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Lab 9: Depression
Video #1 Dysthymic Disorder
What criteria for Dysthymic Disorder does
Susan meet?
 Why does she not meet the criteria for
major depression?
 How/would would you ask about any
suicidal thoughts and behaviours?
 How would her symptoms impact on her
life?
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DSM IV Criteria Dysthymic
Disorder
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Depressed mood for most of the day, for more days than
not, for at least 2 yrs
Presence while depressed of 2 or more of the following
 Poor appetite or overeating
 Insomnia or hyposomnia
 Low energy or fatigue
 Low self-esteem
 Poor concentration or difficulty making decisions
 Feelings of hopelessness
Criteria Dysthymic Disorder cont
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During the 2 yr period of the disturbance the
person has never been without the symptoms in
above criteria for more than 2 months at a time
No Major Depressive Episode has been present
during the first 2 yrs of the disturbance
Symptoms cause clinically significant distress or
impairments
Video #2 Major Depressive
Disorder - Recurrent
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Is Max in a depressive episode at the time of the
interview?
What is the difference between Max’s depressive
symptoms and Susan’s symptoms?
What further information would be important to
find out about?
What impact do you think Max’s symptoms are
having on his life?
DSM IV Criteria Major
Depressive Disorder Recurrent
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Presence of 2 or more major depressive episodes (MDE)
MDE’s not better accounted for by psychotic disorder
No mania
Specify (for the most current episode)
 Severity
 Psychotic elements
 Remission specifiers
 Chronic
 Catatonic features
 Melancholic features
 Atypical features
 Postpartum onset
MDD recurrent criteria cont
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Specify
 Longitudinal course specifiers (with and
without interepisodic recovery)
 Seasonal pattern
Major Depressive Episode DSM
IV Criteria
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Presence of 5 of the following symptoms for at least two weeks
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Either depressed mood or loss of interest in pleasure must be
one of the 5 symptoms
Sad depressed mood, most of the day, nearly every day
Loss of interest and pleasure in usual activities
Sleep disturbance
Shift in activity level
Appetite disturbance, weight loss or gain
Loss of energy, fatigue
Negative self-concept, feelings of worthlessness and guilt
Difficulty concentrating slowed thinking
Reccurrent thoughts of death or suicide
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Depression Case 1
Ralph is a 45 year old male of European descent
who has been living by himself in a flat since his
divorce 3 years ago. His wife initiated the divorce
after years of dissatisfaction over her Ralph’s low
mood, lack of energy, and the absence of any
sense of happiness in their relationship. She and
their two children continue to live in the family
home, and although she supports Ralph staying
involved with the children, he seldom seeks
contact with them. He reports feeling empty most
of the time, with little energy or interest in things.
He used to enjoy fishing and tramping, but now
says these things no longer excite him.
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His sleep is poor, as he often awakens in the
middle of the night and has difficulty getting back
to sleep. He often feels tired and listless during
the day. He believes that he is a failure, and it is
his fault that his marriage failed. He also believes
that he has never lived up to his potential, and that
he is now simply living out the rest of his
mediocre existence. He sometimes thinks it would
be a relief to be dead, although he says that he has
no specific plan to end his life. He reports that he
has had intense periods of these thoughts and
feeling several times since his mid-twenties.
Diagnosis: Major Depressive Disorder, Recurrent
Questions - Ralph
What criteria does Ralph meet?
 How do you think Ralph’s reccurrent
depressive episodes may be impacting on
his family?
 Is Ralph a high suicide risk?
 What are the precipitating factors to his
current depressive episode?
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Depression Case 2
Martha is a 29 year old manager in a large
department store. She lives with her husband of
three years in a comfortable suburban home. She
presents as tearful and distressed, and says that she
has felt intense sadness for the past six weeks.
She reports that she has lost her appetite for food,
and her weight is down five kilograms in the past
month, although she is not trying to lose weight.
She has also lost her interest in sex, which is
leading to tension with her husband. She believes
that she is unable to concentrate effectively most
of the time, and worries that she will be dismissed
from her job.
She moves and speaks in a slow, ponderous
manner, as if it requires a great effort. She
complains of having no energy. She says that she
hasn’t experienced any significantly losses
recently (e.g. no one she knows has died, they
haven’t moved away from friends or family, she
has not changed jobs). She also reports that her
condition is not at all like the way she usually is,
as she has always been an energetic, confident
person.
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Diagnosis: Major Depressive Disorder, Single
Episode
Questions - Martha
What criteria does Martha meet?
 What further information would you like to
find out?
 What things may be maintaining her
symptoms?
 What treatment options would you
consider?
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