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Depression: Major Depression & Unipolar Varieties
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Symptoms of Depressive Disorders

Mark Dombeck, Ph.D.

Worried you may be suffering from some type of depressive disorder? Check here for the symptoms you should look for before consulting a mental health professional.

Note: This document describes only Unipolar forms of depression (characterized by a depressed or irritated mood only). Bipolar Disorders (Manic Depression - characterized by an osscilation between depressed and energetic moods) are described in our Bipolar Center.

Major Depressive Disorder

A person who suffers from a major depressive disorder must have either have a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a 2 week period. This mood must represent a change from the person's normal mood; social, occupational, educational or other important functioning must also be negatively impaired by the change in mood. A depressed mood caused by substances (such as drugs, alcohol, medications) is not considered a major depressive disorder, nor is one that is caused by a general medical condition. Major depressive disorder cannot be diagnosed if a person has a history of manic, hypomanic, or mixed episodes (e.g., a bipolar disorder) or if the depressed mood is better accounted for by schizoaffective disorder and is not superimposed on schizophrenia, a delusional or psychotic disorder.

Major depressive disorder is characterized by the presence of at least one major depressive episode, which is not a disorder in itself, but is a part of another disorder, most often major depressive disorder or bipolar disorder. A major depressive episode includes the following symptoms:

 

     

  • depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). (In children and adolescents, this may be characterized as an irritable mood.)
  • markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
  • significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
  • insomnia or hypersomnia nearly every day
  • psychomotor agitation or retardation nearly every day
  • fatigue or loss of energy nearly every day
  • feelings of worthlessness or excessive or inappropriate guilt nearly every day
  • diminished ability to think or concentrate, or indecisiveness, nearly every day
  • recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Dysthymia

This disorder is characterized by a mild-to-moderate, but chronic state of depression, characterized by a depressed mood for most days for at least a two year period. (In children and adolescents, mood can be irritable and duration must be at least 1 year.) The person who suffers from this disorder must have experienced two or more of the following symptoms for most of the two year period with no more than a month of symptomatic absence:

  • poor appetite or overeating
  • insomnia or hypersomnia
  • low energy or fatigue
  • low self-esteem
  • poor concentration or difficulty making decisions
  • feelings of hopelessness

No Major Depressive Episode has been present during the first two years (or one year in children and adolescents) and there has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder. The symptoms are not due to the direct physiological effects of the use or abuse of a substance (alcohol, drugs, medications) or a general medical condition. The symptoms must also cause significant distress or impairment in social, occupational, educational or other important areas of functioning.

Seasonal Affective Disorder (SAD)

The term 'Seasonal Affective Disorder' is not a recognized diagnosis in the DSM-IV. SAD is, instead, diagnosed as a varient of Major Depression, with a seasonal affect specifier noted in the diagnosis. Symptoms can include all of the characteristics of a major depressive episode. However, certain symptoms seem to be more pronounced such as fatigue, sleeping longer, decreased energy and motivation, increase in appetite especially for carbohydrates, weight gain, and increased irritability.

The symptoms begin during the fall and winter months when the days are shorter and there is less exposure to sunlight. The depressive symptoms disappear when the spring and summer months begin and there is more exposure to sunlight. Researchers have found that SAD seems to occur in some people because without a certain amount of exposure to sunlight they begin to produce higher amounts of a neurochemical in the brain called Melatonin. Melatonin tends to play an important role in affecting a person's sleeping and eating habits. When there is too much Melatonin being produced it will cause a person to want to sleep and eat more, therefore causing the symptoms of SAD.

References:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.