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Major Depressive Episode

According to the DSM-IV-TR, a Major Depressive Episode lasts at least 2 weeks, during which time the person continuously experiences:

  1. A mood that is abnormally low or depressed (or, in children and adolescents, an irritable mood)
  2. and/or

  3. A loss of interest in most of one's usual activities and relationships

In addition to these two symptoms, there are another 7 symptoms described below that the DSM-IV-TR lists as part of a Depressive Episode. A person must experience at least 5 of these 9 symptoms during this 2-week period, including at least one of the two listed above, in order to meet full criteria for a Major Depressive Episode:     

  1. A significant change in appetite or weight (either increased or decreased)
  2. A significant change in sleep (either sleeping too much or being unable to sleep)
  3. Lack of energy, or fatigue
  4. Difficulty concentrating, poor memory, or an inability to make decisions
  5. Lethargy, feeling slowed-down, or agitation and restlessness
  6. Feelings of worthlessness or excessive and inappropriate guilt
  7. Thoughts of death or suicide

Severity of Major Depressive Episodes

An episode of Major Depression is considered severe if the person is experiencing all or nearly all of the possible symptoms described above and is greatly impaired in their ability to function at work, at school or in social situations. A mild episode is one where a minimum number of symptoms are experienced, and the person's level of functioning is impaired in a minor way.  An episode of moderate severity falls somewhere between these two extremes.

Chronic Major Depressive Episodes

A Major Depressive Episode is considered chronic when it continues in its full form (at least 5 of 9 symptoms described above) for a period of two years or more.  This categorization holds whether or not treatments have been tried. 

Disability is a key feature of Depressive Episodes

What the above symptom list does not fully capture is the extent to which a Major Depression can, in many cases, be a source of great suffering.  Many individuals describe their Depression as not simply being an absence of pleasure or energy, but a very intense form of psychological pain.

By definition, a Major Depressive Episode impairs a person's ability to function in life, whether at work, school, in relationships or in hobbies and pastimes.  In some cases, the person may seem to be functioning at their normal level, but only because they are exerting much more effort than usual.  There is also the risk that individuals experiencing a Major Depressive Episode will attempt suicide, especially in severe cases.

Psychosis and Catatonia in Depressive Episodes

Psychosis can sometimes occur as part of a Major Depressive Episode. This is referred to a Major Depressive Episode with Psychotic Features, and is a severe form of an episode.

When these psychotic features have themes that fit with the emotional tones of a Depression, they are labelled as being mood-congruent. An example of this would be nihilistic delusions. On the other hand, when the psychotic features do not seem to be related to the emotional tones of the Depression, they are called mood-incongruent.

Catatonia is another severe reaction that can happen in very rare cases as part of a Major Depressive Episode.

Subtypes of Major Depressive Episodes

There are certain common subtypes of Depressive Episodes that exist, including:

Diagnostic Exclusions

If the depressive symptoms are caused by a particular drug or medication, or are due to a general medical condition, then a diagnosis of a Major Depressive Episode is not made, though this person will still require medical attention.

Also, according to the DSM-IV-TR, if the symptoms of Major Depression occur following the death of a loved one, then the diagnosis of a Major Depressive Episode is made only if the symptoms continue for more than 2 months OR involve at least one of the following:

  • A significant impairment in the person's ability to function at work, school, in relationships or in pleasurable activities
  • A morbid preoccupation with feelings of worthlessness
  • Suicidal thoughts
  • Lethargy or feeling physically slowed-down
  • Psychotic symptoms

 

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Major Depressive Disorder

Atypical Depression