Depression

People can become depressed through different routes, including genetics, traumatic experiences, hormonal problems, substance abuse, head injuries, brain tumors, and other illnesses. People with major depression feel sad and helpless every day for weeks at a time. They have little energy, fell worthless, contemplate suicide, have trouble sleeping, cannot concentrate, find little pleasure, and can hardly even imagine being happy again. Standards for diagnosis inevitably vary from place to place, and psychiatrists have no laboratory tests to confirm diagnosis. Defined by the presence and recurrent episodes of either depressed mood (Depression, Depressive Episode) or manic mood (Mania, Manic Episode). These are disturbances of mood more than thought, distinguishing them from “thought disorder” (most notably, schizophrenia)

This distinction is emphasis rather than exclusivity. Mood disorders are accompanied by thought disturbances. Thought disorders are accompanied by mood disturbances, defined by the presence, duration, and severity of either:

Depressive (Mood) Episodes

Manic (Mood) Episodes

Or Both

Episodes are clearly defined. Episodes define the Mood Disorder

Depressive Episode

Must be either Depressed Mood or Anhedonia, and five or more of…

Appetite/weight disturbance

Sleep disturbance

Psychomotor retardation/agitation

Fatigue or loss of energy

Feelings of worthlessness or guilt

Difficulties in concentration or indecisiveness

Recurrent thoughts of death or suicide

R/O effects of drugs or general medical condition

Importantly, R/O Bereavement

1/3 of bereaving continue to grieve one month later

2 months of grief is the beginning of a red flag

<20% continue to grieve one year later

Concern also when grief is extremely severe, has psychotic features, or includes suicidal ideation

Remember that vulnerability may last two years

Symptoms cause clinically significant distress