Major Depressive Disorder








Major Depressive Disorder

Overview of the Diagnostic Category

The DSM-5 criteria for the diagnosis of major depressive disorder involve five or more symptoms present for more than two weeks. One must have not less than one symptom linked to depressive moods or loss of pleasure in the previously enjoyed activities. The key symptoms of the condition include depressed mood most of the day or nearly every day, as evidenced by the subjective report. There are feelings of sadness, emptiness, and hopelessness (American Psychiatric Association, 2013). There is markedly diminished interest or pleasure in all or almost all activities most of the day or nearly every day. There is a weight loss or gain not associated with dieting; insomnia, psychomotor delay, fatigue, a feeling of worthless, reduced capacity to focus, and recurrent thoughts of death. Other symptoms include impairment in social, occupational, and other crucial functions.

Age-Related Factors

The condition first appears at any age, but the possibility of the onset rises markedly with puberty. The incidences begin and reach at peak at the age of 20s. Nevertheless, the first onset that occurs in late life is not common.

Differential Diagnosis

The differential diagnosis includes manic episodes which present with other symptoms such as irritability or mixed events. Other differential diagnosis includes mood disorder resulting from other healthcare conditions. There is also substance-induced or medically-induced depression. Individuals also present with symptoms that can be linked to disorders like bipolar and attention-deficit or hyperactivity disorder.

Disorder Risk and Prognostic Factors

The risk of exposure to the condition includes temperamental for example, neuroticism which increases the onset of the disease. There are also environmental factors whereby childhood experiences set a potent risk factor for the condition (American Psychiatric Association, 2013). The stressful events precipitate the disease. There are also genetic and physiological factors whereby the first-degree family members in individuals with the condition have a risk for the condition.

Persistent Depressive Disorder (Dysthymia)


This is a mild long-term form of depression whose key features include a low mood for at least two years with not less than two other signs of depression. The diagnosis considers the aspects of a depressed mood for several hours in a day, insomnia, poor appetite, poor concentration, overeating, and difficulty making decisions.

Age-Related Factors

The condition has an early and insidious onset. It is common in childhood, adolescence, and early adult life. The early onset before the age of 21 is linked to high chances of comorbid associated with other mental conditions such as personality disorders and substance use disorders.

Differential Diagnosis

One of the differential diagnoses is a psychotic disorder which present in the form of depressive symptoms like schizoaffective disorder, delusions, and schizophrenia. Other conditions include major depressive disorder, a depressive or bipolar-associated disorder caused by other medical conditions, personality disorder, and substance or medication-induced depressive or bipolar disorder.

Disorder Risk and Prognostic Factors

There is temperamental which is characterized by high levels of neuroticism or negative affectivity. There is an increased severity of the symptom, reduced global functioning, and conduct disorder or anxiety disorder. The other risk factor is environmental, and childhood risk factors is composed of the parental loss or separation (American Psychiatric Association, 2013). There is also risk associated with genetic and physiological factors. There are high possibilities that individuals with first-degree relatives are exposed to the risk of developing these condition. There are various brain regions linked to the condition. These include the amygdala, hippocampus, prefrontal cortex, and anterior cingulate.

Premenstrual Dysphoric Disorder


In most menstrual cycles, there are at least five symptoms in the last seven days prior to the onset of the menses. There must be one or more of the symptoms such as marked affective lability, increased level of anger, depressed mood or hopelessness, and anxiety (American Psychiatric Association, 2013). One or more symptoms are associated with the reduced pleasure of the previously enjoyed activities, personal challenge in concentrating, the loss of energy, insomnia or hypersomnia, out-of-control, and pain or swelling of the breast.

Age-Related Factors

The onset of the condition occurs at any stage after the experience of the menarche. The rate of new cases with more than 40 months follow-up period is 2.5 percent. Most individuals report worsened symptoms as they approach menopause (American Psychiatric Association, 2013). The symptom of the condition stops after menopause, even though the cyclical hormone replacement has a high chance of triggering the re-expression of the symptoms.

Differential Diagnosis

One of the common conditions that can be linked to this disorder is premenstrual syndrome. However, the condition is ruled out since it is less severe than a premenstrual dysphoric disorder. The other differential diagnosis consists of dysmenorrhea, which is characterized by the presence of painful menses. It is differentiated from premenstrual dysphoric disorder since the symptoms begin with the onset of menses (American Psychiatric Association, 2013). The premenstrual dysphoric disorder starts before the onset of menses. Other differential diagnoses include bipolar disorder, persistent depressive disorder, the use of hormonal treatments, and major depressive disorder.

Disorder Risk and Prognostic Factors

The condition’s risk factors are linked to the environmental factors related to the symptoms of the premenstrual dysphoric disorder, like the history of trauma, stress, and seasonal changes. Other factors include genetic and physiological factors. The heritability of the condition is not yet discovered (American Psychiatric Association, 2013). Nevertheless, for the premenstrual symptoms, the estimated chances of inheriting the condition range between 30 and 80 percent, and the steady aspect of the premenstrual symptom approximated at 50 percent.



American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC; London England: American Psychiatric Publishing.

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