The American Psychiatric Association (APA) publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual describes the symptoms necessary for the diagnosis of all mental disorders, including Major Depressive Disorder. The DSM is updated when research and changes in the medical system make it necessary to revise old diagnoses. For example, in the last edition of the DSM, bipolar disorder was classified under MDD. In the most current edition (DSM-5), bipolar disorder is now a completely separate diagnostic category.
The Depressive Disorders category now includes:
These conditions are all similar in that they all have something to do with having a depressed mood. They are separated by the severity of the depression or by what may be causing it.
A person is diagnosed with Major Depressive Disorder when:
- they experience five or more of the following symptoms during the same two-week period for most of the day or nearly every day:
- Feelings of sadness, emptiness, or hopelessness (in children, this may be irritability)
- Having no interest or feeling no pleasure in all or almost all activities
- Weight loss or weight gain by greater than 5% when not trying to lose or gain weight OR a change in appetite nearly every day
- Sleeping too little or too much
- Physical agitation or restlessness that is observed by others
- Being tired and having a lack of energy
- Feelings of worthlessness, self-hate, and guilt
- Not being able to concentrate, think clearly, or make decisions
- Being irritable
- Ongoing thoughts of death or suicide - either thinking about suicide without a plan for how it would happen, having a specific plan or attempting to commit suicide
- Never having a manic or hypermanic episode (being very excited or energetic which would be possible symptoms of bipolar disorder)
- these symptoms cause a great deal of stress in the person's life or cause changes in their daily activities such as not being able to get out of bed, getting ready for the day, and/or handling school, work, relationships, and other commitments.
- at least one of the symptoms is depressed mood or loss of interest or pleasure
Symptoms of MDD
Depressive symptoms can vary a great deal from one person to the next. One person with depression may experience feelings of sadness, hopelessness, and helplessness. Another person may feel angry, irritated, and discouraged. These symptoms may also seem like a change in someone's personality. For example, someone who is usually patient might begin to lose his or her temper about things that normally would not bother him or her.
Symptoms can also change over time when someone is depressed. Someone who is initially withdrawn and sad can become very frustrated and irritable as a result of getting less sleep and not being able to accomplish simple tasks or make decisions. These symptoms cause stress that is noticed by others and cause problems at school, work or in relationships with others.
It is important to note that a diagnosis of MDD is not made when the cause is a substance (medication or drug of abuse) that the person took or because of another medication condition. People usually go to the doctor with complaints of disturbed sleep (not able to sleep or sleeping too much) or tiredness. Even though they may deny sadness, through careful interviewing, facial expressions, and body language, the doctor can often figure out if a person is feeling depressed.
When major depressive disorder is severe, people may experience psychotic symptoms, such as hallucinations and delusions. Hallucinations are "phantom" sensations that appear to be real even though they are not caused by real things in the environment. Hallucinations may involve sights, sounds, tastes, smells or sensations. They can be very convincing, as well as disturbing. The most common form of hallucination involves hearing voices of people who are not actually present.
Delusions are very strongly held false beliefs that cause a person to misinterpret events and relationships. Delusions vary widely and examples include:
- persecutory (someone is spying on or following you)
- referential (a television show or song lyrics contain special messages only for you)
- somatic (thinking that a body part has been altered or injured in some way)
- religious (false beliefs with religious or spiritual content)
- erotomanic (thinking that another person, usually someone of higher status, is in love with you),
- grandiose (thinking that you have special powers, talents, or that you are a famous person).
When someone is depressed, these hallucinations and delusions usually focus on guilt, personal weaknesses, or disease. For instance, someone who is depressed might truly believe that they are not able to do their job or take care of their child because they are a failure. This feeling may be reinforced by voices telling them that they are weak or a belief that everyone is laughing at them behind their back. This can be especially troubling because a person can lose the ability to figure out the difference between real and imagined experiences in this situation.
In this center, we focus on Major Depressive Disorder, Disruptive Mood Dysregulation Disorder, Persistent Depressive Disorder (Dysthymia), Premenstrual Dysphoric Disorder, Substance/Medication-Induced Depressive Disorder, Depressive Disorder Due to Another Medical Condition, and Unspecified Depressive Disorder. For information on Bipolar Disorder, please visit our center on that topic. Throughout our discussion it is important to keep in mind that the term "depression" is not very specific. There are multiple kinds of depression; and the diagnosis of a particular condition varies depending on how severe the symptoms are and how long they last.