Depressive Disorders: Major Depression, Dysthymia, Depression NOS



Depressive Disorders: Major Depression, Dysthymia, Depression NOS







Our generation has had no Great War, no Great Depression. Our war is spiritual. Our depression is our lives.

—Chuck Palahniuk


Clinical Description

Rates of depression have increased over the past five decades, with younger age of onset. Many adolescents suffer from brief periods of depression when they are faced with an upsetting event or disappointment (breakup with girlfriend or boyfriend, for example). With increased rates of depressive disorders has come an increased rate of suicide attempts. However, after a marked increase, the rates of completed suicides for youth have declined since 1990, possibly due to improved detection and intervention of depression. Substance use, concomitant conduct problems, and impulsivity increase risk.

Major depressive disorder (MDD) and dysthymic disorder (DD) in children and adolescents are diagnosed in the same manner as those of adults. However, children and adolescents may present differently. Irritability, the new onset of oppositionality and angry outbursts, and failure to make expected weight
gain may be indicative of depression in children and adolescents. A rather precipitous drop in grades may be a clue to diminished interest and motivation and difficulty concentrating. Depressed mood and/or loss of interest or pleasure are key characteristics of MDD. Neurovegetative symptoms are those that suggest physical manifestations of the depression. Symptoms must be present for at least 2 weeks and must be functionally impairing to make a diagnosis of major depression.



Major Depressive Episode (MDD)

Mnemonic: SIG E CAPS

When checking for neurovegetative symptoms of depression, think of the mnemonic devised by Dr. Carey Gross at MGH which refers to what one might write on a prescription sheet for a depressed patient: SIG: Energy CAPSules



  • Sleep disorder (either increased or decreased)*


  • Interest deficit (anhedonia)


  • Guilt (worthlessness,* hopelessness,* regret)


  • Energy deficit*


  • Concentration deficit*


  • Appetite disorder (either decreased or increased)*


  • Psychomotor retardation or agitation


  • Suicidality

Jul 5, 2016 | Posted by in PSYCHIATRY | Comments Off on Depressive Disorders: Major Depression, Dysthymia, Depression NOS

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