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Diagnosing Depressive Disorders
 

MAJOR DEPRESSIVE EPISODE

Because many people do not recognize mood states, patients may present with somatic complaints - abdominal distress or non-specific pain - rather than with a depressed or anxious mood. People don't necessarily have to look depressed when they are depressed. A patient must have at least five of the symptoms listed in the Criteria for Major Depressive Episode (DSM-IV) to meet the diagnosis, including either a) depressed mood, or b) loss of pleasure.

Depressed patients can present with many symptoms besides those in the criteria list. For example, anxiety symptoms may prevail and mask the underlying depression.

Criteria for Major Depressive Episode (DSM-IV)

In the same two weeks, the patient has had five or more of the following symptoms for most of the day, nearly every day, which are a definite change from usual functioning. Either depressed mood or decreased interest or pleasure must be one of the five.

Mood: The patient reports depressed mood or appears depressed to others.

Interests: Interest or pleasure is markedly decreased in nearly all activities (as noted by the patient or by others).

Appetite and weight: There can be a marked loss or gain of weight (such as 5% in one month) or appetite is markedly decreased or increased.

Sleep: The patient sleeps excessively or not enough.

Observable psychomotor activity: Others can see that the patient's activity is noticeably increased or decreased.

Fatigue: There is tiredness or loss of energy.

Self-worth: The patient feels worthless or inappropriately guilty. These feelings are not just about being sick; they may be delusional.

Concentration: The patient is indecisive or has trouble thinking or concentrating.

Death: The patient has had repeated thoughts about death (other than the fear of dying) or about suicide (with or without a plan) or has made a suicide attempt.

 

Qualifying Features
Major depression can present with different qualifying features and these features may be important in both the diagnosis and treatment of the depression. The following qualifiers can be applied to a number of mood disorders, including manic episodes associated with bipolar affective disorder.

Please see:

Section II: "Managing Major Depression Disorder"
CANMAT – Guidelines for the Diagnosis and Pharmacological Treatment of Depression
(1st Edition Rev., 1999)
P. 18

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Over one million Canadians suffer from some form of depressive illness.