• This is a new disorder – created mostly due to the over diagnosis of Bipolar Disorder in children

• Diagnosed in children/adolescents between the ages of 6-18

• Defined by persistent irritability or anger and frequent episodes of extreme behavioral dyscontrol

• 2021 ICD-10-CM Diagnosis Code for DMDD: F34.81 — Learn more

Treatment Information:

General Information for MDD:

• A major depressive episode without manic or hypomanic episode(s) may begin at any point in lifespan—the highest rates of depression occur between 18-25 years of age.

• Depression is twice as common in women as it is in men.

• Relapse vs. recurrence

  • Prevention of Relapse and Recurrence in Adults with Major Depressive Disorder: Systematic Review and Meta-Analyses of Controlled Trials — Read now

• Bereavement is the period of sadness and loneliness experienced from a loss and/or death of a loved one. Also referred to as grief.

  • Grief and Major Depressive Disorder are distinct; however, they can also coexist. Also, grief can sometimes trigger a major depressive episode.

  • Grief tends to decrease over time and occurs in waves that are triggered by thoughts or reminders of its cause.

  • Depression, on the other hand, tends to be more persistent and pervasive.

Symptoms:

Musculoskeletal Tension

Diagnosis:

In order to be diagnosed there must be at least five of the following symptoms present during a two week period and one of those symptoms must be “depressed mood” or “loss of interest/pleasure”

1. Depressed mood most of the day, nearly every day

2. Markedly diminished interest or pleasure in activities

3. Weight loss or gain

4. Insomnia or hypersomnia

5. Psychomotor agitation or retardation

6. Fatigue/loss of energy

7. Feelings of worthlessness or excessive/inappropriate guilt

8. Diminished ability to think or concentrate, or indecisiveness

9. Recurrent thoughts of death

2021 ICD-10-CM Diagnosis Code for MDD with single episode: Learn more

2021 ICD-10-CM Diagnosis Code for MDD with recurrent episodes: Learn more

Treatment Information:

• A depressed mood for most of the day, for more days than not, and for at least two years

• Diagnosis requires a presence of two or more of the following symptoms:

  • Poor appetite or overeating

  • Insomnia/hypersomnia

  • Low energy/fatigue

  • Low self esteem

  • Poor concentration or indecisiveness or hopelessness

  • Sense of hopelessness

• Original 2021 ICD-10-CM Diagnosis Code (Dysthymia): F34.1 — Learn more

• Updated 2021 ICD-10-CM Diagnosis Code (PDD): F34.9 — Learn more

***Double depression is possible***

*Double Depression: the co-occurrence of Persistent Depressive Disorder and a Major Depressive Episode. This is not a diagnosis—not a diagnosis in the DSM-5 or ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification). However, Persistent Depressive Disorder and Major Depression can co-occur.

What is Double Depression? — Read now

Double Depression: Do I Have It? — Read now

Treatment Information:

In most menstrual cycles during the past year, five or more, of the following symptoms occurred during the final week before the onset of menses, started to improve within a few days after the onset of menses, and were minimal or absent in the week post-menses, with at least one of the symptoms being either (1), (2), (3), or (4)

1. Affective lability (mood swings)

2. Irritability depressed mood, hopelessness, or self-deprecating thoughts (e.g. heart palpitations, muscle tension)

3. Anxiety

4. Diminished interest in usual activities

5. Difficulty concentrating

6. Lack of energy

7. Changes in appetite, overeating, or food craving

8. Sleeping too much or too little

9. Subjective sense of being overwhelmed or out of control

10. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, or bloating

2021 ICD-10-CM Diagnosis Code: F32.81 — Learn more

Treatment Information:

• A differential diagnosis is challenging due to the high comorbidity rate (often individuals are diagnosed with both)

• The separable aspects of anxiety relate to physiological hyperarousal

• The separable aspects of depression relate to lack of capacity for positive emotional experience

• Both anxiety and depression share:

  • Changes in appetite (eating more or eating less)

  • Difficulty concentrating

  • Lack of energy/ easily fatigued

  • Sleep disturbance (sleeping more or sleeping less)

  • Changes in neurotransmitters (serotonin, norepinephrine, and dopamine)

  • Increased risk of self-medication

  • Irritability 

  • Genetic history

  • Distress

“Mental health has always been comparable to the ocean and swimming for me. I think that’s because I had a bad experience once in the ocean when I was actually pretty depressed and I knew I had to keep swimming as hard as I could in order to not drown because the waves were so bad even though I’ve been swimming at that beach my whole life and was a lifeguard. And that wasn’t the first time I had thought about drowning before in terms of my depression and how it comes in waves and it can be the same beach everyday but the conditions aren’t always going to be good and you can either keep swimming and fighting or sink under and let it drown you but, either way, the waves are still going keep coming.”

— George Washington University Student

The following criteria will be assessed for a diagnosis:

Medical doctors (MD’s) miss about 50% of all depression diagnoses as a large percentage of unipolar depression does not present with any sadness.

Individual Risk Factors:

• Lack of social support or social skills

• Hostility and rejection from others

• Marital /interpersonal dissatisfaction

Biological Risk Factors:

• Genetic influence

• Altered neurotransmitter activity

• Hormone and immune system regulation (e.g. cortisol and/or thyroid issues)

• Neuro-physical and neuro-anatomical influences (e.g. prefrontal cortex functioning)

• Sleep and biological rhythms

• Sex differences

Common Features:

• Presence of sad, empty, or irritable mood

• Accompanied by somatic and cognitive changes

• Significantly affect individual’s capacity to function

• What differs:

  • Duration

  • Timing

  • Severity

  • Level of impairment

Relation to College Students:

College is challenging. College can be hard. College can be overwhelming. With exams, grades, projects, deadlines, social dynamics, and, for some, it is the first time being away from home for an extended period of time. It is both understandable and common to struggle with depressive thoughts and symptoms from time to time. For some, these thoughts may only manifest for a short while, such as feeling down for a day or two after taking a difficult exam. For others, particularly if faced consistently with challenges—academic, social, and beyond—the individual may struggle with more long-lasting depressive thoughts. Without the proper care and support system, these thoughts may persist. Everyone is different. Some students struggle with depressive thoughts more than others due to both biological and environmental factors. The level or severity of those depressive thoughts also varies. All this is to say, it is alright to feel down from time to time. Everyone needs help some time and with the appropriate help and support every person can prosper. There is help. There is hope. Don’t give up on yourself.