From the Guidelines
The DSM-5 criteria for major depressive disorder require the presence of five or more symptoms during the same 2-week period, with at least one symptom being either depressed mood or loss of interest/pleasure. According to the American Psychiatric Association, as stated in the study 1, a diagnosis of major depressive disorder requires the presence of 5 or more of the following symptoms within the same 2-week period and represents a change from previous functioning. At least 1 of the symptoms is either depressed mood or loss of interest or pleasure.
Key Symptoms
- Depressed mood most of the day, nearly every day, as indicated by either substantive report or observation made by others
- Markedly diminished interest or pleasure in all, or nearly all, activities most of the day, nearly every day
- Significant weight loss when not dieting or weight gain, or increased or decreased appetite nearly every day
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or inappropriate guilt nearly every day
- Diminished ability to think or to concentrate, or indecisiveness, nearly every day
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt, or a specific plan to commit suicide These symptoms must cause clinically significant distress or impairment in functioning, cannot be attributable to substances or another medical condition, and must not be better explained by schizoaffective disorder, schizophrenia, or other psychotic disorders, as indicated by the study 1.
Severity and Specifiers
The severity of major depressive disorder is specified as mild, moderate, or severe, with possible specifiers for anxious distress, mixed features, melancholic features, atypical features, psychotic features, catatonia, peripartum onset, and seasonal pattern, which helps clinicians accurately identify depression and develop appropriate treatment plans including psychotherapy, medication, or a combination of approaches, based on the information provided in the study 1.
From the Research
DSM-5 Criteria for Major Depression
The DSM-5 criteria for major depression include a combination of symptoms that interfere with a person's ability to function in daily life. According to the studies, the treatment of major depression often involves the use of selective serotonin reuptake inhibitors (SSRIs) 2, 3, 4, 5, 6.
Treatment with Selective Serotonin Reuptake Inhibitors (SSRIs)
- SSRIs are the first-line option for pharmacological management of depression 2.
- The optimal dose of SSRIs is crucial in reducing the burden of depression, with the lower range of the licensed dose achieving the optimal balance between efficacy, tolerability, and acceptability in the acute treatment of major depression 2.
- Initiating treatment with SSRIs at doses higher than those typically used in clinical trials/settings is associated with higher response rates but also higher rates of discontinuation due to intolerance 3.
- Escitalopram was found to be more effective than other defined SSRIs in terms of response rate, remission rate, and withdrawal rate 5.
Key Features of SSRIs
- SSRIs vary in several clinically important ways, including how long they remain in the body and the extent to which they interfere with the metabolism of other medications 6.
- Understanding the distinct properties of SSRIs may help primary care physicians to design the most appropriate therapeutic plan for individual patients 6.
- Common side effects of SSRIs include gastrointestinal disturbances, headache, sedation, insomnia, activation, weight gain, impaired memory, excessive perspiration, paresthesia, and sexual dysfunction 4.