Symptoms and features of Major Depressive Disorder (MDD)

Read textbook pages 84-85

Learn the symptoms of MDD on Quizlet: https://quizlet.com/_3j7byb

case-history-of-depression: Read Vanessa’s story about her depression and the help she received from her community psychiatric nurse (CPN).

depression-introduction1: A PowerPoint to help identify symptoms and features

An excellent link giving up to date data on the prevalence of MDD by gender, age and ethnicity in the US; check out the Native American Indians…https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml

A good site for looking up prevalence data and more: https://www.mentalhealth.org.uk/statistics/mental-health-statistics-most-common-mental-health-problems

depsub-1-pdf: There are various sub-types of depression, we only need to know about uni-polar depression but you might be interested to know a little about some of the others.

One important change in DSM 5 that affects the diagnosis of MDD, useful for the validity of diagnosis: apa_dsm-5-depression-bereavement-exclusion

Activities:

  1. Review Sofia story and search for evidence of ABCS: affective, behavioural, cognitive and somatic symptoms of UPD.
  2. Be sure to have a full sets of ABCS in your book/folder; hrere are a few more symptoms that are not in the book – add them under the correct headings: People with depression may also…
    • be indecisive and find it hard to concentrate or pay attention for long at a time
    • experience loss of libido (sex drive)
    • can be fidgetty, be slow in movement, sit still in same position for long periods
  3. What would you need to know before deciding whether Sofia should be diagnosed or not?
  4. Using the relevant pages from DSM 5 and ICD 10, compare and contrast the symptoms and features. What do they have in common and how do they differ. Discuss this in pairs; present your discussion as a Venn diagram. You can also use this information in your classifications essays too. When you have finished click here
  5. Write no more than 50 words to summarize the symptoms of depression; you must write in grammatical sentences (not bullet-points).

Features

  • The lifetime prevalence of depression in England is between 4 and 10%  (McManus et al.)
  • this could be an under-estimation – many people do not seek a diagnosis.
  • The DSM states that 18-29 year olds are three times more likely to be diagnosed than people over 60
  • females are between 1.5 and 3 times as likely to be diagnosed as males
  • Prognosis is variable and around 40% of people may recover within 3 months and within a year for 80%
  • Prognosis tends to be worse for those with more severe symptoms and those with  psychotic features, anxiety and/or a personality disorders.

starsStretch and challenge

Read up from p.84: Loss, grief and depression

Why should we avoid medicalising grief?


Individual differences

Depressive Specifiers

Each individual person with depression will experiences their symptoms in a way which is unique to them. ‘Specifiers’ can be added to the primary diagnosis to provide more specific information about the person’s condition and these can be useful when choosing the most appropriate treatment option.

For example, Major Depressive Disorder, Recurrent means the person has had at least two episodes of depression whereas MDD, Chronic is used when a person has been constantly depressed for two years or more.

MDD can be experienced with a variety of additional features, such as psychotic symptoms, e.g. hearing accusatory and critical voices, olfactory hallucinations of rotting filth or decomposing flesh, delusions about sin or imminent disasters and catatonic symptoms such as stupor.

MDD may be characterised by a specific time of onset, e.g. post-partum onset means a depressive episode that begins within 4 weeks of giving birth. Sometimes this can also have psychotic features as well and this can require urgent action as the mother or baby may be at risk of harm.


Case study: Sofia’s storysofia

Sofia has started to find it hard to wake up in the mornings. She wakes up every night, worrying about exams and university. She doesn’t seem to realise that the reason she did badly in her mocks may have been because she missed a lot school the previous term due to glandular fever.

Sofia’s friends are concerned; she is tearful and snappy, she can’t make her mind up about anything from the smallest decisions and she has lost weight. She used to always walk her dog every day but now she leaves it to her parents and she has stopped going to the usual rounds of parties, sleep overs and nights out.

Sofia has been letting homework pile up, her teachers have noticed that she has stopped going to the extra study skills sessions, she cancelled her last two driving lessons and has been ignoring texts from her boyfriend as she thinks that he is going to dump her as she has been so miserable lately.

Should Sofia be diagnosed with depression? What further information do you need?


Issues with the diagnosis of depression

Depression can be difficult to diagnose

One weakness of the diagnosis of depression is that it the field trials of both the DSM 5 and ICD10 suggests that it is not the most reliable of diagnoses.

Regier (2013) reports a kappa value of just 0.28 for Major Depressive Disorder while Sartorius reports a figure of 0.3 for mild recurrent depressive disorder, one of lowest figures of all recognized disorders. The diagnosed of ‘mixed anxiety and depressive disorder ‘was just 0.09 with 31% of clinicians saying this was a difficult diagnosis to make.

This is important because it suggests that depression is hard to diagnose reliably, especially if it is mild and presents with anxiety.

Competing argument  This said, an Israeli study using the ICD, studied nearly 1000 Israeli people with depression and mood related disorders  and found a PPV of 83.8% and a kappa of 0.62 (Ponizovsky et al.2006), suggesting that the diagnosis may not be unreliable after all. Although it should be noted that this study was looking at the wider category of affective/mood disorders in general as opposed to the more specific diagnoses.

Cultural differences can make diagnosis difficult

One problem with diagnosing depression is that many world cultures simply do not recognize this disorder and do not even have a word in their language which fully matches the English connotation.

This does not mean that depression does not exist in these cultures simply that it is experienced in different ways. Ethan Watter’s (2010) explains how  people may suffering ‘shoulder or stomach pain’, ‘tightness in the chest’ or ‘burning in gut’ depending on whether they are Chinese, Iranian or Korean, yet all these ailments are symptomatic of culturally distinct forms of depression.

This is important because it means that if a psychiatrist is diagnosing a person from a culture other than his or her own, the diagnosis of depression could be missed due to the nature of the symptoms expressed.

Competing argument This said the DSM 5 includes a while section on how to conduct a ‘Cultural Formulation Interview; in order to reveal how a person’s cultural identity may be affecting the expression of signs and symptoms and this should help psychiatrists to make much more valid diagnoses for disorders which are subject to significant cultural variation.


Overall…

In conclusion, depression is a relatively common but potentially devastating condition, not least due to its links with suicide. On the one hand, Ponizovsky (2006) demonstrates that reliable diagnosis may be possible; however the work of Regier (2013) suggests that this may be more difficult. Type 1 errors may be common as clinicians may be anxious about preventing a person from be able to access the support and treatment that they need. While distress and self -doubt may well be part of the normal human condition for many, it may be necessary to focus on qualitative research which listens to the stories of people with depression, in their own words, to truly comprehend the difference.


Practice Questions

  1. Describe two symptoms of unipolar depression (4)
  2. Explain one issue with the diagnosis of unipolar depression (3)
  3. Sydney is edgy, exhausted and losing weight. He says he is fine but his wife Violet is worried. Discuss her concerns with reference to the symptoms and features of uni-polar depression (8).
  4. Assess the reliability and validity of the diagnosis of one disorder other than schizophrenia (20)