As I wrote recently, I am in the strange position of boning up on the soon-to-be-obsolete diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders IV-TR.

Major Depressive Disorder is one of the most common diagnoses given in the mental health field, almost 15 million adults at a time in the US, according to NIHM. The DSM-IV-TR says that it occurs equally throughout ethnicities, education and income strata, and for married and unmarried people. It does not occur equally by gender, however, with something like three times as many women as men carrying the diagnosis. It’s also not spread equally by nationality. Here’s a Wikipedia map of the distribution. The red countries have twice as much Major Depressive Disorder:

800px-Unipolar_depressive_disorders_world_map_-_DALY_-_WHO2004

Here are the diagnostic criteria for Major Depressive Disorder, first Single Episode then Recurrent, word for word quoted from the DSM-IV-TR, pages 375 and 376. Note that most of the diagnostic action happens in the criteria for Major Depressive Episode, not Major Depressive Disorder. Also, it is interesting (and frustrating, in my case) that most prescribers and a great many diagnosticians use Major Depressive Episode’s criteria A and B, but disregard criteria C, D and E. That is, the symptom lists are considered important but the disqualification by environmental and historical factors are not.

Diagnostic criteria for 296.2x Major Depressive Disorder, Single Episode

A.      Presence of a single Major Depressive Episode (see p. 356)

B.      The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophreniform disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

C.      There has never been a Manic Episode (see p. 362), a Mixed Episode (see p. 365), or a Hypomanic Episode (see p. 368). Note:   This exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects  of a general medical condition.

If the full criteria are currently met for a Major Depressive Episodespecify its current clinical status and/or features:

Mild Moderate, Severe Without Psychotic Features/Severe With Psychotic Features (see p. 412)

        Chronic (see p. 417)

With Catatonic Features (see p. 417)

With Atypical Features (see p. 420)

With Postpartum Onset (see p. 422)

If the full criteria are not currently met for a  Major Depressive Episode, specify the current clinical status of the Major Depressive Disorder or features of the most recent episode:

In Partial Remission, In Full Remission (see p. 412)

        Chronic (see p. 417)

With Catatonic Features (see p. 417)

With Atypical Features (see p. 420)

With Postpartum Onset (see p. 422)

Diagnostic criteria for 296.3x Major Depressive Disorder, Recurrent

A.      Presence of two or more Major Depressive Episodes (see p. 356)

Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode.

B.      The Major Depressive Episodes are not better accounted for by Schizoaffective Disorder and is not superimposed on Schizzophreniform disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

C.      There has never been a Manic Episode (see p. 362), a Mixed Episode (see p. 365), or a Hypomanic Episode (see p. 368). Note:   This exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects  of a general medical condition.

If the full criteria are currently met for a Major Depressive Episodespecify its current clinical status and/or features:

Mild Moderate, Severe Without Psychotic Features/Severe With Psychotic Features (see p. 412)

        Chronic (see p. 417)

With Catatonic Features (see p. 417)

With Atypical Features (see p. 420)

With Postpartum Onset (see p. 422)

If the full criteria are not currently met for a  Major Depressive Episodespecify the current clinical status of the Major Depressive Disorder or features of the most recent episode:

In Partial Remission, In Full Remission (see p. 412)

        Chronic (see p. 417)

With Catatonic Features (see p. 417)

With Atypical Features (see p. 420)

With Postpartum Onset (see p. 422)

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