Clinical depression classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Classification

The diagnostic category major depressive disorder appears in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. The term is generally not used in countries which instead use the ICD-10 system, but the diagnosis of a depressive episode is very similar to an episode of major depression. Clinical depression also usually refers to acute or chronic depression severe enough to need treatment. Minor depression is a less-used term for a subclinical depression that does not meet the criteria for major depression but where there are at least two symptoms present for two weeks.

Major Depression

Major depression is a severely depressed mood that persists for at least two weeks. Episodes may be isolated or recurrent and categorized as mild, major, or severe. If the patient has already had an episode of mania or markedly elevated mood, a diagnosis of bipolar disorder is usually made instead. Depression without periods of elation or mania is therefore sometimes referred to as unipolar depression because the mood remains at one emotional state or "pole." The diagnosis usually excludes cases where the symptoms are a normal result of bereavement, though it is possible for normal bereavement to turn into a depressive episode.

Diagnosticians recognize several possible subtypes of major depression:

• Depression with melancholic features – Melancholia is characterized by a loss of pleasure (anhedonia) in most or all activities, a failure of reactivity to pleasurable stimuli, a quality of depressed mood more pronounced than that of grief or loss, a worsening of symptoms in the morning hours, early morning waking, psychomotor retardation, excessive weight loss (not to be confused with Anorexia Nervosa), or excessive guilt.

• Depression with atypical features – Atypical depression is characterized by mood reactivity (paradoxical anhedonia) and positivity, significant weight gain or increased appetite ("comfort eating")

• Depression with Psychotic Features – Some people with major depressive or manic episodes may experience psychotic features. They may be presented with hallucinations or delusions that are either mood-congruent (content coincident with depressive themes) or non-mood-congruent (content not coincident with depressive themes). It is clinically more common to encounter a delusional system as an adjunct to depression than to encounter hallucinations, whether visual or auditory.

It is possible for a person to have a combination of these subtypes. For instance, someone may experience the loss of pleasure in activities observed in melancholic depression in conjunction with the over-eating and weight gain common in cases of atypical depression.

Other Disorders Featuring Depressed Mood

• Dysthymia is a chronic, mild depression in which a person suffers from a depressive mood almost daily over a span of at least two years without episodes of major depression. The symptoms are not as severe as those for major depression, although people with dysthymia are vulnerable to co-occurring episodes of major depression (sometimes referred to as "double depression").

• Bipolar disorder is an episodic illness characterized by alternating states of mania, hypomania and depression. In the United States, bipolar disorder was previously called "manic depression", but this term is no longer favored by the medical community.

• Postnatal depression or postpartum depression is a form of clinical depression that occurs after childbirth. Postnatal depression primarily occurs in women, less commonly in men, with similar symptoms and treatment methods as clinical depression. Postnatal depression generally lasts only a few weeks with proper diagnosis and treatment.

• Recurrent brief depression (RBD) is distinguished from clinical depression primarily by differences in duration. Patients with RBD have depressive episodes about once per month, with individual episodes lasting less than two weeks and typically less than 2–3 days. Diagnosis of RBD requires that the episodes occur over the span of at least one year and, in female patients, independently of the menstrual cycle. People with clinical depression can develop RBD, and vice versa, with both illnesses having similar risks.