In this video I describe the symptoms and prevalence of several disorders in the DSM-5 category of Depressive Disorders with a focus on Major Depressive Disorder. I describe the symptoms and prevalence of MDD, patterns such as seasonal pattern and peripartum onset, in addition to Persistent Depressive Disorder, formerly known as dysthymia. Please note that the symptoms described in this video are not comprehensive and there are other symptoms involved in diagnosis for each of these disorders.
Video Transcript
Hi, I’m Michael Corayer and this is Psych Exam Review. In this video we’re going to look at the category of depressive disorders in the DSM-5 and this is a new category name in the DSM-5. So if you look in earlier editions you’ll see the category of “mood disorders“, which included types of depression as well as bipolar disorders. But in the DSM-5 these are been separated. So we have a category for a depressive disorders and then a separate category for bipolar disorders, which I’ll talk about in a future video.
So the main disorder that we’ll look at in this category is major depressive disorder and this is what most people are probably thinking of when they think of depression, right? So major depressive disorder is depression that occurs in episodes. So while we all feel depressed or sad sometimes, in order to be diagnosed as major depressive disorder this depressed mood must last most of the day, every day, for at least a two-week period and then that would be categorized as an episode of major depressive disorder.
And this is the main characteristic symptom of major depressive disorder is this depressed mood, but we also see a number of other symptoms as well. So these can include things like anhedonia, which I’ve talked about in some earlier videos and this refers to a lack of pleasure; so things that the person used to enjoy, hobbies that they had, or certain activities or even things like eating or sex that used to be pleasurable are no longer pleasurable for the person. We also see changes in appetite and body weight during depressive episodes and this can go in either direction. For some people they have an increased appetite, they find they’re eating more and they gain weight during their depressive episodes, but for other people they have less appetite, maybe they don’t find eating as pleasurable and as a result they tend to lose weight when they’re suffering from an episode of depression. We also see changes in sleep patterns, so we see sleep disturbance and again this can go in either direction. One way that it can occur is in the form of insomnia and that refers to difficulty falling asleep or staying asleep, and a common type in depression is to see what’s called terminal insomnia. This is where the person can fall asleep at night but they wake up very early in the morning and then they can’t fall back to sleep. So they might wake up at 3 or 4 in the morning, they want to go back to sleep, they still feel tired, but they find that they can’t. They’re there laying in bed, you know, still awake. And we also see what’s called hypersomnia and this is where somebody is sleeping many more hours than they normally would during a depressive episode. Another symptom that we can see is called psychomotor retardation and this refers to a slowing down of the body. The person moves more slowly and things feel like they take a lot more energy than normal. So everyday activities that the person usually will be able to do just seem to be impossible for the person to complete. They just seem to drain their energy so much even just thinking about doing these things just feels like too much for the person to actually do. They just feel fatigued and tired and they move more slowly and so things just seem to take a lot more effort than normal or than they should.
Then we have a number of cognitive symptoms associated with major depressive disorder and these can include things like thoughts of worthlessness or thoughts about failure, difficulty concentrating and making decisions, and in some cases suicidal ideation. This refers to suicidal thoughts and one pattern that we see in the person’s thinking is what’s called rumination; this is where thoughts become persistent and repetitive and these are often negative thoughts. So a person might be having thoughts about worthlessness or they might be recalling a past failure and they just keep bringing it to mind. They can’t stop thinking about it. It’s where they’re just plagued by these thoughts that they they don’t want to be thinking about, that are preventing them from being able to concentrate on other things, and yet they can’t seem to stop bringing them to mind. So that’s referred to as rumination.
The estimated 12-month prevalence for major depressive disorder in the DSM-5 in the U.S. is estimated to be about 7% and it’s more common in young adults than older adults. So it’s about 3 times more common in people aged 18 to 29 compared to people who are over the age of 60. And we can also estimate the lifetime prevalence, and for males this is about 7-12% and it’s about twice as high in females at 20-25%. And one other thing we see in the prevalence is that the more episodes that person has suffered, the more likely they are to suffer from future episodes. So if somebody experiences one episode of major depressive disorder there’s a 50 to 60% chance that they’ll experience a second episode at some time in the future. And of those who have experienced two episodes, 70% of them will experience a third episode. And then if we look at those who have had three episodes 90% of them will have a fourth episode. So we see this sort of snowballing effect, where the more episodes somebody has suffered from, the greater the risk of future episodes.
Okay I’d like to add a few details about the suicide risk for major depressive disorder and one thing to note is that women are more likely to attempt suicide but men are more likely to complete suicide. And the reason for this is in the methods that they tend to choose. So women are more likely to choose methods that have some chance of being rescued and so they do they may do things like consume a bunch of pills, or cut their wrists, and these are things that it is possible to save someone from. But men are more likely to choose more irreversible methods, so things like shooting themselves or jumping off of a building. And so even though more women attempt they’re actually more men who complete suicide when suffering from major depressive disorder.
Now another thing to mention about suicide risk is often people have the misconception that the suicide risk would be greatest when the person’s depression is at its worst. But this is actually not the case. When the depression is at its worst, when the person is in their darkest depths of depression, they’re actually less likely to commit suicide and the reason for this is that they don’t have the energy or motivation to act on their negative thinking or their suicidal ideation. And so even though they may be having suicidal thoughts at that time, they often don’t do anything. The danger is really when the person starts getting a little bit better. They’ve been in a very dark place, they start recovering a little bit, they find their energy and their motivation is coming back, but they still have the negative thoughts. They still have the suicidal ideation and this is where the risk is greatest because it’s a dangerous combination of these negative thoughts and actually having the feeling of energy or motivation to do something about it. Snd so that’s actually when we have to be most careful in watching somebody and trying to make sure that they can get help in order to prevent them from attempting suicide.
Okay, we can also see ways of specifying when the episodes occur in major depressive disorder and so two patterns that commonly occur are seasonal pattern and peripartum onset. So seasonal pattern is also referred to as seasonal affective disorder and this is where a person has episodes of major depressive disorder that occur in the fall or winter but not in the spring and summer. And the reason for this seasonal pattern seems to be related to hours of sunlight. So as the days get shorter and the person’s not getting as much sunlight, we see that they’re more likely to experience depressive episodes, but when the days are longer and there’s more sunlight they’re less likely to experience this. One of the treatments for this is to use light therapy, this is something I’ll talk about in a future video when we talk about treatments.
And another pattern we see in episodes is what’s called peripartum onset and this refers to episodes of depression that occur just before childbirth or during pregnancy up until the the weeks following childbirth. You may also see this called postpartum depression and the reason that the name was changed is because this can occur prior to birth, so postpartum is not the most precise term. Peripartum refers to around the time of birth so it can have onset before childbirth actually occurs. In both of these cases, the seasonal pattern and the peripartum onset, we can see the role of hormones in that during different periods of sunlight that’s going to influence hormones in the body and then also during pregnancy, of course, we have large changes in hormones in a pregnant woman’s body. And these both indicate to us that hormones are playing a role in mood and perhaps this can help us to better understand the disorder.
I’d like to end by just talking about two other types of depression that are less common and one of these is persistent depressive disorder. And so in the case of major depression it occurs in episodes which lasts for two weeks or longer perhaps several months but in persistent depressive disorder, which was formerly known as dysthymia, we see that the depression is lasting most of the day, most days for a period of at least 2 years. And so it’s a less severe in terms of the depths of the depressed mood, but it’s much longer lasting. So people have depressed mood that lasts for at least 2 years. And this is less common with an estimated 12 month prevalence of about 0.5%. And then it’s also possible to have this persistent depressive disorder where you have slightly depressed mood or mild depressed mood most of the time, in addition to having more severe episodes, and so in that case you would be diagnosed with what’s called persistent depressive disorder with major depressive episodes. This was previously called double depression but that was changed in the DSM-5. Okay so I hope you found this helpful if so please like the video and subscribe to the channel for more. Thanks for watching!
