Depression isn’t just an occasional feeling of sadness or moodiness experienced in response to life’s setbacks, like what most people experience from time to time.
A diagnosis of major depressive disorder is made if this overwhelming feeling of sadness or despair:
• Lasts two weeks or longer at a time,
• Interferes with daily routine, occupational functioning, and social life or if there is marked distress as a result of the depression,
• Represents a change from the person’s baseline personality, and
• At least 5 of these 9 symptoms present, nearly every day:
2. Insomnia or hypersomnia
3. Psychomotor agitation or retardation
4. Depressed mood or irritability most of the day
5. Thoughts of death or suicide, or has suicide plan
6. Feelings of worthlessness or excessive or inappropriate guilt
7. Significant weight change (5%) or change in appetite
8. Decreased interest or pleasure in most activities, most of each day
9. Diminished ability to think or concentrate, or more indecisiveness
Other causes of low mood should also be screened and excluded:
• Substance abuse (e.g. drugs, alcohol, medications)
• Medical illness causing depressed mood
Updates to the major depressive disorder criteria in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) also state that a major depressive episode can occur in the context of bereavement or grief. The severity of the depressive symptoms, functional impairment and the prognosis are worse in this case, compared with a typical grief reaction that is not accompanied by major depressive disorder.
Management of Depression
Selective serotonin reuptake inhibitors (SSRIs) and serotoninnorepinephrine reuptake inhibitors (SNRIs) are generally considered safer and cause fewer side effects than other types of antidepressants. Cognitive-behavioral therapy is the most popular and commonly-used therapy for the effective treatment of depression.
Written by By Adjunct Assistant Professor Tan Pei Lin Lynnette, Consultant, Department of Psychological Medicine, TTSH