Major Depressive Disorder (DSM 5 Diagnosis)

In this brief guide, Major Depressive Disorder, symptoms of Major Depressive Disorder along with the diagnostic criteria, causes, and treatment options for Major Depressive Disorder will be discussed.

What is the DSM 5 Major Depressive Disorder?

The DSM 5 Major Depressive Disorder is different from the term mostly misused by the layman, but the meanings of depression is different in the mental health field.

As per diagnostic criteria given in Diagnostic and Statistical Manual of Mental Disorders (DSM 5, 2013), depression is termed as low mood, lack of interest in doing anything, sleep disturbance and emotional dysregulation.

There are several types of DSM 5 Major Depressive Disorder, and the manifestation of symptoms of Major Depressive Disorder vary with the severity of disorder.

Major Depressive Disorder is also called Crippling depression.

Improvements in DSM 5 Depression Category

In DSM 5 Major Depressive Disorder criteria and categories have been revised.

Two new categories in depressive disorder are added as disruptive mood dysregulation disorder and premenstrual dysphoric disorder (PMDD).

While the former diagnosis is for children ages between 6 years to 18 years. The main feature of this diagnosis is irritability and frequent tantrums.

PMDD is related to the intense experiences of depression, anxiety, irritability because of the hormonal fluctuations in the menstrual cycle.

Another change in DSM 5 depression is the exclusion of dysthymia.

Whereas new specifiers have been introduced while no major changes are proposed in major depressive disorder.

How to know if you have Symptoms of DSM 5 Major Depressive Disorder?

Symptoms of Major Depressive Disorder are more than sadness and the diagnosis needs a number of different symptoms to be diagnosed as DSM5 Major Depressive Disorder.

Without meeting a mental health professional, a person can take help from the self-assessment tests for symptoms of Major Depressive Disorder available online for initial screening which is based on DSM 5 Major Depressive Disorder.

This test will help in screening for a specific type of Major Depressive Disorder called, Major depression (DSM 5 Depression).

Symptoms of Major Depressive Disorder

The symptoms of Major Depressive Disorder vary with the types of depression.

The symptoms are massive and affect the person’s functioning in different domains of life.

There are different types of symptoms for DSM 5 Major Depressive Disorder, such as psychological, physical, and social symptoms.

Psychological Symptoms

Person experiencing symptoms of Major Depressive Disorder go through low mood, feelings of worthlessness, guilt, irritability, tearful, unable to focus, having no motivation, disturbed sleep pattern.

For example, if a person excuses for inability to focus on a task, and requires repeated instruction by claiming to be forgetful this symptom can be because of lack of concentration as a result of symptoms of Major Depressive Disorder. E.g., a person claiming overly sleepy or complains about the quality of sleep could also be experiencing Major Depressive Disorder.

Physical Symptoms

Unable to perform required tasks, lack of pleasure in the activities they once enjoyed, disturbed appetite, crying spells, and suicidal intention or suicidal attempt.

For example, if someone starts missing out the activities they use to enjoy once, and seems uninterested then this is a sign of Major Depressive Disorder.

Social Symptoms

Lack of interest in socialization, neglecting hobbies, and difficulty in relationships.

For example, if someone stop interacting and meeting people and started showing a lack of interest in social situations, then it can be a sign of symptoms of Major Depressive Disorder as well.

Diagnosis of DSM 5 Major Depressive Disorder

Diagnosis can only be given by the professionals in the mental health field on the basis of criteria given in DSM-5 for Major Depressive Disorder(DSM 5, 2013). Following this criteria following summary has been extracted for :

A. The condition of a person needs to be monitored or reported by themselves considering the last 2 weeks, and five or more symptoms are required to be diagnosed with Major Depressive Disorder.

a.  Depressed or low mood either reported by the person or observed by others around.

b.  Lack of interest in doing any activity at all, or we can call this anhedonia

c.  Increase or decrease in body weight

d.  Sleep disturbance, either getting overly sleep or not getting sleepy at all

e.  Decreased physical or motor activity, restricted oneself to bed or slowed down

f.   Overly exhausted, or tired

g.  Excessive feelings of remorse or guilt

h.  Extremely low self-esteem and self-worth

i.   Inability to concentrate or focus on the tasks at hand, as well as unable to make decisions

j.   Continuously or excessively experiencing thoughts of death

B. These symptoms are disabling the person to work efficiently in their environment

C.  The condition is not because of any medication or substance use

On the basis of the above criteria, mental health practitioners diagnose the client with Major Depressive Disorder.

Types of DSM 5 Depression

There are several types of DSM 5 depression which are recognized as:

1.  Clinical Depression / Major Depressive Disorder

2.  Dysthymia (Persistent Depressive Disorder)

3.  Postpartum Depression

4.  Seasonal Depression

5.  Psychotic Depression

6.  Premenstrual Dysphoric Disorder

7.  Disruptive Mood Dysregulation Disorder

Clinical Depression / Major Depressive Disorder

The types of depression discussed above are having different diagnostic criteria.

This type of depression is called clinical depression or major depressive disorder.

The clinical depression is unipolar and characterized by an intense feeling of sadness and lack of interest.

The symptoms of Major Depressive Disorder are lack of pleasure in the activities they once enjoyed, disturbed appetite, crying spells, low mood, feelings of worthlessness, guilt, irritability, tearful, unable to focus, having no motivation to work and disturbed sleep pattern.

Dysthymia (Persistent Depressive Disorder)

This is another type of depression and is known as persistent because the symptoms of major depression are mild in intensity by the lasts for more than 2 years.

This is also called chronic depression.

The person is considered as gloomy, sad, complainer.

Another main condition is that the person didn’t remain without the symptoms of depression for more than 2 months.

Postpartum Depression

This type of depression is linked with the childbirth. This is also known as “baby blues”.

This is quite common and because of hormonal changes, the mother starts feeling down, sad, depressed, anxious for a number of weeks after childbirth.

Seasonal Depression

This type of depression is based on the changes in the season, this is experienced at a particular time in a year.

Mostly the symptoms of depression appear at the start of winters and remain there for months.

Person experience fatigue, low mood, hopelessness and progress towards getting severe.

Psychotic Depression

This type of depression is experienced in people around 20%.

The depression gets so severe that they start experiencing psychotic symptoms and start having hallucinations, delusions and disorganized thinking.

Premenstrual Dysphoric Disorder

This is based on the cyclic hormonal disturbance during the menstrual cycle.

Around 85% of females experience this disorder but only around 5-6% get the diagnosis of the disorder.

The disorder causes low mood, irritability, frustration, mood disturbance, and anxiety.

Disruptive Mood Dysregulation Disorder

DMDD disorder is for the first time introduced in DSM 5.

This diagnosis is specifically for children and symptoms includes the dysregulation of mood expected for their age.

Excessive temper tantrums, behavioural and emotional disturbances are experienced.

Causes of Major Depressive Disorder

There are a number of different causes for different types of DSM 5 Major Depressive Disorder.

There are a number of factors which plays their role in triggering Major Depressive Disorder.

The causes of symptoms of Major Depressive Disorder are multiple, they range from physiological, psychological, and environmental.

Brain Structure

The changes in the brain structure and its chemistry can cause Major Depressive Disorder.

The neurotransmitter dopamine and serotonin are considered to be involved in the levels of symptoms of Major Depressive Disorder.

Physiological Causes

The causes can be altered level of hormones due to pregnancy or menstrual cycle, the effect of any medication of substance as well as there can be the genetic causes of symptoms of Major Depressive Disorder.

Psychological Causes

These causes include environmental stresses, traumatic events, and the death of loved ones.

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:

Beck Depression Inventory

This tool was developed by Beck, and this is the most popularly used tool among practitioners.

The tool has 21 question items and it has been revised several times after it was developed in 1961.

This tool was developed according to the diagnostic and statistical manual of mental disorder Major Depressive Disorder criteria.

The tool is based on the cognitive triad concept used by Cognitive behaviour therapist and developed by Aaron T. Beck.

This theory says that the thoughts are affected by negativity about self, others and the world.

Hamilton Depression Rating Scale

This HAM-D scale is the oldest scale for Major Depressive Disorder.

This is scale is time taking but is validated as BDI.

There is a shorter version of the HAM-D as well, but the validity and reliability of that version is not yet fully developed.

Patient Health Questionnaire

The PHQ scale is quite long and takes a lot of time, as it includes the five psychiatric conditions (depression, anxiety, somatoform, alcohol and eating disorders).

The shorter version of PHQ is available which is called PHQ-9, this scale takes only about 3-5 minute of the practitioner.

Treatment of Major Depressive Disorder

After the complete assessment, the treatment plan is proposed by the professional to deal with the condition.

There two different types of evidence-based treatments:

Medication

Psychotherapy

Medication

Antidepressant use to be prescribed by the psychiatrist.

There are about thirty different types, among which if the client doesn’t respond to one medication the other one is given.

When a person uses medication there are chances of side effects and psychiatric medication usually have adverse side effects.

Person needs to take medication for several months so their effect starts to get visible.

Apart from Antidepressants, modern medication of SSRIs can be used.

They help the brain to naturally increase the levels of serotonin required for good mood regulation.

Then another type available is Tricyclic Antidepressants (TCAs), they are used to treat moderate to severe Major Depressive Disorder.

These help the person to lift their mood by increasing the level of hormones required for mood regulation.

Psychotherapy

Talk therapy can be beneficial and researches have been conducted where psychotherapy give equally effective results to medication or sometimes more efficient and long-lasting results.

In psychotherapy, Cognitive behaviour therapy is the evidence-based therapy which improves the condition of the person.

The focus of CBT is on the present and identification of thinking patterns. Because according to CBT, the faulty thinking patterns makes one person sad or depressed.

The negative automatic thoughts are considered to be the cause of Major Depressive Disorder.

There are a number of different psychotherapies which can be used along with the improvement in the lifestyle of the person is required.

Yoga, appropriate diet, exercise, and getting enough sleep also helps in the symptoms of Major Depressive Disorder.

 Recommended food for Major Depressive Disorder

The antioxidant prevents cells from damage, and vitamin C and E enriched food is beneficial in Major Depressive Disorder.

Fruits such as blueberries, grapefruit, kiwi, peaches, carrots, spinach, sweet potato, as well as nuts, seeds, margarine, and wheat germ are effective in the condition of Major Depressive Disorder.

Smart carbohydrates also give calming and relaxing effect, these include limited sugar foods such as whole grains, fruits, and healthy fibre.

Protein-rich food is also healthy and beneficial for the alertness and gives the boost of energy.

This includes turkey, tuna, chicken, meat and poultry.

Vitamin D is also the essential ingredient and particularly effective especially for seasonal affective disorder.

DSM 5 Major Depressive Disorder is a condition in which people experience extreme sadness, lack of interest, irritability, sleep and appetite disturbance as well as crying spells.

There are different types of Major Depressive Disorder. The criteria for the diagnosis of Major Depressive Disorder is given in DSM 5.

There are multiple causes of Major Depressive Disorder and different treatment strategies available.

Frequently Asked Questions for DSM 5 Major Depressive Disorder

References

NHS

Mayo Clinic

WebMD

Recommended Readings

Depression: The Way Out of Your Prison

Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions

 Depression: A practical guide (The Flag Series Book 2)

Depression (Clinical psychology: A Modular Course)

The 4 Pillar Plan: How to Relax, Eat, Move and Sleep Your Way to a Longer, Healthier Life