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12.04.2014

Dsm criteria for major depressive disorder single episode, buzzing in your ears - Review

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Depression is startlingly common; "more common than hypertension in primary care medicine," according to one article. In a later section of this paper, we'll discuss some of the societal effects of depression. Prozac is the commercial name for fluoxetine, the first selective serotonin reuptake inhibitor (SSRI). Figure 9: Relationship between dose and change in score on 21-item Hamilton Depression Scale. According to an estimate published in 1993, depression swallowed 43.7 billion dollars in direct costs, mortality costs, and loss of productivity the previous year.
Since the classic descriptions, depression has been conceived as an episodic and recurrent illness.
This article provides an update on the diagnosis, causation, and treatment of chronic depressive problems, with a focus on the recently introduced diagnostic category of persistent depressive disorder (PDD).


In DSM-III and DSM-IV, the protracted forms of depression have been conceptualized as dysthymia and by the chronic specifier of major depressive episodes.
In DSM-III and DSM-IV, dysthymia was trumped by MDD and was only diagnosed if the threshold for a major depressive episode was not met in the initial 2 years of symptoms. While the merger of dysthymia and chronic depression into PDD is well justified by their strong sequential comorbidity and similar implications for prognosis and treatment, several aspects of the new diagnosis are not well supported by evidence and may not be useful. The assumption that most individuals with chronic depression also fulfill the dysthymia criteria may not hold consistently enough—it creates a group of individuals who suffer from chronic depression but do not receive the PDD diagnosis. Depressive episodes with clear onset and offset and sharp contrast with one’s usual mood and behaviors are perhaps the most conspicuous feature of severe mood disorders. Dysthymia was characterized by milder symptoms not fully meeting criteria for MDD, but lasting 2 years or longer and meriting clinical attention because of the cumulative burden of long-standing symptoms. Major depressive episodes could be specified as chronic if the full criteria were continuously met for 2 years or longer.


This new division of depressive disorders gives more weight to duration than to severity of symptoms.
While it is undisputable that prolonged duration and nonepisodic character are relevant, there is no good justification for the 2-year cutoff.
The symptomatic criteria for dysthymia differed in part from those for major depressive episode, with an emphasis on low self-esteem and hopelessness (Table 1). DSM-5 defines PDD on the basis of the set of symptoms for dysthymia, with the assumption that most individuals who meet the full symptoms for MDD also meet criteria for dysthymia.



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