Depressive Disorders

Depressive Disorders

Depressive disorders are family disorders that have a negative impact on our health, behavior, and feelings. People usually mixed term worry and depression. But this is not true, actually worry is a normal part of life and is for a shorter period but depression is intense feelings of irritability, worthlessness, alogia, fatigue, and difficulty in concentrating and it remains for a long period of time (generally most of the time in a day or over years).

Depressive disorders are categorized with respect to the age of the client, timing, and presumed etiology. Depressive disorders include:

  • Disruptive mood dysregulation disorder
  • Major depressive disorder
  • Persistent depressive disorder
  • Premenstrual dysmorphic disorder
  • Substance medication-induced depressive disorder
  • Depressive disorder due to another medical condition
  • Other specified depressive disorder
  • Unspecified depressive disorder

Disruptive Mood Dysregulation Disorder

DMDD is a new disorder created to more accurately diagnose children who were previously diagnosed with pediatric bipolar disorder, even though they did not experience the episodic mania or hypomania characteristic of bipolar disorder.

  • DMDD symptoms typically begin before the age of 10, but the diagnosis is not given to children under 6 or adolescents over 18
  • Temper outbursts can involve yelling, pushing, hitting, or destruction of property.

Before Diagnosing, Carefully check:

  • Irritable or angry mood 
  • Severe temper outbursts (verbal or behavioral) at an average of three or more times per week are out of keeping with the situation and the child’s developmental level.
  • Trouble functioning due to irritability in more than one place (e.g., home, school, with peers)
  • Inappropriate for the child’s age level.

Overlap with

Treatment:

  • Behavioral interventions 
  • Psychotherapeutic
  • Medication

Coping:

Coping with disruptive mood dysregulation disorder can present challenges for both children and caregivers. The disorder can make it difficult for kids to function at home and at school, and parents and other adults may find it tough to handle children’s intense temper outbursts. 

Some coping strategies that can help:

Understand Your Child’s Triggers

If your child is likely to have a tantrum in certain settings or situations, try to have a plan in place. Briefly removing your child from the situation can sometimes help. 

Keep Your Child Safe

If your child is prone to acting out physically, try to keep any potentially dangerous objects out of reach. For example, make sure that all of the furniture in your home is safely secured and keep heavy, sharp, throwable objects out of reach.

Teach Coping Skills

In one case study, a child with DMDD was taught to mentally recite song lyrics whenever she found herself becoming angry. This was also combined with using deep breathing and reciting verbal reminders to help interrupt angry outbursts before they began.

Encourage Positive Behaviors

Reward appropriate behaviors with attention, praise, and privileges. In multi-child households, kids sometimes go unnoticed when they are acting good, but are able to get one-on-one attention when they misbehave. This tends to reinforce misbehavior and discourage good behavior. Break this pattern by making sure that you notice and reward your child’s positive actions.

Summary

DMDD can be a challenging condition that can result in significant problems in a child’s life. It can also increase a child’s risk of experiencing depression and anxiety as an adult, so it is important to seek treatment if you suspect that your child may have this condition. While these temper outbursts can be upsetting, appropriate treatment can help your child manage such symptoms and improve relationships in school, home, and social settings.

 DMDD vs. bipolar disorder

DMDD was introduced as a diagnosis to address what psychiatrists and psychologists believed to be the overdiagnosis of pediatric bipolar disorder. The key feature of bipolar disorders is the presence of manic or hypomanic episodes.

A manic episode is defined as a period of elevated, expansive, or irritable mood. In addition, a person also has an increase in goal-directed activity or energy. Hypomanic episodes are less severe versions of manic episodes. A person with bipolar disorder doesn’t always experience manic episodes. They aren’t a normal part of their daily functioning.

DMDD and bipolar disorders may both lead to irritability. Children with DMDD tend to be persistently irritable and angry, even when full-blown tantrums aren’t present. Manic episodes tend to come and go. You may ask yourself if your child is persistently in a bad mood, or if their mood seems to be out of the ordinary. If it’s persistent, they may have DMDD. If it’s out of the ordinary, their doctor may consider a bipolar disorder diagnosis.

Additionally, the key feature of DMDD is irritability, while mania may also include:

  • euphoria, or extreme positive emotion
  • extreme excitement
  • sleeplessness
  • goal-directed behavior

Differentiating DMDD and bipolar isn’t always straightforward and should be done by a professional. Talk to your child’s doctor if you suspect either of these conditions.

Major Depressive Disorder

MDD, also referred to as clinical depression, is a significant medical condition. It impacts mood and behavior as well as various physical functions, such as appetite and sleep. 

Before Diagnosing, Carefully check:

  • you must experience a change in your previous functioning
  • symptoms must occur for a period of 2 or more weeks
  • at least one symptom is either depressed mood or loss of interest or pleasure
  • In children, Depressive replace with irritable mood, Unable to gain expected weight

You must also experience 5 or more of the following symptoms in the 2-week period:

  • The feeling of Hopeless, Empty or feeling sad, Guilt, Worthlessness
  • Changes in 
    • Weight (Without dieting)
    • Sleep (insomnia or hypersomnia)
    • Energy level (Low energy level)
    • Thinking pattern or concentration
    • Feeling (Guilt or Worthlessness)Psychomotor agitation or retardation (restlessness)
  • Suicidal thoughts
  • Disturbance in
    • Job
    • Social Interaction
    • Other functioning areas
  • Never been manic or Hypomanic Episode.

What causes major depressive disorder?

MDD may also be triggered by:

  • certain medical conditions, such as cancer or hypothyroidism
  • particular types of medications, including steroids
  • abuse during childhood
  • alcohol or drug use
  • Genes and stress effects
  • Hormonal changes

Overlap with:

  • Mood disorder
  • ADHD
  • Bipolar disorder
  • Adjustment disorder
  • The occurrence of the major depressive episodes is not better explained by schizoaffective disorder, schizophrenia, schizophreniform, delusional, or specified and unspecified schizophrenia spectrum and other psychotic disorders.

Treatment:

  • Medication
  • Behavioral  Techniques
  • Psychotherapy

Persistent Depressive Disorder

The persistent depressive disorder also called dysthymia and chronic major depression is a continuous long-term (chronic) form of depression. Although symptoms of persistent depressive disorder may be less severe than other types of depression, they are long-lasting in duration.

Before Diagnosing, Carefully check:

  • The depressed mood at least for 2 years. 1 year for children and adolescents.

You must also experience 2 or more of the following symptoms in the 2-years period:

  • Changes in 
    • Appetite
    • Sleep (insomnia or hypersomnia)
    • Energy level (Low energy level)
    • Decision making (poor)
    • Concentration
    • Self-esteem
    • Feelings (hopelessness)
  • Never been manic or Hypomanic Episode.
  •  Disturbance in
    • Job
    • Social Interaction
    • Other functioning areas

Overlap With:

  • Major depressive disorder
  • Psychotic disorders
  • Cyclothymic disorder
  • Personality disorder
  • Bipolar disorder
  • Not better explained by a persistent Schizoaffective, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorders. 
  • Anxious Distress
  • Mixed features
  • Melancholic features
  • Atypical features
  • Mood congruent psychotic features
  • Mood incongruent psychotic features

Treatment:

Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) is a condition in which a woman has severe depression symptoms, irritability, and tension before menstruation as hormone levels begin to fall after ovulation. The symptoms of PMDD are more severe than those seen with premenstrual syndrome (PMS).

PMS refers to a wide range of physical or emotional symptoms that most often occur about 5 to 11 days before a woman starts her monthly menstrual cycle. In most cases, the symptoms stop when, or shortly after, her period begins.

Before Diagnosing, Carefully check:

At least 5 symptoms must be present in the final week before the onset of menses and improve within a few days after onset of menses and disappear in the week post menses.

One or more of the following symptoms must be present:

  • Mood swings or crying often
  • Increase sensitivity to rejection
  • Irritability or anger 
  • Interpersonal conflicts
  • Depressed moods (Hopelessness, self-deprecating thoughts)
  • Feeling of anxiety, tension & being keyed up or on edge

One or more of the following symptoms must be additionally present:

  • Changes in 
    • Interest in activities
    • Concentration
    • Energy(lethargy, easy fatigability)
    • Appetite(overeating, specific food craving)
    • Sleep
    • Self-control (overwhelmed, out of control)

Physical symptoms:

  • Cramps
  • Bloating
  • Breast tenderness
  • Headaches
  • Joint or muscle pain
  • Disturbance in
    • Job
    • school
    • Social activities
    • Relationship
    • Home
  • Should be confirmed by prospective daily ratings during at least two symptomatic cycles.

Overlap with

  • Major depressive disorder
  • Panic disorder
  • Persistent depressive disorder
  • Personality disorder
  • Premenstrual syndrome
  • Dysmenorrhea
  • Bipolar  disorder
  • Use of hormonal treatment

Treatment

Substance/Medication Induced Depressive Disorder

Substance/medication-induced depressive disorder is characterized by a substance/medication that has been taken, or during withdrawal from the substance/medication. 

Before Diagnosing, Carefully check:

  • Depressed mood, loss of interest in all activities due to intake or withdrawal of substance.
  • Patient history, physical exam, or lab findings that confirm substance use, abuse, intoxication, or withdrawal prior to the start of the depressive symptoms
  • Symptoms persist for 1 month.

Sign:

  • A prominent and persistent change in mood, exhibiting clear signs of depression or a marked decrease in interest or pleasure in daily activities and hobbies, and these symptoms start during or soon after a certain 

Overlap with

  • Depressive disorder
  • Delirium 

Causes:

Substance/medication-induced depressive disorder is caused directly by a specific substance/medication that is taken or during withdrawal from the substance/medication. There are a number of substances and medications that could cause this, including:

  • Alcohol
  • Phencyclidine
  • Hallucinogens
  •  Inhalants
  •  Opioids
  •  Amphetamines
  • Valium
  • Xanax

Depressive Disorder Due to Another Medical Condition

Pathophysiological Consequences of a medical condition.

  • Depressed mood, loss of interest in all activities due to intake or withdrawal of substance.
  • Evident from history, physical examination, and laboratory findings.

Overlap with

  • Depressive disorder
  • Delirium
  • Adjustment disorder

Other Specified Depressive Disorder

Clinically significant impairment or distress in social, occupational, and other important areas of functioning predominate.

The other specified depressive disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific depressive disorder.

This is done  by recording other specified depressive disorder followed by specific reasons  (e.g short-duration depressive episodes)

Concurrent presence of depressed mood and at least four other symptoms of depression for 2-13 days at least once per month (not associated with the menstrual cycle) for at least 12 consecutive months in an individual whose presentation has never met criteria for any other depressive or bipolar disorder and does not currently meet active or residual criteria for any psychotic disorder.

  • Short duration depressive episode(4-13days)

Depressed affect and at least four of the other eight symptoms of a major depressive episode associated with clinically significant distress or impairment that persists for more than 4 days, but less than 14 days, in an individual whose presentation has never met criteria for any other depressive or bipolar disorder, does not currently meet active or residual criteria for any psychotic disorder, and does not meet criteria for recurrent brief depression.

  • The depressive episode with insufficient symptoms

Depressing effect and at least one of the other eight symptoms of a major depressive episode associated with clinically significant distress or impairment that persists for at least 2 weeks in an individual whose presentation has never met criteria for any other depressive or bipolar disorder, does not currently meet active or residual criteria for any psychotic disorder and does not meet criteria for mixed anxiety and depressive disorder symptoms.

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Depressive Disorders

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