Tuesday, July 16, 2024

Major Depressive Disorder Recurrent Moderate With Anxious Distress

New Specifiers For Depression In Dsm

Major Depressive Disorder (MDD) & Generalized Anxiety Disorder (GAD)

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders , the DSM-5, added two specifiers to further classify diagnoses:

  • With Mixed Features â This specifier allows for the presence of manic symptoms as part of the depression diagnosis in patients who do not meet the full criteria for a manic episode.
  • With Anxious Distress â The presence of anxiety in patients may affect prognosis, treatment options, and the patientâs response to them. Clinicians will need to assess whether or not the individual experiencing depression also presents with anxious distress.

Clinical Considerations If Anxious Distress Is Suspected:

Stay tuned for the next post on Monday, October 11, for a tour of Melancholic Features, perhaps the “darkest flavor” of Major Depressive Disorder.


Barlow, D.H. and Durand, V.M. . Abnormal psychology: an integrative approach. Cengage.

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.

Yang, M.J., Kim, B.N., Lee, E.H., Lee, D., Yu, B.H., Jeon, H.J., & Kim, J.H. . Diagnostic utility of worry and rumination: a comparison between generalized anxiety disorder and major depressive disorder. Psychiatry and Clinical Neurosciences , 712â720 doi:10.1111/pcn.12193

Zimmerman, M., Martin, J., McGonigal, P., Harris, L., Kerr, S., Balling, C., Keifer, R., Stanton, K., & Dalrymple, K. . Validity of the dsm-5 anxious distress specifier for major depressive disorder. Depression and Anxiety 1, 31-38.

The Icd Code F33 Is Used To Code Major Depressive Disorder

Major depressive disorder is a mental disorder characterized by a pervasive and persistent low mood that is accompanied by low self-esteem and by a loss of interest or pleasure in normally enjoyable activities. The term “depression” is used in a number of different ways. It is often used to mean this syndrome but may refer to other mood disorders or simply to a low mood. Major depressive disorder is a disabling condition that adversely affects a person’s family, work or school life, sleeping and eating habits, and general health. In the United States, around 3.4% of people with major depression die by suicide, and up to 60% of people who die by suicide had depression or another mood disorder.


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Criteria For Severity/psychotic/remission Specifiers For Current Major Depressive Episode

Note: These criteria are coded for in fifth digit of the DSM-IV diagnostic code. Can be applied to the most recent Major Depressive Episode in Major Depressive Disorder and to a Major Depressive Episode in Bipolar I or II Disorder only if it is the most recent type of mood episode.

.x1Mild: Few, if any, symptoms in excess of those required to make the diagnosis and symptoms result in only minor impairment in occupational functioning or in usual social activities or relationships with others.

.x2Moderate: Symptoms or functional impairment between mild and severe.

.x3Severe Without Psychotic Features: Several symptoms in excess of those required to make the diagnosis, and symptoms markedly interfere with occupational functioning or with usual social activities or relationships with others.

.x4Severe With Psychotic Features: Delusions or hallucinations. If possible, specify whether the psychotic features are mood-congruent or mood-incongruent:

.x5In Partial Remission: Symptoms of a Major Depressive Episode are present but full criteria are not met, or there is a period without any significant symptoms of a Major Depressive Episode lasting less than 2 months following the end of the Major Depressive Episode.

.x6In Full Remission: During the past 2 months, no significant signs or symptoms of the disturbance were present.


Last medically reviewed on May 17, 2016

Effects On The Patients Family And Children


Symptoms of depression and anxiety have consequences not just for the affected individual but also for the persons family. Drs Thase and Manning found the Sequenced Treatment Alternatives to Relieve Depression -Child study,20 which looked at the impact of mothers unremitted depression on their children, particularly meaningful. Effective treatment of women was associated with reduction of symptoms and diagnosis rates in their children in essentially a dose-response relationshipand more persistent depression in the mothers was linked to development of more psychiatric difficulties in their children. Dr Thase commented astutely that people who might be ambivalent about pursuing treatment for depression need look no further than the well-being of their children, because it is directly dependent on their own well-being.

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Diagnostic And Statistical And Manual Of Mental Disorders Essay

DIAGNOSTIC IMPRESSIONClaimant ‘s multi- axial assessment was established by using Fifth Edition of Diagnostic and Statistical and Manual of Mental Disorder. Claimant DSM-V multi- axial classification is as follows: Axis I:Major Depressive Disorder, Recurrent, Severe Without Psychotic Features Generalized Anxiety DisorderAXIS II:DeferredAXIS III: Ewings Sarcoma Cancer, in remission AXIS IV:Problems Related To The Social Environment:

Deterrence And Patient Education

Patient education has a profound impact on the overall outcome of major depressive disorder. Since MDD is one of the most common psychiatric disorders causing disability worldwide and people in different parts of the world are hesitant to discuss and seek treatment for depression due to the stigma associated with mental illness, educating patients is very crucial for their better understanding of the mental illness and better compliance with the mental health treatment. Family education also plays an important role in the successful treatment of MDD.

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Transcranial Direct Current Stimulation

Transcranial direct current stimulation is another noninvasive method used to stimulate small regions of the brain with the help of a weak electric current. Increasing evidence has been gathered for its efficiency as a depression treatment. A meta-analysis was published in 2020 summarising results across nine studies concluded that active tDCS was significantly superior to sham for response , remission and depression improvement. According to a 2016 meta analysis, 34% of people treated with tDCS showed at least 50% symptom reduction compared to 19% sham-treated across 6 randomised controlled trials.

Whats The Difference Between Depression And Persistent Depressive Disorder

What is Major 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.

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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.

Enhancing Healthcare Team Outcomes

An interdisciplinary approach is essential for the effective and successful treatment of MDD. Primary care physicians and psychiatrists, along with nurses, therapists, social workers, and case managers, form an integral part of these collaborated services. In the majority of cases, PCPs are the first providers to whom individuals with MDD present mostly with somatic complaints. Depression screening in primary care settings is very imperative. The regular screening of the patients using depression rating scales such as PHQ-9 can be very helpful in the early diagnosis and intervention, thus improving the overall outcome of MDD. Psychoeducation plays a significant role in improving patient compliance and medication adherence. Recent evidence also supports that lifestyle modification, including moderate exercises, can help to improve mild-to-moderate depression. Suicide screening at each psychiatric visit can be helpful to lower suicide incidence. Since patients with MDD are at increased risk of suicide, close monitoring, and follow up by mental health workers becomes necessary to ensure safety and compliance with mental health treatment. The involvement of families can further add to a better outcome of the overall mental health treatment. Meta-analyses of randomized trials have shown that depression outcomes are superior when using collaborative care as compared with usual care.

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Life Expectancy And The Risk Of Suicide

Depressed individuals have a shorter life expectancy than those without depression, in part because people who are depressed are at risk of dying of suicide. Up to 60% of people who die of suicide have a mood disorder such as major depression, and the risk is especially high if a person has a marked sense of hopelessness or has both depression and borderline personality disorder. About 2â8% of adults with major depression die by suicide, and about 50% of people who die by suicide had depression or another mood disorder. The lifetime risk of suicide associated with a diagnosis of major depression in the US is estimated at 3.4%, which averages two highly disparate figures of almost 7% for men and 1% for women . The estimate is substantially lower than a previously accepted figure of 15%, which had been derived from older studies of people who were hospitalized.

Depressed people have a higher rate of dying from other causes. There is a 1.5- to 2-fold increased risk of cardiovascular disease, independent of other known risk factors, and is itself linked directly or indirectly to risk factors such as smoking and obesity. People with major depression are less likely to follow medical recommendations for treating and preventing cardiovascular disorders, further increasing their risk of medical complications.Cardiologists may not recognize underlying depression that complicates a cardiovascular problem under their care.

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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Screening Tools For Clinical Settings

Several easy-to-administer, well-validated, and sensitive scales are available for measuring depressive and anxious symptoms .

WHO-5. The 5-item World Health Organization Well-Being Index is a short rating scale measuring subjective well-being. The items consist of 5 positively phrased statements and are rated on a 6-point Likert scale based on the proportion of time, over the last 2 weeks, when the respondent would agree with the statement. The WHO-5 has good validity as a depression screening measure.29 Drs Trivedi and Manning agreed that this scale was a meaningful assessment in clinical practice, particularly because of its focus on elements important to patient functioning such as energy, restfulness, and purposefulness.

PHQ-9. The Primary Care Evaluation of Mental Disorders 9-item Patient Health Questionnaire 30 is a self-rated depression measure that focuses exclusively on DSM-based symptoms.30 The frequency of 9 symptoms is rated on a scale of 0 to 3: not at all, several days, more than half the days, and nearly every day, respectively, in the last 2 weeks. A follow-up question inquires about the patients functioning. Katzelnick et al31 demonstrated that the PHQ-9 allowed clinicians to successfully determine rates of response and remission of depressive symptoms at 12 and 24 weeks. Dr Manning mentioned that one advantage of the PHQ-9 is that it allows for ongoing inquiry about thoughts of death or distress.

What Are The Symptoms Of Recurrent Depressive Disorder

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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Major Depressive Disorder In Adults

ICD-10 codes:

Recurrent, mild F33.0

Recurrent, moderate F33.1

Major depressive disorder is part of a cluster of diagnoses called the depressive disorders. Depressive disorders are a group of psychiatric conditions that include:

The depressive disorders are characterized primarily by mood disturbance . Individuals with depressive disorders often experience significant somatic changes, such as disruptions in sleep , eating , or energy level. Changes in cognition, such as difficulty concentrating, indecisiveness, and morbid ideation are also common.

Individuals with major depressive disorder experience pervasive sadness or anhedonia along with significant changes in somatic and/or cognitive functioning. To be diagnosed, these problems must be present nearly every day for at least two weeks. Individuals with persistent depressive disorder experience similar symptoms, including sad mood and problems with somatic and/or cognitive functioning that occur most days for at least two years. Individuals with premenstrual dysphoric disorder experience marked changes in mood and interpersonal functioning that begin sometime following ovulation and remit within a few days of the onset of menses. Disruptive mood dysregulation disorder is diagnosed in children under 12 years old who experience persistent irritability and extreme behavioral dyscontrol.

Major Depressive Disorder

What Is Moderate Depression

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

While everyone feels down from time to time, depression is a serious mental health condition that can make it difficult to function normally. But depression can vary in intensity. How depression is experienced can vary from one person to the next, and the condition can also be classified as either mild, moderate, or severe.

One survey found that among U.S. adults with depression, approximately 20% had mild symptoms, 50% had moderate symptoms, and 30% had severe symptoms.

Depression is one of the most common mental disorders in the United States. According to the National Institute of Mental Health, an estimated 19.4 million of American adults in the United States had at least one major depressive episode in 2019.

When a major depressive disorder is diagnosed, it is typically classified by the degree of severity as well as whether or not there are psychotic features or a seasonal pattern. Moderately severe depression is marked by symptoms of depression that can affect a persons ability to function normally. It may differ from mild depression in terms of severity and frequency of symptoms that a person experiences.

Someone with moderate depression may experience symptoms that are more serious in terms of severity and duration than someone with mild depression. They may also experience more symptoms than a person with mild depression does.

  • Lack of motivation
  • Low self-esteem

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What Is The Outlook For Someone With Major Depressive Disorder

While someone with MDD can feel hopeless at times, its important to remember that the disorder can be treated successfully. There is hope.

To improve your outlook, its critical to stick with your treatment plan. Dont miss therapy sessions or follow-up appointments with your healthcare professional.

Never stop taking your medications unless your therapist or healthcare professional advises you to.

On days when you feel particularly depressed despite treatment, it can be helpful to call a local crisis or mental health service or the National Suicide Prevention Lifeline. Resources are available.

A friendly, supportive voice could be just what you need to get you through a difficult time.

Case Analysis : ‘ 911 ‘

History: Tanyas mother is an African American female who suffers from an extensive history of psychiatric illness and is currently incarcerated. She never had a relationship with his father. The clients brother has a history of bipolar disorder. There are no other known maternal relatives that struggle with mental illness or addiction. Tanya reports that she was born full-term via spontaneous vaginal delivery. She reports being pregnant two times. She reports having a miscarriage

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Complementary And Alternative Treatments

There are some alternative remedies that may be helpful for some people who have mild to moderate depression. St. John’s wort, for example, is one herbal supplement that is sometimes used to help alleviate symptoms of mild to moderate depression. While the supplement is not FDA-approved for the treatment of depression, some research suggests that it may help reduce symptoms.

Because St. John’s wort affects serotonin levels in the brain, it can lead to a serious condition known as serotonin syndrome. It can also interact with other medications, including antidepressants. You should always talk to your doctor before trying any complementary treatment such as St. John’s wort.

Causes And Risk Factors Of Recurrent Depressive Disorder

Diagnosis and management of major depressive disorder

Although no specific cause of recurrent depressive disorder has been established, researchers believe that it can be related to genetics, hormones, and brain chemistry.3 Additionally, those who have depression have been shown to have physiological differences in their brains compared to those without depression.

Because there is such a high recurrence rate for depressive disorders, extensive research has been done in this area. While many risk factors have been studied to determine if an individual will experience a recurrence of depressive episodes, studies have identified only a few that may show an indication for recurrent depression:3

  • severity of first depressive episode
  • comorbid conditions, such as major depression, dysthymia , and anxiety
  • proneness to psychological distress
  • stressful life events
  • family history of mental illness, especially depression

Some studies have found that those who abuse drugs, have been discriminated against, or were abused as children may have a higher risk for developing recurrent depressive disorder.7

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