Depressive Disorders
• The most commonly diagnosed and most severe depression is called a major depressive
episode. The DSM-5 criteria describes it as an extremely depressed mood state that
lasts at least 2 weeks and includes cognitive symptoms (such as feelings of
worthlessness and indecisiveness) and disturbed physical functions (such as altered
sleeping patterns, significant changes in appetite and weight, or a notable loss of
energy) to the point that even the slightest activity or movement requires an
overwhelming effort.
• The episode is typically accompanied by a general loss of interest in things and an
inability to experience any pleasure from life, including interactions with family or
friends or accomplishments at work or at school.
• Although all symptoms are important, evidence suggests that the most central
indicators of a full major depressive episode are the physical changes (sometimes called
somatic or vegetative symptoms) along with the behavioral and emotional “shutdown,”
as reflected by low scores on behavioral activation scales
• Anhedonia (loss of energy and inability to engage in pleasurable activities or have any
“fun”) is more characteristic of these severe episodes of depression than are, for
example, reports of sadness or distress, This anhedonia reflects that these episodes
represent a state of low positive affect and not just high negative affect
• Exact cause is unknown but probably involves heredity, changes in neurotransmitter
levels, altered neuroendocrine function, and psychosocial factors. Diagnosis is based on
history. Treatment usually consists of drugs, psychotherapy.
• The term depression is often used to describe the low or discouraged mood that results
from disappointments (eg, financial calamity, natural disaster, serious illness) or losses
(eg, death of a loved one). However, better terms for such moods are demoralization
and grief.
• The negative feelings of demoralization and grief, unlike those of depression, do the
following:
• Occur in waves that tend to be tied to thoughts or reminders of the inciting event
• Resolve when circumstances or events improve
• May be interspersed with periods of positive emotion and humor
• Are not accompanied by pervasive feelings of worthlessness and self-loathing
• The low mood usually lasts days rather than weeks or months, and suicidal thoughts and
prolonged loss of function are much less likely.
• However, events and stressors that cause demoralization and grief can also precipitate a
major depressive episode, particularly in vulnerable people (eg, those with a past history
or family history of major depression).
• Depression can happen at any age, but often begins in adulthood. Depression is now
recognized as occurring in children and adolescents, although it sometimes presents
