Determining Severity Of A Depressive/major Depressive Episode
Both ICD10 and DSMIV classify clinically important depressive episodes as mild, moderate and severe based on the number, type and severity of symptoms present and degree of functional impairment. shows the number of symptoms required by each diagnostic system, which are less specific than DSMIV. The prescriptive symptom counting approach of ICD10 tends to lend itself to using symptom counting alone to determine severity.
Number of symptoms required in ICD10 and DSMIV for a diagnosis of depressive episode/major depression .
As ICD10 requires only four symptoms for a diagnosis of a mild depressive episode, it can identify more people as having a depressive episode compared with a DSMIV major depressive episode. One study in primary care in Europe identified two to three times more people as depressed using ICD10 criteria compared with DSMIV . However another study in Australia found similar rates using the two criteria but slightly different populations were identified , which appears to be related to the need for only one of two core symptoms for DSMIV but two out of three for ICD10. These studies emphasise that, although similar, the two systems are not identical and that this is particularly apparent at the threshold taken to indicate clinical importance.
Types Of Major Depressive Disorder
You might be surprised to learn that there are many different types of major depressive disorder that can affect you can make living your daily life difficult. Each type often has different causes, but they typically involve the same feeling of disinterest in activities that you once loved and an overall feeling of melancholy. These are divided into subtypes called specifiers that determine how long the diagnosis of depression lasts and the defining characteristic of each type.
Disruptive Mood Dysregulation Disorder
DMDD is a fairly recent diagnosis, appearing for the first time in the Diagnostic and Statistical Manual of Mental Disorders in 2013. The DSM-5 classifies DMDD as a type of depressive disorder, as children diagnosed with DMDD struggle to regulate their moods and emotions in an age-appropriate way. As a result, children with DMDD exhibit frequent temper outbursts in response to frustration, either verbally or behaviorally. In between outbursts, they experience chronic, persistent irritability.
Your Questions Answered
- How is DMDD different from bipolar disorder?While the key feature of DMDD is irritability, the hallmark of bipolar disorder is the presence of manic or hypomanic episodes. Although DMDD and bipolar disorder can both cause irritability, manic episodes tend to occur sporadically, while in DMDD the irritable mood is chronic and severe.
- What is the treatment for DMDD?A combination of psychotherapy and parent management techniques are the first step towards teaching children coping skills for regulating their moods and emotions and teaching parents how to manage outbursts. However, medication may also be prescribed if these methods alone are not effective.
- Can children grow out of DMDD?Children are unlikely to simply grow out of DMDD without learning how to effectively regulate their moods and emotions. If you think your child may have DMDD, seek advice from a mental health professional for diagnosis and an effective treatment plan.
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Depressive Phase Of Bipolar Disorder
Clinical depression can also be a feature of another mental health condition called bipolar disorder. People with bipolar disorder tend to alternate between periods of depression and periods of greatly elevated mood called mania.
In the depressive phase, symptoms can be very similar major depression. During the manic phase, symptoms at the opposite end of the spectrum are more likely, such as:
- Increased energy
- Impulsivity
- Poor judgment
Other forms of depression are classified a bit differently, often because they occur in specific situations or require different treatment approaches.
Other Medications And Supplements
The combined use of antidepressants plus benzodiazepines demonstrates improved effectiveness when compared to antidepressants alone, but these effects may not endure. The addition of a benzodiazepine is balanced against possible harms and other alternative treatment strategies when antidepressant mono-therapy is considered inadequate.
There is insufficient high quality evidence to suggest omega-3 fatty acids are effective in depression. There is limited evidence that vitamin D supplementation is of value in alleviating the symptoms of depression in individuals who are vitamin D-deficient. There is some preliminary evidence that COX-2 inhibitors, such as celecoxib, have a beneficial effect on major depression.Lithium appears effective at lowering the risk of suicide in those with bipolar disorder and unipolar depression to nearly the same levels as the general population. There is a narrow range of effective and safe dosages of lithium thus close monitoring may be needed. Low-dose thyroid hormone may be added to existing antidepressants to treat persistent depression symptoms in people who have tried multiple courses of medication. Limited evidence suggests stimulants, such as amphetamine and modafinil, may be effective in the short term, or as adjuvant therapy. Also, it is suggested that folate supplements may have a role in depression management. There is tentative evidence for benefit from testosterone in males.
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How Is Major Depression Treated
Major or clinical depression is a serious but treatable illness. Depending on the severity of symptoms, your primary care doctor or a psychiatrist may recommend treatment with an antidepressant medication. They may also suggest psychotherapy, or talk therapy, in which you address your emotional state.
Sometimes, other medications are added to the antidepressant to boost its effectiveness. Certain medicines work better for some people. It may be necessary for your doctor to try different drugs at different doses to determine which medicine works best for you.
There are other treatment options for clinical depression — such as electroconvulsive therapy, also called ECT or shock therapy — that can be used if drugs prove ineffective or symptoms are severe.Ã Other treatments for depression that is difficult to treat include intranasal ketamine or transcranial magnetic stimulation
Are Women At Higher Risk For Major Depression
Almost twice as many women as men have major or clinical depression hormonal changes during puberty, menstruation, pregnancy, miscarriage, and menopause, may increase the risk.
Other factors that boost the risk of clinical depression in women who are biologically vulnerable to it include increased stress at home or at work, balancing family life with career, and caring for an aging parent. Raising a child alone will also increase the risk.
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How Can I Find Help
If you think you may have depression, start by making an appointment to see your doctor or health care provider. This could be your primary care practitioner or a health provider who specializes in diagnosing and treating mental health conditions. Visit the NIMH Find Help for Mental Illnesses if you are unsure of where to start.
What Are Symptoms And Signs Of Depression
Clinical depression is not something you feel for a day or two before feeling better. In true depressive illnesses, the symptoms last weeks, months, or sometimes years if you don’t seek treatment. If you are depressed, you are often unable to perform daily activities. You may not care enough to get out of bed or get dressed, much less work, do errands, or socialize.
- Adults: You may be said to be suffering from a major depressive episode if you have a depressed mood for at least 2 weeks and have at least 5 of the following clinical symptoms:
- Feeling sad or blue
- Feelings of worthlessness or excessive guilt
- Thoughts of death or suicide
Men and women sometimes show depression differently. Specifically, men are more likely to experience irritability, sleep problems, fatigue, and loss of interest in activities they liked previously as a result of depression whereas women tend to have overt sadness and feelings of worthlessness and guilt when depressed. For people who tend to suffer from an increase in appetite, tiredness, and the tendency to sleep , carbohydrate craving, sometimes specifically for chocolate, may occur. That has been found to sometimes be an indication that the person tends to suffer from irritability and anxiety in addition to depression.
Since symptoms of depression tend to be more physical in elderly individuals compared to younger individuals, this puts these individuals at risk for having their depressive symptoms erroneously attributed to medical problems.
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How Can I Help Someone With Major Depression
People with depression might not acknowledge that theyre struggling. Lack of awareness about symptoms of depression can cause people to consider their feelings normal or dismiss them as a time-limited struggle. The stigma of seeking treatment for depression can also cause people to attempt to overcome treatment without professional help. One of the best ways you can help a loved one is to become educated about the symptoms, causes, and treatment for MDD and encourage them to work with a doctor or mental health counselor. Be a compassionate listener and avoid giving unhelpful advice like,“This is just a phase, it will pass.” Another way you can help is to offer to assist with daily tasks and recognize and respond to a crisis. If you believe your loved one is in danger of harming themselves, do not leave them alone. Dial 9-1-1 and stay with them until help arrives.
How Is Depression Syndrome Treated
Depression can be serious, but its also treatable. Treatment for depression includes:
- Self-help: Regular exercise, getting enough sleep, and spending time with people you care about can improve depression symptoms.
- Counseling: Counseling or psychotherapy is talking with a mental health professional. Your counselor helps you address your problems and develop coping skills. Sometimes brief therapy is all you need. Other people continue therapy longer.
- Alternative medicine: People with mild depression or ongoing symptoms can improve their well-being with complementary therapy. Therapy may include massage, acupuncture, hypnosis and biofeedback.
- Medication: Prescription medicine called antidepressants can help change brain chemistry that causes depression. Antidepressants can take a few weeks to have an effect. Some antidepressants have side effects, which often improve with time. If they dont, talk to your provider. A different medications may work better for you.
- Brain stimulation therapy: Brain stimulation therapy can help people who have severe depression or depression with psychosis. Types of brain stimulation therapy include electroconvulsive therapy , transcranial magnetic stimulation and vagus nerve stimulation .
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Recurrence Of Early Depression
According to the AmericanAcademyofChildandAdolescentPsychiatry practice parameters for depressive disorders in childhood and adolescence, a history of a previous depressive episode, subsyndromal symptoms of depression, dysthymia, and anxiety disorders increase the risk for future depression. In a study of an epidemiologic sample of 776 adolescents by Pine and associates, symptoms of majordepressioninadolescencestrongly predicted episodes of major depression in adulthood.
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.
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Ongoing Mood Cognitive Changes May Require Professional Help
Depression is not only hard to endure, it is also a risk factor for heart disease and dementia. “Depressive symptoms can occur in adults for many reasons. If you are experiencing mood or cognitive changes that last for more than a few weeks, it’s a good idea to bring this up with your doctor or consult a mental health specialist to help sort out possible causes,” says Dr. Nancy Donovan, an instructor in psychiatry at Harvard Medical School.The four most common types of depression are major depression, persistent depressive disorder, bipolar disorder, and seasonal affective disorder.
Major depression. The classic depression type, major depression is a state where a dark mood is all-consuming and one loses interest in activities, even ones that are usually pleasurable. Symptoms of this type of depression include trouble sleeping, changes in appetite or weight, loss of energy, and feeling worthless. Thoughts of death or suicide may occur. It is usually treated with psychotherapy and medication. For some people with severe depression that isn’t alleviated with psychotherapy or antidepressant medications, electroconvulsive therapy may be effective.
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.
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Whats The Difference Between Sadness And Depression
Sadness is a normal reaction to a loss, disappointment, problems, or other difficult situations. Feeling sad from time to time is just another part of being human. In these cases, feelings of sadness go away quickly and you can go about your daily life.
Other ways to talk about sadness might be feeling low, feeling down, or feeling blue. A person may say they are feeling depressed, but if it goes away on its own and doesnt impact life in a big way, it probably isnt the illness of depression.
Where can I learn more?
About the author
The Canadian Mental Health Association promotes the mental health of all and supports the resilience and recovery of people experiencing a mental illness through public education, community-based research, advocacy, and direct services. Visit www.cmha.bc.ca.
Q& A is for readers who want to take charge of their well-being, support a friend or loved one, find good help, or just learn more about mental health and substance use. Here, the information and resource experts at HeretoHelp will answer the questions that were asked most often. We’ll offer tips and information, and we’ll connect you with help in BC, Canada. If you have a question youd like to ask, email us at , tweet , or log in to HeretoHelp and post a comment on this page.
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When you face the low feelings of depression, hope can seem distant. But the good news, says Beth Esposito, MS, LPCC-S, LSW, of Samaritan Behavioral Health: Depression is a treatable illness.
Depression treatment that works for one person, however, may not work for another. Thats because depression varies from one person to the next in severity and type. Finding the right treatment for you may take time and fine-tuning, Esposito says.
She offers the following comparisons of two common types of depression and their symptoms, diagnosis and treatment:
- Bipolar depression, which is characterized by alternating periods of depression and mania
- Unipolar depression, more commonly known as major depression, which has no manic periods
If you experience one episode of depression, you are at risk of recurring bouts.
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Risk Factors For Depression
Depression can affect anyoneeven a person who appears to live in relatively ideal circumstances.
Several factors can play a role in depression:
- Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms of depression.
- Genetics: Depression can run in families. For example, if one identical twin has depression, the other has a 70 percent chance of having the illness sometime in life.
- Personality: People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience depression.
- Environmental factors: Continuous exposure to violence, neglect, abuse or poverty may make some people more vulnerable to depression.
Alternative Treatments Complementary Therapies And Electroconvulsive Therapy
Alternative treatments
Several nonprescription herbal and dietary supplements are used by some people to treat depression. Little is known about the safety, effectiveness, or appropriate dosage of these remedies, although they are taken by thousands of people around the world.
- A few of the best-known alternative remedies continue to be studied scientifically to see how well they work, but to date, there is little evidence that herbal remedies effectively treat moderate to severe clinical depression.
- Medical professionals usually are hesitant to recommend herbs or dietary supplements because they are not regulated by the U.S. Food and Drug Administration , as prescription drugs are, to ensure their purity and quality. Regardless, if you are on any medication, dietary supplement, or other remedy, be sure to check with your health-care provider before starting an herbal or dietary supplement.
- When you buy a supplement from the drugstore or health-food store, you cannot be sure exactly what you are getting and what is the appropriate dosage.
- There are few guidelines for correct doses. Potency can vary from product to product, even batch to batch of the same product.
St. John’s wort: This is probably the best-known alternative therapy for depression. It is derived from a plant, Hypericum perforatum, and has been part of folk medicine for centuries.
St. John’s wort is not without its own negative effects.
Complementary therapies
Electroconvulsive therapy
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Antenatal And Postnatal Depression
Women are at an increased risk of depression during pregnancy and in the year following childbirth . This time frame may also be referred to as the perinatal period.
The causes of depression at this time can be complex and are often the result of a combination of factors. In the days immediately following birth, many women experience the baby blues, which is a common condition related to hormonal changes, affecting up to 80 per cent of women who have given birth.
The baby blues, or the general stress of adjusting to pregnancy or a new baby, are common experiences, but are different from depression.
Depression is longer lasting and can affect not only the mother, but her relationship with her baby, the childs development, the mothers relationship with her partner and with other members of the family.
Up to one in 10 women will experience depression during pregnancy. This increases to 16 per cent in the first three months after having a baby.