Major Depressive Disorder - Definitions and Diagnosis

Depression is a broad and heterogeneous diagnosis. This slide deck offers opportunities to discuss the core definitions of Major Depressive Disorder (MDD) as well as a presentation of the key components of its diagnosis, signs and symptoms.

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

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Definitions and Diagnosis

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Definitions

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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 April 2016 Available at:

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Major Depressive Disorder – Definitions and Diagnosis – slide 4

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 – Definitions and Diagnosis – slide 5

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 N369. http://www.who.int/mediacentre/factsheets/fs369/en/#. Accessed…

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Major Depressive Disorder – Definitions and Diagnosis – slide 6

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 – Definitions and Diagnosis – slide 7

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 may describe having no feelings…

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Major Depressive Disorder – Definitions and Diagnosis – slide 8

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; Bech et al., 2002]}

MADRS item 1. Apparent…

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Major Depressive Disorder – Definitions and Diagnosis – slide 9

The course of MDD

This slide illustrates the typical course of illness for patients with depression. Discontinuing antidepressant treatment in the acute phase before full symptomatic remission drastically increases the likelihood of relapse of the original episode, and discontinuing treatment during the continuation phase…

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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 antidepressants benefits many patients by^[Kupfer,…

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Major Depressive Disorder – Definitions and Diagnosis – slide 11

Depression – signs and symptoms

The slide aims at giving a simple definition for the terms signs and symptoms. It also highlights that the criteria used in the diagnostic manuals cover all major signs and symptoms of depression.

Reference: Shivani, et al. Alcohol Research &…

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Major Depressive Disorder – Definitions and Diagnosis – slide 12

Definitions of epidemiological terms

The slide explains the difference between prevelance and incidence as key epidemiological terms. While prevalence is the number of persons with disease, in a given population, at a designated time, the incidence looks into the number of new persons with…

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Major Depressive Disorder – Definitions and Diagnosis – slide 13

Definitions of burden of disease and key epidemiological terms

This slide gives definitions for key epidemiological terms used in studies to quantify the burden of a disease. Term defined are the Burden of disease (BoD), Quality adjusted life years (QALYs), Years of life lost (YLLs), Years lived with disability…

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Major Depressive Disorder – Definitions and Diagnosis – slide 14

Definitions of Clinical Course and Treatment Outcomes

References: 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…

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Major Depressive Disorder – Definitions and Diagnosis – slide 15

Definitions of Clinical Course and Treatment Outcomes

MDD is a chronic disorder, most frequently characterised by relapses and recurrences.^{[Frank et al., 1991]} Relapse can be defined as an episode of MDD that occurs within 6 months of response or remission;^{[Nierenberg & Petersen 2003; Riso et al., 1997]…}

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