So we talked earlier about the
different types of major depression.
Now, we’re going to go through the
criteria in a little bit more detail.
So some patients will experience
an anxious depression.
And in order to qualify
for this diagnosis,
patients have to meet two or
more of the following criteria.
So one is tension, restlessness,
impaired concentration due to worry,
fear that something
awful might happen,
fear of losing control.
Now, let’s review the type of depression
called depression with atypical features.
To qualify for this diagnosis,
a patient must have
three or more of the
following target symptoms.
So they actually feel reactive
to pleasurable stimuli,
meaning that if one of their former hobbies
is introduced to them or a funny joke,
the patient is actually able
to respond appropriately
with some good humor
and a positive affect.
This kind of patient though will have an
increased appetite or potentially weight gain,
something that we call
hyperphagia, eating a lot.
They may also have hypersomnia,
so sleeping at least 10 hours
a day and possibly even more
and sleeping far more than usual
when they’re not feeling depressed.
This patient also will describe having
a heavy or leaden feel to their limbs.
And finally, they’ll have
a longstanding pattern
meaning that they feel a lot of
anxiety and often like an outcast
or humiliated when they’re not
included in social functions.
Here’s an example from clinical practice
of a patient who has atypical depression.
This is Susan.
She’s a 19-year-old woman who always
feels like her friends don’t like her.
So she overeats and describes
feeling like her body is so heavy,
she feels like she’s
moving through mud.
She‘s being treated for
Depression wit catatonia can look like
very prominent psychomotor disturbances.
So this could be either increased
or decreased activity,
which occur during most of
the depressive episode.
You treat catatonia actually through
a number of different ways.
Often antidepressants are used,
but sometimes these patients
will also really respond well
at the same time.
There’s also melancholic depression.
And to qualify for
patients have to have four
or more of the following.
Loss of pleasure in
They’re unreactive to
So even when you reintroduce a hobby to
them, they get no pleasure or enjoyment.
Depressed mood that’s marked by
profound despondency or despair.
There’s early morning awakening
with these patients.
They usually get up about two or three
hours earlier than their normal time.
retardation or agitation.
They have anorexia or weight
loss and excessive guilt.
Here’s a case example of
This is story about Jim.
He’s 35 years old, he’s an accountant
and he's suffered from depression.
He finds himself with a
low mood during the week
and notably when he wakes
up in the morning.
He coincidentally is getting up
before the sun even comes out
and then he finds himself
feeling restless all day.
He’s lost weight and also
has felt extremely guilty
over what he perceives as
poor performance at work.
He’s feeling safe with
no suicidal thoughts,
but he doesn’t enjoy playing softball
anymore with friends on the weekends.
So here’s my question to you,
how do you know that Jim is suffering
from melancholic depression
and not another subtype?
Well, here are some clues.
He has early morning awakening,
feels excessive guilt,
and also the fact that he’s lost
interest in pleasurable activities
are all signs that
this is melancholia.
There can also be mixed
features of depression
defined by three or more of the following:
Elevated or expansive mood,
inflated self-esteem or grandiosity,
more talkative or
flight of ideas,
increased energy or
decreased need for sleep
and excessive involvement
in pleasurable activities
that actually have a high potential for
causing some negative consequences.
There’s peripartum depression,
which is defined as the onset
referring to a mood episode
that occurs during pregnancy or within
the first four weeks after childbirth.
And here’s a question for you,
when is the specifier postpartum
onset applied to major depression?
So we just reviewed that, it’s when symptoms
appear within 4 weeks of childbirth.
What’s the incidence of major
depression among postpartum women?
Well, the answer there
is it’s about 10 to15%.
Now, it’s really important that
postpartum depression be differentiated
from what’s considered
the normal baby blues,
which are experienced in about at
least half of postpartum women.
The baby blues are associated with
frequent crying, periods of sadness;
however, women doesn’t meet at least
five or more of those SIGECAPS criteria
for major depression.
There can be major depression
with psychotic features
and this includes delusions, which are the
fixed false beliefs or hallucinations,
false sensory perceptions, which can occur
at any time during a depressed episode.
There can also be seasonal
patterns to major depression.
A regular temporal relationship
between the onset of major depression
and a particular time of
year for the past two years.
Remission will occur at a
specific time of year.
For example, patients will often
feel depressed in the winter,
but then symptoms go into
remission during the summer.
Here’s case example of what it
can look like when somebody
experiences a major depression
with a seasonal component.
John is a 50-year-old salesman.
He enjoys riding his bike in the
summer and going to the beach.
This winter, he came into your
office at the urgency of his wife,
who’s found him to be
quite irritable lately.
John tells you that in
addition to his short fuse,
he’s feeling tired, eating more,
and especially eating more
sweets and carbohydrates.
And he’s feeling unmotivated.
He said this tends to happen to him every
winter, but then he’s fine in the summer.
So John is experiencing the classic
triad for seasonal affective disorder.
It’s irritability, increased appetite
for carbohydrates and sweets,
and also hypersomnia.
Dysthymia, which is now called
persistent depressive disorder,
is defined by having three
or more of the following:
A depressed mood most of the
day, more days than not;
decreased or increased appetite,
insomnia or hypersomnia,
low energy or fatigue,
This is a case example of somebody who could
be presenting with clinical depression.
Peggy is a 45-year-old attorney
who was recently widowed.
She lost her parents
when she was nine
and now she’s grieving
the loss of her husband.
She has three children who are alive
and well and very supportive to her.
That’s good because Peggy has been
having some health problems lately
and she’s undergoing
treatment for breast cancer.
She comes to you, her primary care doctor,
complaining of low mood, trouble
sleeping and frequent crying
that are interfering with her work.
So my question for you is what are Peggy’s
risk factors for having clinical depression?
Well, she’s female in gender
and we know that women
more often than men will
experience major depression.
She had a death of her
parents before age 11.
She’s currently widowed.
She has poor medical
health of her own
and she’s actually showing signs of
clinical depression including poor sleep.
So when the symptoms of
depression develop or persist
beyond two months past the
death of a loved one.
A diagnosis of normal bereavement
gives way to major depression.
So normal grief and bereavements
can look like depression,
so long as it’s happening
within two months.
But once it’s going beyond that time
period and the symptoms are lingering
and they’re interfering with
work life or social life,
then a patient qualifies
for major depression.