Diagnostic Parameter, Major Depressive Episode

Major Depressive Episode

Depression, which affects people of all ages, income, race, and cultures, is a disturbance of mood and is characterized by a loss of interest or pleasure in normal everyday activities. People who are depressed may feel "down in the dumps" for weeks, months, or even years at a time.

in the same 2 weeks, the patient has had 5 or more of the following symptoms, which are a definite change from usual functioning. Either depressed mood or decreased interest or pleasure must be one of the five:

Mood. For most of nearly every day, the patient reports depressed mood or appears depressed to others.

Interests. For most of nearly every day, interest or pleasure is markedly decreased in nearly all activities (noted by the patient or by others).

Eating and weight. Although not dieting, there is a marked loss or gain of weight (such as five percent in one month) or appetite is markedly decreased or increased nearly every day.

Sleep. Nearly every day the patient sleeps excessively or not enough.

Motor activity. Nearly every day others can see that the patient's activity is agitated or retarded.

Fatigue. Nearly every day there is fatigue or loss of energy.

Self-worth. Nearly every day the patient feels worthless or inappropriately guilty. These feelings are not just about being sick; they may be delusional.

Concentration. Noted by the patient or by others, nearly every day the patient is indecisive or has trouble thinking or concentrating.

Death. The patient has had repeated thoughts about death (other than the fear of dying), suicide (with or without a plan) or has made a suicide attempt.

These symptoms cause clinically important distress or impair work, social or personal functioning.

They don't fulfill criteria for Mixed Episode

This disorder is not directly caused by a general medical condition or the use of substances, including prescription medications.

Unless the symptoms are severe (defined as severely impaired functioning, severe preoccupation with worthlessness, ideas of suicide, delusions or hallucinations or psychomotor retardation), the episode has not begun within two months of the loss of a loved one.

Use the following codes (including Chronic) for the current or most recent Major Depressive Episode in Major Depressive, Bipolar I or Bipolar II Disorders.

Fifth Digit Severity Code for Major Depressive Episode.

.1 Mild. Symptoms barely meet criteria for major depression and result in little distress or interference with the patient's ability to work, study or socialize.

.2 Moderate. Intermediate between Mild and Severe.

.3 Severe without Psychotic Features. The number of symptoms well exceeds the minimum for diagnosis, and they markedly interfere with patient's work, social or personal functioning.

.4 With Psychotic Features. The patient has delusions or hallucinations, which may be mood-congruent or mood-incongruent. Specify, if possible:

Severe With Mood-congruent Psychotic Features. The content of the patient's delusions or hallucinations is completely consistent with the typical themes of depression: death, disease, guilt, nihilism, personal inadequacy or punishment that is deserved.

Severe With Mood-incongruent Psychotic Features. The content of the patient's delusions or hallucinations is not consistent with the typical themes of depression. Mood incongruent themes include delusions of control, persecution, thought broadcasting and thought insertion.

.5 In Partial Remission. Use this code for patients who formerly met full criteria for Major Depressive Episode and now either (1) have fewer than five symptoms or (2) have had no symptoms for less than two months.

.6 In Full Remission. The patient has had no material evidence of Major Depressive Episode during the past 2 months.

.0 Unspecified.

Chronicity Specifier: Chronic. All the criteria for a Major Depressive Episode have been met without interruption for the previous 2 years or longer.

Psychomotor Agitation and Psychomotor Retardation

Psychomotor agitation and retardation occur in depression, producing states of over activity and under activity respectively. Agitation and retardation can lead to impaired cognition, judgment, reason, and decision making, which often further isolates depressed people and prolongs symptoms. Psychomotor agitation can also lead to generalized restlessness.
Motor agitation is rarer than motor retardation and is often occurs in the elderly. Over activity in this sense does not mean mania. The agitated state in major depressive disorder should not be confused with the manic episode that occurs in bipolar disorder, when mood is temporarily elevated by a transient sense of hope and elation.

Psychomotor activities are the physical gestures that result from mental processes and are a product of the psyche. Many psychomotor behaviors associated with mental disorder affect impulses, cravings, instincts, and wishes. The spectrum of agitated behavior includes the following:

Incoherent conversation
Expansive gesturing
Pacing and hair twirling

Psychomotor retardation manifests as a slowing of coordination, speech, and impaired articulation. In this state, a person appears sluggish and seems hesitant or confused in speech and intention.

Essentially Features:

Physical illness, alcohol, medication, or street drug use.
Normal bereavement.
Bipolar Disorder
Mood-incongruent psychosis (e.g., Schizoaffective Disorder, Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified).

Major Depressive Disorder causes the following mood symptoms:

Abnormal depressed mood:

Sadness is usually a normal reaction to loss. However, in Major Depressive Disorder, sadness is abnormal because it:

Persists continuously for at least 2 weeks.

Causes marked functional impairment.

Causes disabling physical symptoms (e.g., disturbances in sleep,
appetite, weight, energy, and psychomotor activity).

Causes disabling psychological symptoms (e.g., apathy, morbid
preoccupation with worthlessness, suicidal ideation, or psychotic
symptoms).

The sadness in this disorder is often described as a depressed, hopeless, discouraged, "down in the dumps," "blah," or empty. This sadness may be denied at first. Many complain of bodily aches and pains, rather than admitting to their true feelings of sadness.

Abnormal loss of interest and pleasure mood:

The loss of interest and pleasure in this disorder is a reduced capacity to experience pleasure which in its most extreme form is called anhedonia.

The resulting lack of motivation can be quite crippling.

Abnormal irritable mood:

This disorder may present primarily with irritable, rather than depressed or apathetic mood. This is not officially recognized yet for adults, but it is recognized for children and adolescents.

Unfortunately, irritable depressed individuals often alienate their loved ones with their cranky mood and constant criticisms.

Major Depressive Disorder causes the following physical symptoms:

Abnormal appetite: Most depressed patients experience loss of appetite and weight loss. The opposite, excessive eating and weight gain, occurs in a minority of depressed patients. Changes in weight can be significant.

Abnormal sleep: Most depressed patients experience difficulty falling asleep, frequent awakenings during the night or very early morning awakening. The opposite, excessive sleeping, occurs in a minority of depressed patients.

Fatigue or loss of energy: Profound fatigue and lack of energy usually is very prominent and disabling.

Agitation or slowing: Psychomotor retardation (an actual physical slowing of speech, movement and thinking) or psychomotor agitation (observable pacing and physical restlessness) often are present in severe Major Depressive Disorder.

Major Depressive Disorder causes the following cognitive symptoms:

Abnormal self-reproach or inappropriate guilt:

This disorder usually causes a marked lowering of self-esteem and self-confidence with increased thoughts of pessimism, hopelessness, and helplessness. In the extreme, the person may feel excessively and unreasonably guilty.

The "negative thinking" caused by depression can become extremely dangerous as it can eventually lead to extremely self-defeating or suicidal behavior.

Abnormal poor concentration or indecisiveness:

Poor concentration is often an early symptom of this disorder. The depressed person quickly becomes mentally fatigued when asked to read, study, or solve complicated problems.

Marked forgetfulness often accompanies this disorder. As it worsens, this memory loss can be easily mistaken for early senility (dementia).

Abnormal morbid thoughts of death (not just fear of dying) or suicide:

The symptom most highly correlated with suicidal behavior in depression is hopelessness