42.1 Major Depressive Disorder

major depressive disorder a disorder in which a person experiences, in the absence of drugs or another medical condition, two or more weeks with five or more symptoms, at least one of which must be either (1) depressed mood or (2) loss of interest or pleasure.

Joy, contentment, sadness, and despair exist at different points on a continuum, points at which any of us may find ourselves at any given moment. The difference between a blue mood after bad news and major depressive disorder is like the difference between gasping for breath after a hard run and having chronic asthma. Major depressive disorder occurs when at least five signs of depression last two or more weeks (TABLE 42.2). To sense what major depressive disorder feels like, suggest some clinicians, imagine combining the anguish of grief with the exhaustion you feel after pulling an all-nighter.

Table 14.3: TABLE 42.2
Diagnosing Major Depressive Disorder The DSM-5 classifies major depressive disorder as the presence of at least five of the following symptoms over a two-week period of time (minimally including depressed mood or reduced interest) (American Psychiatric Association, 2013).

  • Depressed mood most of the time

  • Dramatically reduced interest or enjoyment in most activities most of the time

  • Significant challenges regulating appetite and weight

  • Significant challenges regulating sleep

  • Physical agitation or lethargy

  • Feeling listless or with much less energy

  • Feeling worthless, or feeling unwarranted guilt

  • Problems in thinking, concentrating, or making decisions

  • Thinking repetitively of death and suicide

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Although phobias are more common, depression is the number-one reason people seek mental health services. In the United States, 7.6 percent of people interviewed by the Centers for Disease Control and Prevention (2014) reported they were experiencing moderate or severe depression. Worldwide, depression trails only low back pain as the leading cause of disability (Global, 2015). In any given year, 3.9 percent of men and 7.2 percent of women worldwide will have a depressive episode (Ferrar et al., 2013).