Summary
Depressive disorders are a group of conditions manifesting with symptoms of depression that impair an individual's ability to function. They include major depressive disorder (MDD), premenstrual dysphoric disorder (PMDD), disruptive mood dysregulation disorder (DMDD), persistent depressive disorder (dysthymia), depressive disorder due to another medical condition, and substance/medication-induced depressive disorder. Depressive disorders are typically identified during routine screening or examination. The diagnosis is clinical based on DSM-5 criteria after exclusion of organic causes of depression and differential diagnoses of depressive symptoms. Treatment varies based on the specific diagnosis but typically includes psychotherapy, and/or medication.
Major depressive disorder, premenstrual dysphoric disorder, and disruptive mood dysregulation disorder are covered in separate articles.
Overview
Epidemiology
Varies depending on the underlying disorder, e.g.:
- Lifetime prevalence for MDD of ∼ 20% [1]
- Annual prevalence for PMDD of 1–8% [2][3]
- Substance/medication-induced depressive disorder is rare. [2]
Clinical features [2]
- Symptoms of depression (e.g., low mood, anhedonia)
- Somatic features may be present depending on the condition (e.g., somatic symptoms of PMDD)
- Symptoms may not be reported, but can be identified through screening for depression.
Diagnosis [2]
- Clinical diagnosis based on the relevant DSM-5 criteria.
- Exclude differential diagnoses of depressive disorders.
- Depending on symptoms, consider workup for organic causes of depression.
Differential diagnoses of depressive disorders [2]
- Bipolar affective disorder
- Personality disorder
- Adjustment disorder
- Bereavement and grief
- Burnout syndrome
Management [2]
- Treatment is specific to the underlying disorder but usually includes psychotherapy and/or antidepressants.
- Screen for and treat concurrent disorders (e.g., substance use disorder, anxiety).
- Refer patients with severe or refractory symptoms, suicidal ideation, and/or psychotic features to psychiatry.
- See also:
Types of depressive disorders [2]
| Overview of depressive disorders [2] | ||
|---|---|---|
| Condition | Timing of symptoms | Selected clinical features |
| Major depressive disorder |
|
|
| Persistent depressive disorder (dysthymia) |
| |
| Major depressive disorder with seasonal pattern |
|
|
| Premenstrual dysphoric disorder (PMDD) |
| |
| Mood disorder due to another medical condition |
|
|
| Substance/medication-induced depressive disorder |
|
|
| Disruptive mood dysregulation disorder (DMDD) |
|
|
Persistent depressive disorder
Persistent depressive disorder (dysthymia) is a chronic depression characterized by a consistently low mood and additional depressive symptoms lasting for ≥ 2 years (≥ 1 year in adolescents and children). [2]
Diagnosis [2][4]
- Diagnosis is confirmed using the DSM-5 diagnostic criteria for persistent depressive disorder.
- Often occurs concurrently with other psychiatric conditions (e.g., MDD, personality disorders).
- Assess severity to help determine management:
- Mild: Symptoms are manageable.
- Moderate: Symptoms are mild to severe.
- Severe: Symptoms are severe, unmanageable, and significantly exceed the requirement for diagnosis.
Depressive disorders are frequently identified during screening for depression. [2]
DSM-5 diagnostic criteria for persistent depressive disorder [2]
Diagnosis is confirmed in individuals who meet all of the following criteria.
-
Depressed mood
- In adults: most of the day for the majority of days for ≥ 2 years
- In children and adolescents: irritable or depressed mood for ≥ 1 year
-
≥ 2 of the following clinical features of persistent depressive disorder
- Overeating or poor appetite
- Sleep disturbance (insomnia or hypersomnia)
- Fatigue, loss of energy
- Poor self-esteem
- Diminished concentration and decision-making ability
- Hopelessness
- Symptoms clinically significant distress or impaired functioning in important areas of life (e.g., work, school)
- Periods of remission last ≤ 2 consecutive months.
- Features of differential diagnoses are not present.
- No history of manic or hypomanic episodes
- Symptoms are not due to:
- Persistent schizoaffective disorder or another psychotic disorder
- Effects of substances or organic disease
Thoughts of suicide, loss of interest, and psychomotor agitation or retardation may manifest in PDD but are not part of the diagnostic criteria. [2]
HE'S 2 SAD: Hopelessness, Energy loss or fatigue, Self-esteem is low, 2 years minimum of depressed mood, Sleep is increased or decreased (insomnia or hypersomnia), Appetite is increased or decreased, Decision-making and/or concentration is impaired.
Treatment [4]
Treatment of persistent depressive disorder is the same as treatment for depression.
Depressive disorder due to another medical condition
- Depressed mood and/or anhedonia attributable to a general medical condition
- Conditions associated with depressive disorder include the following:
- Hypothyroidism
- Primary adrenal insufficiency
- Stroke (especially anterior cerebral artery stroke)
- Parkinson disease
- CNS neoplasms
- Other neoplasms (e.g., pancreatic cancer)
- Dementia
- Parathyroid disorders
- See also “Depression in patients with cancer” and “Depression post myocardial infarction.”
Substance/medication-induced depressive disorder
- Depressed mood and/or anhedonia attributable to the use of, or withdrawal from, substances or medications
- Substances or medications associated with depressive disorder include the following:
- Marijuana, γ-hydroxybutyric acid (GHB), flunitrazepam, ketamine
- Alcohol
- Corticosteroids
- Oral contraceptive pill