Tuesday, June 25, 2024

Chronic Recurrent Major Depressive Disorder

How Is Dysthymia Diagnosed

Persistent Depressive Disorder (Dysthymia) | Risk Factors, Symptoms, Diagnosis, Treatment

Depression often happens with other conditions, such as heart disease, or cancer. It may also happen with substance abuse or anxiety disorders. Often, people with dysthymia grow accustomed to the mild depressive symptoms and do not seek help. But, early diagnosis and treatment is key to recovery.

A diagnosis may be made after a careful psychiatric exam and medical history done by a mental health professional.

How Is Major Depressive Disorder Treated

MDD is often treated with medication and psychotherapy. Some lifestyle adjustments can also help ease certain symptoms.

People who have severe MDD or have thoughts of harming themselves may need to stay in a hospital during treatment. Some might also need to take part in an outpatient treatment program until symptoms improve.

What Causes Persistent Depressive Disorder

Scientists dont fully understand what causes PDD. But it might be related to low levels of serotonin. Serotonin is a natural hormone that controls our emotions and feelings of well-being. It also influences other body functions.

PDD may get triggered by a traumatic event in life. Examples include losing a job, having a loved one die, experiencing a crime or going through a breakup.

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What Are The Symptoms Of Major Depressive Disorder

Your doctor or a mental health professional can diagnose major depressive disorder based on your symptoms, feelings, and behaviors.

Typically, youll be asked specific questions or given a questionnaire so health professionals can better determine whether you have MDD or another condition.

To be diagnosed with MDD, you need to meet the symptom criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition . This manual helps medical professionals diagnose mental health conditions.

According to its criteria:

  • you must experience a change in your previous functioning
  • symptoms must occur for a period of 2 or more weeks
  • at least one symptom is either depressed mood or loss of interest or pleasure

You must also experience 5 or more of the following symptoms in the 2-week period:

  • You feel sad or irritable most of the day, nearly every day.
  • Youre less interested in most activities you once enjoyed.
  • You suddenly lose or gain weight or have a change in appetite.
  • You have trouble falling asleep or want to sleep more than usual.
  • You experience feelings of restlessness.
  • You feel unusually tired and have a lack of energy.
  • You feel worthless or guilty, often about things that wouldnt usually make you feel that way.
  • You have difficulty concentrating, thinking, or making decisions.
  • You think about harming yourself or suicide.

Symptoms parents should be aware of in their teens include the following:

Va Rating For Major Depressive Disorder Rating Criteria

Major Depressive Disorder (MDD): Pathogenesis and Clinical ...

MAJOR DEPRESSIVE DISORDER claims are rated on a scale from 0% to 100%. The level of occupational and social impairment is what determines your overall rating under the law.


A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.


Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.


Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks , due to such symptoms as: depressed mood, Major Depressive Disorder, suspiciousness, panic attacks , chronic sleep impairment, mild memory loss .



100% VA Rating Criteria for MAJOR DEPRESSIVE DISORDER:

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What Exactly Is Chronic Depression

First things first. Chronic depression isnt technically a diagnosis in the DSM-5, the official guide of mental disorders. That doesnt mean its not a real thing, though. Its just that most people have depressive episodes with a clear start and end , so thats how experts have framed the disorder.

What Are The Signs And Symptoms

Major depression symptoms vary from person to person. To receive a diagnosis of major depressive disorder, some of these signs and symptoms must be present for at least two weeks. Anyone who has questions should consult their doctor.

  • Continued feelings of sadness, hopelessness, pessimism, emptiness
  • Fatigue, lack of energy
  • Insomnia or other sleep issues such as waking up very early or sleeping too much
  • Anxiety, irritability, restlessness
  • Lack of interest or joy in hobbies and activities
  • Changes in appetite, leading to weight loss or weight gain
  • Moving, talking, or thinking more slowly
  • Forgetfulness
  • Trouble concentrating, thinking clearly, or making decisions
  • Vague aches and pains, such as headaches, joint pain, back pain, or digestive problems
  • Thoughts of death or suicide, or suicide attempts

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How Can I Cope With Persistent Depressive Disorder

In addition to taking medication and going to therapy, consider doing things you enjoy, such as:

  • Do something nice for someone else.
  • Go to a movie, a show or a ballgame.
  • Hang out with people who have positive attitudes.
  • Paint, or try some arts and crafts.
  • Spend time outside.
  • Spend time with friends, in person or on the phone.
  • Take a yoga class, learn to meditate, or walk with a friend.

A note from Cleveland Clinic

PDD can make you feel sad or down most of the day, most days, over a long period of time. Talk to your healthcare provider if you have depressive symptoms. Medication, counseling and healthy lifestyle choices can make you feel better. If you feel like you might hurt yourself or someone else, seek help immediately. Youre not alone.

Last reviewed by a Cleveland Clinic medical professional on 03/08/2021.


What Is Recurrent Depression

Persistent Depressive Disorder (Chronic Depression) and CBASP

Nothing is so disheartening than repeated bouts of depression that negatively impact your quality of life. A major depressive episode may last 2 weeks or two years, and continue to haunt you will recurring episodes. Depression is considered recurrent if the symptoms present themselves after a period of remission. The severity of the depressive episodes can vary from mild depression to severe depression. This blog will focus on recurrent severe depressive episodes and how to treat the condition.

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What Is Persistent Depressive Disorder

Persistent depressive disorder is mild or moderate depression that doesnt go away. A person with PDD has a sad, dark, or low mood and two or more other symptoms of depression. The symptoms last most of the day, on most days, over a long period of time.

Healthcare providers used to call the condition dysthymia or dysthymic disorder.

Major Depressive Disorder Recurrent Unspecified

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  • F33.9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
  • The 2022 edition of ICD-10-CM F33.9 became effective on October 1, 2021.
  • This is the American ICD-10-CM version of F33.9 – other international versions of ICD-10 F33.9 may differ.
  • Applicable To annotations, or

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Major Depression A Chronic Illness

Major depression is a serious mental illness. It is classified as a mood disorder, which means that it is characterized by negative patterns in thoughts and emotions that dont line up with a persons actual circumstances. It is also a chronic mental illness. This means it is not curable and that it can come and go, sometimes for a persons entire life. Someone diagnosed with depression may feel fine for a long period of time and then have symptoms. The period during which someone experiences the symptoms is called a depressive episode.

Most people with major depression live with it as a chronic illness. Episodes come and go, although they may be made less severe and less frequent with good treatment. In some cases, though, a person may experience a singular episode of depression, just once in a lifetime. Often these episodes of depression are triggered by a situational event: a death in the family, the loss of a job or relationship, or some kind of trauma, like a physical assault. This single depressive episode may be just as serious as those experienced by someone with recurrent major depression, with all the same symptoms and persistence.

What Are The Symptoms Of Recurrent Depressive Disorder

Icd Major Depressive Disorder Recurrent Moderate

Symptoms of recurrent depressive disorder are similar to those of any type of depression except that the individual will be free from symptoms for weeks or even years at a time before experiencing another episode.

Symptoms include the following:4

  • persistent feelings of sadness or emptiness
  • loss of interest in activities
  • difficulty concentrating or making decisions
  • irritability or anger
  • changes in appetite or weight
  • fatigue or lack of energy
  • feelings of worthlessness or excessive guilt
  • changes in sleep patterns
  • unexplained physical pains or gastrointestinal disturbances
  • suicidal thoughts or attempts

The degree to which these symptoms affect an individuals ability to function determines if an episode is considered to be mild, moderate, or severe. For example, a mild episode may be irritating and annoying, whereas a severe episode may prevent a person from engaging in daily activities. In severe cases, psychosis may or may not be present.

It is important to note that with each subsequent depressive episode, an individual has an increased risk of developing suicidal thoughts or of attempting suicide.5

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How Do Doctors Diagnose Chronic Depression

Well, they probably wont since, as we mentioned, chronic depression isnt an actual diagnosis per the DSM-5its a colloquial term.

Your doctor will probably consult the DSM-5 and ask questions to see if your experience matches with the symptoms of PDD. Answering the questions to the best of your ability will lead to a more accurate diagnosis.

Since theres no blood test or cheek swab that can determine if you have chronic depression, your doctor will need to rely on conversations with you to get a full history, including any depression symptoms in childhood, adolescence, and adulthood what stressors youre dealing with now any physical symptoms youre currently experiencing your medical history, plus a family history of mental illness and major medical issues.

Your doctor may also want to rule out underlying medical causes, such as thyroid disease and vitamin deficiency, which can mimic symptoms of depression.

They may ask about any medications youre taking, such as beta-blockers for hypertension, acid reflux drugs, anti-inflammatory corticosteroids, cholesterol-lowering statins, and more, or they might ask about your use of alcohol and street drugs. Theyre not just being nosytheyre trying to get to the root of the problem, and some of these substances are linked to depressive symptoms.

Before we move on to treatments, remember thisits important!

How Is Recurrent Depressive Disorder Diagnosed

According to the ICD-11, to be diagnosed with recurrent depressive disorder, all of the following conditions must be met:

  • at least one previous depressive episode that lasted for at least 2 weeks
  • at least five current depressive symptoms that have lasted at least 2 weeks
  • at least 2 months with no depressive symptoms in between episodes
  • no increase in energy levels or evidence of mania or hypomania

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Diagnosing Major Depressive Disorder

If you or a loved one have been feeling depressed and low, seek help as soon as possible. You can reach out to a mental healthcare provider or contact your primary care doctor for a diagnosis or referral.

Your healthcare provider will ask you a series of questions that will likely cover your symptoms, thoughts and feelings, and medical history. They may need to perform a physical or psychological exam, or conduct lab tests, in order to rule out other health conditions that can cause similar symptoms.

Your healthcare provider will determine whether or not your symptoms meet the diagnostic criteria for major depressive disorder, which include:

  • Having a persistently depressed mood and lack of interest in activities
  • Having five or more symptoms of depression
  • Having symptoms every day, almost all day
  • Having symptoms for over two weeks
  • Being unable to function like you did before, due to the symptoms

Major Depressive Disorder Single Episode Unspecified

What is the Course of Major Depressive Disorder?
    2016201720182019202020212022Billable/Specific Code
    • 2016201720182019202020212022Billable/Specific Code

    Applicable To

    • 2017 – New Code20182019202020212022Billable/Specific Code

    Applicable To

  • Single episode of ‘masked’ depression NOS
    • recurrent episode F33.9
    • 2016201720182019202020212022Billable/Specific Code

    Applicable To

    • 2016201720182019202020212022Billable/Specific CodeAdult Dx POA Exempt

    Applicable To

      • 2017 – New Code20182019202020212022Billable/Specific Code

      Applicable To

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    What Is Recurrent Depressive Disorder

    Recurrent depressive disorder is a type of clinical depression. Rather than having one episode of depression, whether short or long, a person with recurrent depressive disorder will experience additional episodes of depression after periods of time without symptoms.1 These episodes can be considered as mild, moderate, or severe and with or without psychosis, depending on the number of symptoms and how much these symptoms impact an individuals life.

    Although not included in the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders , recurrent depressive disorder is listed in the World Health Organizations International Classification of Diseases . This is not a type of bipolar depression. In fact, according to the ICD-11, to be diagnosed with recurrent depressive disorder, the affected individual cannot have a period of increased energy, hypomania, or mania during the time in between depressive episodes.2 The period in between episodes is simply without symptoms of depression.

    Those who have had an episode of depression are 50% more likely to have a recurrence.3 Additionally, individuals with recurrent depressive disorder who have had two episodes are 80% more likely to have a third.

    Treatment And Efficacy Assessment

    All the subjects underwent the fMRI scanning at baseline. The patients with MDD received paroxetine for 6 months based on the judgment of their physician. Their dosage started at 10mg daily, and was increased to 20mg or higher in the second week. The maximum dosage was 60mg daily, based on the severity of symptoms, clinical responses and side effects. After baseline assessment and scanning, the MDD patients were assessed using HAM-D24 at the end of the 0.5, 1st, 2nd, 3rd, 4th, 5th and 6th months. At the end of the 6th month, the patients received other clinical assessments and a second MRI scan. And the patients with a HAM-D24 score of 7 for at least two months was regarded as clinical remission. Of the 107 patients enrolled, 5 had excessive head motions , and 7 experienced manic episodes during the six months of treatment thus, their data were removed from the study. A total of 95 patients were included in further analyses. During the treatment, 7 patients received electroconvulsive therapy or other antidepressant agents, and 25 patients discontinued their participation. Thus, a total of 63 patients finished the 6-month treatment period and underwent the second MRI scan, with 56 clinically remitted patients included in the final analyses while 7 unremitted patients excluded due to the relatively small number of them.

    A group of 117 matched HCs also underwent the baseline scan and clinical assessments, with 6 excluded for excessive head motions.

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    Tips For Living Well With Major Depressive Disorder

    Living with major depression can feel lonely. People may be fearful or ashamed of being labeled with a serious mental illness, causing them to suffer in silence, rather than get help. In fact, most people with major depression never seek the right treatment. But those struggling with this illness are not alone. Its one of the most common and most treatable mental health disorders. With early, continuous treatment, people can gain control of their symptoms, feel better, and get back to enjoying their lives.

    What Are The Types Of Major Depression


    There are several types of depressive disorders:

  • Postpartum Depression affects women after having a baby. It causes intense, long-lasting feelings of anxiety, sadness, and fatigue, making it difficult for mothers to care for themselves and/or their babies, as well as handle daily responsibilities. Postpartum depression can start anywhere from weeks to months after childbirth.
  • Psychotic Depression is a form of depression with psychosis, such as delusions and/or hallucinations .
  • Seasonal Affective Disorder is triggered by changes in seasons. This form of depression usually occurs during the fall and winter months when there is less sunlight.
  • Melancholic Depression is a severe form of depression where people have a complete loss of pleasure in almost all activities.
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    Whats The Difference Between Depression And Persistent Depressive Disorder

    Persistent depressive disorder is a type of depression. Its less severe than major depressive disorder another type but its ongoing. Its defined as lasting at least two years in adults and at least one year in children and teens. During this time, symptoms can’t be absent for more than two consecutive months to meet the criteria for PDD.

    Faq: How To Win Your Major Depressive Disorder Va Disability Benefits Claim

    Can I get VA disability compensation and benefits for MAJOR DEPRESSIVE DISORDER VA Claim?

    Yes. The Department of Veterans Affairs will pay veterans with service-connected MAJOR DEPRESSIVE DISORDER monthly compensation.

    Is MAJOR DEPRESSIVE DISORDER considered a disability?

    The Department of Veterans Affairs recognizes MAJOR DEPRESSIVE DISORDER as a mental condition that may be related to service, and MAJOR DEPRESSIVE DISORDER is therefore compensable.

    What is the disability rating for MAJOR DEPRESSIVE DISORDER?

    The VA will give you a disability rating based upon the severity of your MAJOR DEPRESSIVE DISORDER, specifically related to your level of occupational and social impairment. If you are considered service-connected, you will receive a VA disability rating for MAJOR DEPRESSIVE DISORDER of 0%, 10%, 30%, 50%, 70%, or 100%.

    How much does the VA pay for MAJOR DEPRESSIVE DISORDER?

    If your MAJOR DEPRESSIVE DISORDER claim is approved, you may receive up to $3,350.87 per month. That is currently the max that the VA will pay veterans with MAJOR DEPRESSIVE DISORDER, if at the 100% rating criteria for MAJOR DEPRESSIVE DISORDER. 100% rating for MAJOR DEPRESSIVE DISORDER.


    Some veterans may receive a permanent and total rating. If your MAJOR DEPRESSIVE DISORDER is not expected to improve, you may obtain the status of permanent disability.

    Can the VA reduce your disability rating for MAJOR DEPRESSIVE DISORDER?

    Deserve a HIGHER VA Rating?

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