Is Major Depressive Disorder Permanent
If depression were permanent, wed all be in deep trouble! No, depressive episodes dont tend to last forever. Most people diagnosed with MDD go into remission. But depression is chronic. MDD recurs in the majority of cases, so its important to be prepared. You can learn ways to reduce the severity of future episodes, either with a therapist or on your own. For example, you might work on the following:
- Identifying your triggers
Written by Wistar Murray
Wistar Murray writes about mental health at Thriveworks. She completed her BA at the College of William & Mary and her MFA at Columbia University.
We only use authoritative, trusted, and current sources in our articles. Read our editorial policy to learn more about our efforts to deliver factual, trustworthy information.
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Cuijpers P, Dekker J, Hollon SD, Andersson G. Adding psychotherapy to pharmacotherapy in the treatment of depressive disorders in adults: a meta-analysis. J Clin Psychiatry. 2009 Sep 70:1219-29. doi: 10.4088/JCP.09r05021. PMID: 19818243.
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Cuijpers P, van Straten A, Warmerdam L, Andersson G. Psychotherapy versus the combination of psychotherapy and pharmacotherapy in the treatment of depression: a meta-analysis. Depress Anxiety. 2009 26:279-88. doi: 10.1002/da.20519. PMID: 19031487.
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Pagnin D, de Queiroz V, Pini S, Cassano GB. Efficacy of ECT in depression: a meta-analytic review. J ECT. 2004 Mar 20:13-20. doi: 10.1097/00124509-200403000-00004. PMID: 15087991.
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Depression Is Different From Sadness Or Grief/bereavement
The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such situations. Those experiencing loss often might describe themselves as being depressed.
But being sad is not the same as having depression. The grieving process is natural and unique to each individual and shares some of the same features of depression. Both grief and depression may involve intense sadness and withdrawal from usual activities. They are also different in important ways:
- In grief, painful feelings come in waves, often intermixed with positive memories of the deceased. In major depression, mood and/or interest are decreased for most of two weeks.
- In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness and self-loathing are common.
- In grief, thoughts of death may surface when thinking of or fantasizing about joining the deceased loved one. In major depression, thoughts are focused on ending ones life due to feeling worthless or undeserving of living or being unable to cope with the pain of depression.
Grief and depression can co-exist For some people, the death of a loved one, losing a job or being a victim of a physical assault or a major disaster can lead to depression. When grief and depression co-occur, the grief is more severe and lasts longer than grief without depression.
Diagnostic Criteria For Major Depressive Disorder Dsm
The following criteria, as determined by the DSM-5, must be met in order for a diagnosis of major depressive order to be made:
At least five of the following symptoms must be present during the same 2-week period and represent a change from previous functioning. Additionally, at least one of the symptoms is either a depressed mood or a loss of interest or pleasure.
The diagnostic code for major depressive disorder is based on recurrence of episodes, severity, presence of psychotic features, and status of remission. These codes are as follows:
Severity
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Major Depressive Disorder Recurrent Unspecified
- 2016201720182019202020212022Billable/Specific Code
- 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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New Specifiers For Depression
The DSM-5 added new specifiers to further clarify depression diagnoses when applicable: with mixed features and with anxious distress.
- With mixed features: This new specifier allows for the presence of manic symptoms within a diagnosis of depression for patients who do not meet the full criteria for a hypomanic or manic episode .
- With anxious distress: This specifier was added to account for the presence of anxiety, tension, or restlessness with the potential to impact prognosis and treatment choices.
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Symptoms Of Depression In Dsm
The DSM defines major depressive disorder, or MDD, as a mental disorder characterized by the presence of one or more major depressive episodes. A major depressive episode is defined as a period of at least two weeks during which you experience five or more of the following symptoms:
- Depressed mood most of the day, nearly every day
- 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
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Feelings of worthlessness or excessive guilt
- Recurrent thoughts of death, suicide, or wishing oneself dead
The symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The DSM-5 requires five of the nine symptoms to present during the same two-week period. The diagnosis is made if the symptoms are not due to a medical condition, medication use, substance abuse, or another mental disorder.
Major depressive disorder can occur at any age, but it is most common in adults. It affects women more often than men. Symptoms can vary from person to person, and some people may experience only a few symptoms, while others may experience many.
Assessment Of Dsm 5 Major Depressive Disorder
When the assessment is being done, then there are a number of ways to do it. Such as mental health professionals do the assessment on the basis of clinical interview, and standardized tool.
Similarly, self-assessment tools are available as well which helps the person to get the idea regarding his condition and its severity.
Some of the self-assessment tools are available here.
While the tools mental health professionals use are based on their preference and expertise.
There are few standardized and validated mostly used in the clinical settings are:
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Who Is At Risk For Major Depression
Major depression affects about 6.7% of the U.S. population over age 18, according to the National Institute of Mental Health. Overall, between 20% and 25% of adults may suffer an episode of major depression at some point during their lifetime.
Major depression also affects older adults, teens, and children, but frequently goes undiagnosed and untreated in these populations.
How Is Major Depression Diagnosed
A health professional — such as your primary care doctor or a psychiatrist — will perform a thorough medical evaluation. You might receive a screening for depression at a regular doctorââ¬â¢s visit. The professional will ask about your personal and family psychiatric history and ask you questions that screen for the symptoms of major depression.
There is no blood test, X-ray, or other laboratory test that can be used to diagnose major depression. However, your doctor may run blood tests to help detect any other medical problems that have symptoms similar to those of depression. For example, hypothyroidism can cause some of the same symptoms as depression, as can alcohol or drug use and abuse, some medications, and stroke.
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What Is Major Depressive Disorder According To The Dsm
Major depressive disorder is a common but serious mood disorder that is characterized by a low mood and negative emotions that last for most of the day.
Individuals who struggle with MDD have persistent feelings of sadness, hopelessness, and lose interest in people and their surroundings. MDD is commonly referred to as depression.
Below are a few MDD statistics to be aware of.
- An estimated4 percent of the United States adult population has experienced at least one major depressive episode.
- The condition is more prevalent in women than in men.
- It is three times more likely for people between the ages of 18-25 to experience depression as compared to adults 60 and over.
- MDD frequently occurs with other medical or psychological conditions like substance abuse, anxiety, hypothyroidism and diabetes.
People who have experienced cancer, a heart attack, post-traumatic stress disorder or Parkinsons Disease are likely to be diagnosed with MDD.
Statistical Methods And Measurement Caveats
Diagnostic Assessment:
Population:
- The entirety of NSDUH respondents for the major depressive episode estimates is the civilian, non-institutionalized population aged 12-17 and 18 years old or older residing within the United States.
- The survey covers residents of households and persons in non-institutional group quarters .
- The survey does not cover persons who, for the entire year, had no fixed address were on active military duty or who resided in institutional group quarters .
- Some adults and adolescents in these excluded categories may have had a major depressive episode in the past year, but they are not accounted for in the NSDUH major depressive episode estimates.
- Sex was recorded by the interviewer.
Interview Response and Completion:
- In 2020, 39.6% of the selected NSDUH sample did not complete the interview.
- Reasons for non-response to interviewing include: refusal to participate respondent unavailable or no one at home and other reasons such as physical/mental incompetence or language barriers .
- Adults and adolescents with major depressive episode may disproportionately fall into these non-response categories. While NSDUH weighting includes non-response adjustments to reduce bias, these adjustments may not fully account for differential non-response by mental illness status.
Data Suppression:
Background on the 2020 NSDUH and the COVID-19 Pandemic:
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Substance/medication Induced Depressive Disorder
The symptoms preceded the onset of the substance/medication use the symptoms persist for a substantial period of time after the cessation of acute withdrawal or severe intoxication or there is other evidence suggesting the existence of an independent non substance/medication induced depressive disorder .
What Are The Dsm
The specific DSM-5 criteria for major depressive disorder are outlined below.
At least 5 of the following symptoms have to have been present during the same 2-week period :
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Depressed mood: For children and adolescents, this can also be an irritable mood
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Diminished interest or loss of pleasure in almost all activities
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Significant weight change or appetite disturbance: For children, this can be failure to achieve expected weight gain
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Sleep disturbance
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Fatigue or loss of energy
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Feelings of worthlessness
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Diminished ability to think or concentrate indecisiveness
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Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide
The symptoms cause significant distress or impairment in social, occupational or other important areas of functioning.
The symptoms are not attributable to the physiological effects of a substance or another medical condition.
The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorders
There has never been a manic episode or a hypomanic episode
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Complications & Comorbid Conditions Rules For F331
When F33.1 is used as a secondary diagnostic code, the patients visit may be considered to have Complications & Comorbid Conditions or Major Complications & Comorbid Conditions .
Exclusions apply. When the primary diagnostic code is is in the exclusion list, the patient visit CC/MCC does not qualify for a CC or MCC.
CC/MCC grouping rules are adjusted each year, so check the rules for the fiscal year of the patients discharge date.
What Not Otherwise Specified Means
Bipolar disorder NOS is more of a catch-all category than an actual type of bipolar disorder. Your doctor may use the classification to document symptoms which are consistent with bipolar disorder but fall short of the criteria needed to make a definitive diagnosis.
In general, NOS is most commonly ascribed when a mood disorder is characterized by depression alternating with short episodes of hypomania . Oftentimes, the mood swings are rapid, occurring within days of each other. By and large, children and adolescents are most frequently diagnosed with NOS as they will be least likely to have a previous history of mood dysfunction.
From a psychiatric standpoint, bipolar disorder NOS is taken just as seriously as any other form of mood disorder. It presumes that there is a concern and that it likely will be more definitively diagnosed in the future.
Still, there remains contention in the psychiatric community as to whether bipolar disorder NOS is a valid diagnosis or if it may lead to the premature treatment or over-treatment of an otherwise presumptive illness.
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What Is Considered A Major Depressive Disorder
There is only one major depressive disorder, though multiple depressive disorders exist within the classification system of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition , published by the American Psychiatric Society. Depression disorders are also classified more broadly as mood disorders. In addition to MDD, the depression disorders are as follows:
- Persistent depressive disorder , formerly known as dysthymia, which is chronic depression lasting at least two years in adults or at least one year in children and adolescents.
- Disruptive mood dysregulation disorder, which is a childhood condition characterized by extreme irritability and anger.
- Premenstrual dysphoric disorder, which is a more severe form of premenstrual syndrome .
- Substance/medication-induced depressive disorder, which can be caused by certain sedatives, alcohol, steroids, antihypertensives, anticonvulsants, and more.
- Depressive disorder due to another medical condition, which can be caused by some metabolic disturbances, nutritional deficiencies, infectious diseases, and more.
- Unspecified depressive disorder, which is diagnosed when someones depression doesnt meet the criteria for any of the above disorders.
Complications & Comorbid Conditions Rules For F339
When F33.9 is used as a secondary diagnostic code, the patients visit may be considered to have Complications & Comorbid Conditions or Major Complications & Comorbid Conditions .
Exclusions apply. When the primary diagnostic code is is in the exclusion list, the patient visit CC/MCC does not qualify for a CC or MCC.
CC/MCC grouping rules are adjusted each year, so check the rules for the fiscal year of the patients discharge date.
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What Triggers Major Depression
Some common triggers or causes of major depression include:
- Loss of a loved one through death, divorce, or separation
- Social isolation or feelings of being deprived
- Major life changes — moving, graduation, job change, retirement
- Personal conflicts in relationships, either with a significant other or a superior
- Physical, sexual, or emotional abuse
Who Is At Risk Of Developing Major Depressive Disorder Dsm
The twelve-month prevalence of major depressive disorder in the United States is roughly 7% however, there are clear variations between sexes, as females experience 1.5 to 3-fold higher rates than males. Major depressive disorder may emerge at any age, but its likely to surface with puberty and peak in the 20s. Additionally, there are a few risk and prognostic factors:
1) Temperamental: Neurotic individuals are more likely to develop major depressive disorder as well as depressive episodes in response to stressful life events.
2) Environmental: Rough childhoods can put someone at a greater risk of developing major depressive disorder.
3) Genetic and physiological: Individuals with close relatives who have major depressive disorder have a risk for the disorder 2 to 4-fold higher than that of the general population.
4) Course modifiers: Basically all major non-mood disorders increase the risk of someone developing depression. Substance use, borderline personality disorders, and substance use make up a large portion of these non-mood disorders. On the contrary, depressive episodes worsen diseases like diabetes and cardiovascular disease.
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Attenuated Psychosis Syndrome And Shared Psychotic Disorder
The Psychotic Disorders Work Group considered adding attenuated psychosis syndrome as a new diagnosis to DSM-5, but instead decided to place it in Section III as a condition for further study, after field trial data showed that it was not diagnosed reliably by clinicians. Attenuated psychosis syndrome is meant to describe people who show recent onset of modest, psychotic-like symptoms and clinically relevant distress and disability . In addition, the person who experiences the symptoms must recognize them as unusual and experience sufficient distress or disability to seek clinical evaluation. Despite the clear guidance in the DSM-5 that conditions in Section III are not intended for clinical use, this syndrome is not just in Section III, but is also specifically identified in Other Specified Schizophrenic Spectrum and Other Psychotic Disorder as one of four examples of alternative presentations of a psychotic disorder where it is labeled other psychotic disorder, attenuated psychosis syndrome .
Specifiers For Mood Disorders
DSM-5 includes multiple specifiers to describe the Bipolar and Depressive Disorders , as part of a mixed categorical-dimensional approach. The specifiers are meant to define a more homogeneous subgrouping of individuals with the disorder who share certain characteristics and to convey information that is relevant to the management of the individual’s disorder . The presence of new and more detailed descriptive specifiers for the bipolar and depressive disorders may have some impact on forensic psychiatry. The specifiers are intended to be used to describe the course of a person’s disorder and should not affect the frequency of the underlying diagnosis, but some specifiers may have implications for suicide risk. In addition, these specifiers may be useful in forensic contexts where a prediction of future course may be helpful, such as sentencing, civil commitment, and child custody.
The specifier with seasonal pattern now includes all mood episodes in the introduction and the criteria, instead of being limited, as in DSM-IV, only to episodes of depression. However, the explanatory note makes it clear that the essential feature is the onset and remission of major depressive episodes at characteristic times of the year , which retains the intent of the DSM-IV criteria.
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