fewer than half of those who need help receive it — and in some countries, that number drops below 10%. The main roadblocks? Limited resources, a shortage of trained professionals, and the lingering stigma surrounding mental health. That’s why raising awareness about the signs, symptoms, and available treatments for depression is so important. The more we talk about it, the more lives we can help change — or even save.
