Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Major Depressive Disorder – Revisited

Depressive Disorders

There is considerable misunderstanding about Major Depressive Disorder, including the degree of impairment that arises, whether it constitutes a disability, and whether it is more severe than other mood (or even adjustment) disorders.Major Depressive Disorder

The key point is the interpretation of the word “Major” by non-clinicians. Arguably the term was not well chosen.

Patients with a major depressive episode will have problems with sleep, significant weight change, agitation or slowing, loss of energy, feelings of worthlessness, difficulties with concentration, and may have preoccupying thoughts of death as well as other symptoms. The important apect is that a major depressive episode can be readily and successfully treated by a combination of medication and psychotherapy. Individuals can, and do, work with major depressive disorder. But, again, the term “major” leads many to interpret the disorder itself as dangerous, disabling and difficult to manage. In reality, the aforementioned symptoms need only to be present for a two week period for the diagnosis to be made.

Importantly, less concern is expressed by non-clinicians for the diagnosis of Persistent Depressive Disorder which is often called “minor depression” by some. Individuals with dysthymic disorder have symptoms that have persisted for at least two years, during which their symptoms are present most of the day and for most days. Many of the symptoms of major depressive disorder are present in dysthymic disorder including changes in appetite, sleep disorder, decreased energy, low self esteem, problems with concentration or decision making and the same sense of hopelessness.

Dysthymic disorder, however, is not as immediately responsive to medication and psychotherapy. While both are clinically indicated, the patient has developed a longstanding pattern of self-defeating thoughts and behaviors that make resistance to change an appreciable concern.

Some would argue that we often do not know enough about our injured workers to accurately detect the existence of Bipolar I and Bipolar II disorders. In the case of Bipolar I Disorder, the patient and family may emphasize that the patient has had periods of incredible productivity and seemingly little need for sleep. They admired his/her grandiose ideas and plans even though they were, in fact, unrealistic. Similarly, the family of the Bipolar II Disorder patient, sees the hypomanic episodes as merely “periods when he (she) was simply irritable and argumentative.” They may be aware of past depressive episodes but fail to recognize the implications of the manic or hypomanic episodes.

Finally, there are those who simply have a brief period of depression while dealing with a specific event with which they must cope. This Adustment Disorder with Depressed Mood is a time limited response to a recent and definable disappointment and resolves with minor psychotherapeutic input.

In toto, precise differential diagnosis is mandatory to insure that the injured worker’s actualy problems are being addressed, and those emerging from the past are not ignored.



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