One important change in DSM 5 that affects the diagnosis of MDD: apa_dsm-5-depression-bereavement-exclusion
Depression is an affective disorder involving low mood. The term uni-polar distinguishes it from bi-polar affective disorder, in which people experience episodes of mania and depression. Both ICD10 and DSM5 distinguish between single and recurrent depressive episodes and between mild, moderate and severe depression. There are many symptoms of depression including affective cognitive, behavioural, somatic and even psychotic symptoms (see Think Link on the left).
DSM 5 says the person must have experienced at least five symptoms one of which must be depressed mood and loss of interest interests or pleasure while ICD10 says the person may have four symptoms, so long as they have experienced at least two of the following: depressed mood, loss of interest/enjoyment and/or increased fatigability. Both systems require symptoms to have been present for at least two weeks. The DSM also suggests that the individual’s level of distress and social/occupational functioning must also be considered.
Affective (mood) symptoms
People with depression may feel sad, empty or hopeless and may be tearful while children and adolescents with depression may be irritable. The term anhedonia describes a lack of enjoyment or pleasure found in previously enjoyed activities, events or places.
Cognitive symptoms
People with depression may be indecisive and find it hard to concentrate or pay attention for long at a time. They blame themselves for events outside their control. They feel guilty and unworthy of others time and care. They lack self-confidence and feel incompetent and incapable and have a bleak and pessimistic outlook. They may experience recurrent thoughts of death or suicidal ideation (thoughts of suicide, but without a specific plan).
Bodily symptoms
People with depression may feel that they have no energy; they become tired very quickly after minor exertion. They may suffer from decreased or increased appetite leading to significant weight loss or gain, (a change of more than 5% of body weight in one month). Loss of libido (sex drive) is common as is disturbed sleep. People with depression often suffer with insomnia, finding it hard to get to sleep or waking in the early hours and unable to return to sleep. Over sleeping (hypersomnia) is also common.
Behavioural symptoms
Fatigue and loss of pleasure and enjoyment can lead to social withdrawal and diminished activity. Some people with depression show signs of psychomotor retardation or agitation but this must be observable by others in order to count as a symptom. Self-harm and suicidal behaviour can also be symptomatic of depression, though both can exist in the absence of other depressive symptoms.
Sofia’s story
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, 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 clinic, 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 can be diagnosed with depression? Give reasons for your answer.
- Would the diagnosis be useful?
- Write a few more sentences to the extract giving more information that might help to clinch the diagnosis.
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