Major Depressive Disorder – Course, Natural History and Prognosis

This slide covers course, natural history and prognosis of Major Depressive Disorder. It covers the definition for depression based on WHO’s ICD-10 classification system or the American Psychiatric  Association’s DSM-IV and DSM-5 system.

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This slide shows core definitions for depression based on World Health Organization’s ICD-10 classification system or the American Psychiatric Association’s DSM-IV and DSM-5 system.

References:
NICE CG90. Depression in adults: recognition and management. 2009. Update Apri…

Reference:
American Psychiatric Association. Diagnostic and statistical manual of mental disorders 5th edition:  American Psychiatric Association. 2013

References:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Health Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

Jaeger J et al. Psychiatry Res 2006; 145: 39–48.

World Health Organization Depression Fact Sheet N3…

References:
McIntyre RS et al. Depress Anxiety 2013; 30(6): 515–527.

Hammar A, Ardal G. Front Hum Neurosci 2009; 3:26. doi: 10. 3389/neuro. 09. 026. 2009.

The American Psychiatric Association (APA) describes nine depressive symptoms for diagnostic purposes.^{[APA, 2013]}

Depressed mood

• Patients may describe their mood as depressed, sad, hopeless, discouraged, or ‘down in the dumps’.^{[APA, 2013]} Alternatively, the patient may …

The Montgomery–Åsberg Depression Rating Scale (MADRS), which was designed to be sensitive to the effects of antidepressants, includes ten depressive symptoms, six of which are described as ‘core symptoms’.^{[Montgomery & Asberg, 1979; Beck et al., 2002]}

MADRS item 1. Appare…

The optimal outcome for a patient with major depressive disorder (MDD) is a full recovery from the major depressive episode and to never become depressed again.^{[Nierenberg & DeCecco, 2001]} Treatment of MDD is divided into three phases, corresponding to different stages of…

Previous slide illustrates the typical course of illness for patients with depression; either receiving only acute-phase treatment or receiving longer-term treatment designed to prevent relapse. It also highlights that long-term treatment of depression with antidepressant…

Source (slide):
Nierenberg et al. J Clin Psychiatry 2003; 64 (suppl 15): 13–17; page 13 (‘Remission, relapse, recurrence’ section)

Riso et al. J Affect Disord 1997; 43 (2): 131–142

Nierenberg & DeCecco. J Clin Psychiatry 2001; 62 (suppl 16): 5–9; page 8

Frank et al. Arc…

MDD is a chronic disorder, most frequently characterised by relapses and recurrences.^{[Nierenberg et al., 2003]} Relapse can be defined as an episode of MDD that occurs within 6 months of response or remission;^{[Nierenberg et al., 2003; Riso et al., 1997]} theoretically, rela…

References on the slide:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition (DSM-5™). © American Psychiatric Association, 2013.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fou…

References on the slide:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition (DSM-5™). © American Psychiatric Association, 2013.

Oxford Concise Medical Dictionary. Second Edition. © Oxford University Press, 1998.

References on the slide:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition (DSM-5™). © American Psychiatric Association, 2013.

Oxford Concise Medical Dictionary. Second Edition. © Oxford University Press, 1998.

References on the slide:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition (DSM-5™). © American Psychiatric Association, 2013.

Oxford Concise Medical Dictionary. Second Edition. © Oxford University Press, 1998.

References on the slide:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition (DSM-5™). © American Psychiatric Association, 2013.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fou…

Highlights of Changes from DSM-IV-TR to DSM-5. American Psychiatric Association 2013. Available from: https://www.psychiatry.org/dsm5. Accessed April 2016.

While bereavement may precipitate major depression in people who are especially vulnerable (i.e. they have already s…

References:
American Psychiatric Association (1994)

Angst et al (1990)

References:
Howarth et al (1992)

Johnson et al (1992)

Judd et al (1994)

Differential diagnosis is the distinguishing of a disorder from others presenting with similar signs and symptoms.

Manic episodes with irritable mood; mixed episodes (bipolar disorder)
Major depressive episodes with prominent irritable mood may be difficult to distinguis…