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

This slide deck has been developed in collaboration with the former Lundbeck International Neuroscience Foundation.

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Major Depressive Disorder - Course Natural History and Prognosis - slide 1
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.

Slide deck scheduled for revie…

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Major Depressive Disorder - Course Natural History and Prognosis - slide 2
Depression
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 Apr…
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Major Depressive Disorder - Course Natural History and Prognosis - slide 3
Depression

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

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Major Depressive Disorder - Course Natural History and Prognosis - slide 4
Depression is a clinically heterogeneous disorder
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 …
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Major Depressive Disorder - Course Natural History and Prognosis - slide 5
Cognitive symptoms of depression have a negative impact on many aspects of the patient’s life
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.
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Major Depressive Disorder - Course Natural History and Prognosis - slide 6
MDD symptoms – American Psychiatric Association
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 m…
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Major Depressive Disorder - Course Natural History and Prognosis - slide 7
MDD symptoms – The Montgomery-Åsberg Depression Rating Scale
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. Appar…
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Major Depressive Disorder - Course Natural History and Prognosis - slide 8
The course of MDD
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…
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Major Depressive Disorder - Course Natural History and Prognosis - slide 9
MDD is a complex, often recurrent and remitting disorder
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…
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Major Depressive Disorder - Course Natural History and Prognosis - slide 10
Definitions of Clinical Course and Treatment Outcomes I
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. …
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Major Depressive Disorder - Course Natural History and Prognosis - slide 11
Definitions of Clinical Course and Treatment Outcomes
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…
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Major Depressive Disorder - Course Natural History and Prognosis - slide 12
MDD specifiers – I
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. Fo…
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Major Depressive Disorder - Course Natural History and Prognosis - slide 13
MDD specifiers – II
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.
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Major Depressive Disorder - Course Natural History and Prognosis - slide 14
MDD specifiers – III
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.
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Major Depressive Disorder - Course Natural History and Prognosis - slide 15
MDD specifiers – IV
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.
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Major Depressive Disorder - Course Natural History and Prognosis - slide 16
MDD specifiers – V
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. Fo…
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Major Depressive Disorder - Course Natural History and Prognosis - slide 17
Depression – DSM-5: Updates from DSM-IV
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 …
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Major Depressive Disorder - Course Natural History and Prognosis - slide 18
Recurrent Brief Depressive Disorder

References:
American Psychiatric Association (1994)

Angst et al (1990)

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Major Depressive Disorder - Course Natural History and Prognosis - slide 19
Subsyndromal symptoms of Unipolar Depression and Bipolar Depression

References:
Howarth et al (1992)

Johnson et al (1992)

Judd et al (1994)

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Major Depressive Disorder - Course Natural History and Prognosis - slide 20
Differential diagnosis
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 distingui…
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