Textbook of psychiatry
H7.1 Depressive disorders
A depressed mood is pathological if its intensity and duration are out of proportion to the
cause. It becomes a disorder if the depressed mood is combined with other symptoms,
constituting a depressive episode.
Depressive disorders only comprise depressive episodes, unlike bipolar disorder
Classification of depressive disorders (DSM-5):
- Depressive disorder
- Persistent depressive disorder
- Premenstrual dysphoric disorder
- Substance/medication-induced depressive disorder
- Depressive disorder due to another medical condition
Syndromes:
Depressive disorder:
It is characterized by 1 or more depressive episodes.
Affective symptoms:
Depressed mood
Loss of interest or pleasure in day-to-day activities (anhedonia)
at least one of these 2 symptoms must be present (key symptoms)
mood symptoms can fluctuate in severity during the day
typical: patients feel worst in the morning and gradually feel better
Physical symptoms:
Fatigue
Anergia (lack of physical energy)
Sleep problems
Anorexia (reduced appetite)
Weight loss
Constipation
Loss of libido
Amenorrhoea in women
Various sleep symptoms
o Most typical: waking up early, several hours earlier than normal
o Difficulty falling asleep and waking up frequently during the night
o Sleeping for extremely long periods and waking up unrefreshed
Cognitive symptoms:
Problems mainly in the areas of concentration, memory, judgement and the form
and content of thought
o Feeling worthless
, o Overvalued and/or misplaced guilt
o Indecisiveness
o Thoughts of despair
o Hopelessness
o Helplessness
o Preoccupation with death or suicide
o Loss of self-confidence
o Incapable of doing very much
o Expecting the worst from the future
o Suicidal thoughts
o Retarded speed of thought
Slowed thoughts or even stopping
Not thinking clearly
Not being able to make decisions
Thoughts going round in circles (inefficiency of thought)
Conative symptoms:
Changed psychomotor function
o Retardation
o Agitation (restlessness, pacing up and down and hand wringing)
o Slowed motor function
o Reduced facial expression
o Lack of spontaneous movements
o Collapsed posture
o Downcast gaze
o Delayed, monosyllabic answers
Changed motivation
Changed behaviour
H7.1 Depressive disorders
A depressed mood is pathological if its intensity and duration are out of proportion to the
cause. It becomes a disorder if the depressed mood is combined with other symptoms,
constituting a depressive episode.
Depressive disorders only comprise depressive episodes, unlike bipolar disorder
Classification of depressive disorders (DSM-5):
- Depressive disorder
- Persistent depressive disorder
- Premenstrual dysphoric disorder
- Substance/medication-induced depressive disorder
- Depressive disorder due to another medical condition
Syndromes:
Depressive disorder:
It is characterized by 1 or more depressive episodes.
Affective symptoms:
Depressed mood
Loss of interest or pleasure in day-to-day activities (anhedonia)
at least one of these 2 symptoms must be present (key symptoms)
mood symptoms can fluctuate in severity during the day
typical: patients feel worst in the morning and gradually feel better
Physical symptoms:
Fatigue
Anergia (lack of physical energy)
Sleep problems
Anorexia (reduced appetite)
Weight loss
Constipation
Loss of libido
Amenorrhoea in women
Various sleep symptoms
o Most typical: waking up early, several hours earlier than normal
o Difficulty falling asleep and waking up frequently during the night
o Sleeping for extremely long periods and waking up unrefreshed
Cognitive symptoms:
Problems mainly in the areas of concentration, memory, judgement and the form
and content of thought
o Feeling worthless
, o Overvalued and/or misplaced guilt
o Indecisiveness
o Thoughts of despair
o Hopelessness
o Helplessness
o Preoccupation with death or suicide
o Loss of self-confidence
o Incapable of doing very much
o Expecting the worst from the future
o Suicidal thoughts
o Retarded speed of thought
Slowed thoughts or even stopping
Not thinking clearly
Not being able to make decisions
Thoughts going round in circles (inefficiency of thought)
Conative symptoms:
Changed psychomotor function
o Retardation
o Agitation (restlessness, pacing up and down and hand wringing)
o Slowed motor function
o Reduced facial expression
o Lack of spontaneous movements
o Collapsed posture
o Downcast gaze
o Delayed, monosyllabic answers
Changed motivation
Changed behaviour
