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Chapter 3.1 - Clinical Features of Depressive Disorders

Published online by Cambridge University Press:  04 April 2024

By
Ian M. Anderson  and
Kate Williams-Markey
Edited by
David Kingdon ,
Paul Rowlands  and
George Stein
David Kingdon
Affiliation:
University of Southampton
Paul Rowlands
Affiliation:
Derbyshire Healthcare NHS foundation Trust
George Stein
Affiliation:
Emeritus of the Princess Royal University Hospital
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Summary

Depressive disorders have been recognised since antiquity, although how they have been described and understood has changed considerably over time. In this chapter, we outline key aspects of the history of depression as well as some of the limitations in its current classification in ICD-11 and DSM-5. We describe the range of symptoms experienced in depressive disorders, together with the recognised variations in clinical presentation and how these are conceptualised and classified. The relationship between depression and related disorders including anxiety disorders, premenstrual dysphoric disorder and grief is discussed, as well as boundary issues with bipolar disorder and primary psychotic disorders. We review current knowledge about depression’s considerable psychiatric and medical comorbidity, along with its epidemiology, natural history and health burden. A brief practical guide to assessing depressive disorders is given, together with rating scales that are useful for clinical assessment and monitoring.

Keywords

depressive disordershistory of depressiondepressive symptomsclassificationdiagnosisICD-11DSM-5epidemiology of depressionnatural history of depressionassessment
Type
Chapter
Information
Seminars in General Adult Psychiatry , pp. 64 - 88
Publisher: Cambridge University Press
Print publication year: 2024

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References

Kendler, KS. The origin of our modern concept of depression – the history of melancholia from 1780–1880: a review. JAMA Psychiatry 2020;77(8):863–8.CrossRefGoogle ScholarPubMed
Shorter, E. The doctrine of the two depressions in historical perspective. Acta Psychiatrica Scandinavica Supplementum 2007;433:5–13.CrossRefGoogle Scholar
Kendler, KS. The phenomenology of major depression and the representativeness and nature of DSM criteria. American Journal of Psychiatry 2016;173(8):771–80.CrossRefGoogle ScholarPubMed
Baumeister, H, Parker, G. Meta-review of depressive subtyping models. Journal of Affective Disorders 2012;139(2):126–40.Google Scholar
Parker, G, McClure, G, Paterson, A. Melancholia and catatonia: disorders or specifiers? Current Psychiatry Reports 2015;17(1):536.CrossRefGoogle ScholarPubMed
Ross, CA, Margolis, RL. Research Domain Criteria: strengths, weaknesses, and potential alternatives for future psychiatric research. Molecular Neuropsychiatry 2019;5(4): 218–36.Google ScholarPubMed
Johnstone, L, Boyle, M, Cromby, J, et al. The Power Threat Meaning Framework: Overview. Leicester: British Psychological Society; 2018.Google Scholar
Tylee, A, Gastpar, M, Lépine, JP, et al. DEPRES II (Depression Research in European Society II): a patient survey of the symptoms, disability and current management of depression in the community. DEPRES Steering Committee. International Clinical Psychopharmacology 1999;14(3):139–51.Google Scholar
Faravelli, C, Servi, P, Arends, JA, et al. Number of symptoms, quantification, and qualification of depression. Comprehensive Psychiatry 1996;37(5): 307–15.CrossRefGoogle ScholarPubMed
Cavanagh, A, Wilson, CJ, Kavanagh, DJ, et al. Differences in the expression of symptoms in men versus women with depression: a systematic review and meta-analysis. Harvard Review of Psychiatry 2017;25(1):29–38.CrossRefGoogle ScholarPubMed
Ribeiro, JD, Huang, X, Fox, KR, et al. Depression and hopelessness as risk factors for suicide ideation, attempts and death: meta-analysis of longitudinal studies. British Journal of Psychiatry 2018;212(5):279–86.CrossRefGoogle ScholarPubMed
Griep, SK, Mackinnon, DF. Does nonsuicidal self-injury predict later suicidal attempts? A review of studies. Archives of Suicide Research 2020;26(2):428–46. DOI: 10.1080/13811118.2020.1822244.Google ScholarPubMed
Akkaoui, MA, Lejoyeux, M, d’Ortho, MP, et al. Nightmares in patients with major depressive disorder, bipolar disorder, and psychotic disorders: a systematic review. Journal of Clinical Medicine 2020;9(12):3990.CrossRefGoogle ScholarPubMed
Plante, DT, Cook, JD, Barbosa, LS, et al. Establishing the objective sleep phenotype in hypersomnolence disorder with and without comorbid major depression. Sleep 2019;42(6): zsz060.CrossRefGoogle ScholarPubMed
Mula, M, Pini, S, Cassano, GB. The neurobiology and clinical significance of depersonalization in mood and anxiety disorders: a critical reappraisal. Journal of Affective Disorders 2007;99(1–3):91–9.CrossRefGoogle ScholarPubMed
Swann, AC. Activated depression: mixed bipolar disorder or agitated unipolar depression? Current Psychiatry Reports 2013;15(8):376.CrossRefGoogle ScholarPubMed
Rasmussen, SA, Mazurek, MF, Rosebush, PI. Catatonia: our current understanding of its diagnosis, treatment and pathophysiology. World Journal of Psychiatry 2016;6(4):391–8.CrossRefGoogle ScholarPubMed
World Health Organization. ICD-11 for Mortality and Morbidity Statistics (Version : 05/2021). 2021. icd.who.int/browse11/l-m/en. (Accessed 26 May 2021).Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Washington DC: American Psychiatric Association; 2022.Google Scholar
World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Clinical descriptions and Diagnostic Guidelines. Geneva: World Health Organization; 1992.Google Scholar
Stein, DJ, Szatmari, P, Gaebel, W, et al. Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC Medicine 2020;18(1):21.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence. Depression in adults: treatment and management. www.nice.org.uk/guidance/ng222. (Accessed 20 November 23).Google Scholar
Dubovsky, SL, Ghosh, BM, Serotte, JC, et al. Psychotic depression: diagnosis, differential diagnosis, and treatment. Psychotherapy and Psychosomatics 2021;90(3):160–77. DOI: 10.1159/000511348.CrossRefGoogle ScholarPubMed
Solmi, M, Pigato, GG, Roiter, B, et al. Prevalence of catatonia and its moderators in clinical samples: results from a meta-analysis and meta-regression analysis. Schizophrenia Bulletin 2018;44(5):1133–50.CrossRefGoogle ScholarPubMed
Demyttenaere, K, Heirman, E. The blurred line between anxiety and depression: hesitations on comorbidity, thresholds and hierarchy. International Review of Psychiatry 2020;32(5–6): 455–65.CrossRefGoogle ScholarPubMed
McManus, S, Bebbington, P, Jenkins, R, et al. Mental Health and Wellbeing in England: Adult Psychiatric Morbidity Survey. Leeds: NHS Digital; 2016.Google Scholar
Möller, H-J, Bandelow, B, Volz, HP, et al. The relevance of ‘mixed anxiety and depression’ as a diagnostic category in clinical practice. European Archives of Psychiatry and Clinical Neuroscience 2016;266(8):725–36.CrossRefGoogle ScholarPubMed
Hasin, DS, Sarvet, AL, Meyers, JL, et al. Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA Psychiatry 2018;75(4):336–46.CrossRefGoogle ScholarPubMed
McGrath, PJ, Khan, AY, Trivedi, MH, et al. Response to a selective serotonin reuptake inhibitor (citalopram) in major depressive disorder with melancholic features: a STAR*D report. Journal of Clinical Psychiatry 2008;69(12):1847–55.Google ScholarPubMed
Gili, M, Roca, M, Armengol, S, et al. Clinical patterns and treatment outcome in patients with melancholic, atypical and non-melancholic depressions. PLoS ONE 2012;7(10):e48200.CrossRefGoogle ScholarPubMed
Łojko, D, Rybakowski, JK. Atypical depression: current perspectives. Neuropsychiatric Disease and Treatment 2017;13:2447–56.CrossRefGoogle ScholarPubMed
Sampogna, G, Del Vecchio, V, Giallonardo, V, et al. Diagnosis, clinical features, and therapeutic implications of agitated depression. Psychiatric Clinics of North America 2020;43(1):47–57.CrossRefGoogle ScholarPubMed
Meesters, Y, Gordijn, MC. Seasonal affective disorder, winter type: current insights and treatment options. Psychology Research and Behavior Management 2016;9:317–27.CrossRefGoogle ScholarPubMed
Traffanstedt, MK, Mehta, S, LoBello, SG. Major depression with seasonal variation: is it a valid construct? Clinical Psychological Science 2016;4(5): 825–34.CrossRefGoogle Scholar
Jones, I, Cantwell, R. The classification of perinatal mood disorders – suggestions for DSMV and ICD11. Archives of Women’s Mental Health 2010;13(1):33–6.CrossRefGoogle ScholarPubMed
O’Hara, MW, McCabe, JE. Postpartum depression: current status and future directions. Annual Review of Clinical Psychology 2013;9:379–407.CrossRefGoogle ScholarPubMed
Woody, CA, Ferrari, AJ, Siskind, DJ, et al. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. Journal of Affective Disorders 2017;219:86–92.CrossRefGoogle ScholarPubMed
Grayson, L, Thomas, A. A systematic review comparing clinical features in early age at onset and late age at onset late-life depression. Journal of Affective Disorders 2013;150(2):161–70.CrossRefGoogle ScholarPubMed
Schramm, E, Klein, DN, Elsaesser, M, et al. Review of dysthymia and persistent depressive disorder: history, correlates, and clinical implications. Lancet Psychiatry 2020;7(9):801–12.CrossRefGoogle ScholarPubMed
Pezawas, L, Angst, J, Kasper, S. Recurrent brief depression revisited. International Review of Psychiatry 2005;17(1):63–70.CrossRefGoogle Scholar
Zachar, P, Kendler, KS. A diagnostic and statistical manual of mental disorders history of premenstrual dysphoric disorder. Journal of Nervous and Mental Disease 2014;202(4):346–52.CrossRefGoogle ScholarPubMed
Epperson, CN, Steiner, M, Hartlage, SA, et al. Premenstrual dysphoric disorder: evidence for a new category for DSM-5. American Journal of Psychiatry 2012;169(5):465–75.CrossRefGoogle ScholarPubMed
Wittchen, H-U, Becker, E, Lieb, R, et al. Prevalence, incidence and stability of premenstrual dysphoric disorder in the community. Psychological Medicine 2002;32(1):119–32.CrossRefGoogle ScholarPubMed
Carlini, SV, Deligiannidis, KM. Evidence-Based Treatment of Premenstrual Dysphoric Disorder: A Concise Review. J Clin Psychiatry 2020;81(2):19ac13071.CrossRefGoogle ScholarPubMed
Stroebe, M, Schut, H, Boerner, K Bereavement. In: Wright, J (ed.) International Encyclopedia of the Social & Behavioral Sciences, 2nd ed., Vol. 2. Amsterdam: Elsevier Ltd; 2015: 531–6.Google Scholar
Stroebe, M, Schut, H, Stroebe, W. Health outcomes of bereavement. Lancet 2007;370(9603):1960–73.CrossRefGoogle ScholarPubMed
Onrust, SA, Cuijpers, P. Mood and anxiety disorders in widowhood: a systematic review. Aging & Mental Health 2006;10(4):327–34.CrossRefGoogle ScholarPubMed
Lundorff, M, Holmgren, H, Zachariae, R, et al. Prevalence of prolonged grief disorder in adult bereavement: a systematic review and meta-analysis. Journal of Affective Disorders 2017;212:138–49.CrossRefGoogle ScholarPubMed
Shear, MK, Reynolds, CF III, Simon, NM, et al. Optimizing treatment of complicated grief: A randomized clinical trial. JAMA Psychiatry 2016;73:685–94.CrossRefGoogle ScholarPubMed
Wakefield, JC, First, MB. Validity of the bereavement exclusion to major depression: does the empirical evidence support the proposal to eliminate the exclusion in DSM-5? World Psychiatry 2012;11(1):3–10.CrossRefGoogle ScholarPubMed
Zachar, P, First, MB, Kendler, KS. The bereavement exclusion debate in the DSM-5: a history. Clinical Psychological Science 2017;5(5):890–906.CrossRefGoogle Scholar
Fiedorowicz, JG, Endicott, J, Leon, AC, et al. Subthreshold hypomanic symptoms in progression from unipolar major depression to bipolar disorder. American Journal of Psychiatry 2011;168(1):40–8.CrossRefGoogle ScholarPubMed
Etchecopar-Etchart, D, Korchia, T, Loundou, A, et al. Comorbid major depressive disorder in schizophrenia: a systematic review and meta-analysis. Schizophrenia Bulletin 2021;47(2):298–308.CrossRefGoogle ScholarPubMed
McGrath, JJ, Lim, CCW, Plana-Ripoll, O, et al. Comorbidity within mental disorders: a comprehensive analysis based on 145 990 survey respondents from 27 countries. Epidemiology and Psychiatric Sciences 2020;29:e153.CrossRefGoogle Scholar
Steffen, A, Nübel, J, Jacobi, F, et al. Mental and somatic comorbidity of depression: a comprehensive cross-sectional analysis of 202 diagnosis groups using German nationwide ambulatory claims data. BMC Psychiatry 2020;20(1):142.CrossRefGoogle ScholarPubMed
Hunt, GE, Malhi, GS, Lai, HMX, et al. Prevalence of comorbid substance use in major depressive disorder in community and clinical settings, 1990–2019: systematic review and meta-analysis. Journal of Affective Disorders 2020;266:288–304.CrossRefGoogle ScholarPubMed
Friborg, O, Martinsen, EW, Martinussen, M, et al. Comorbidity of personality disorders in mood disorders: a meta-analytic review of 122 studies from 1988 to 2010. Journal of Affective Disorders 2014;152–154:1–11.CrossRefGoogle ScholarPubMed
Gold, SM, Köhler-Forsberg, O, Moss-Morris, R, et al. Comorbid depression in medical diseases. National Review. Disease Primers 2020;6(1):69.CrossRefGoogle ScholarPubMed
Momen, NC, Plana-Ripoll, O, Agerbo, E, et al. Association between mental disorders and subsequent medical conditions. New England Journal of Medicine 2020;382(18):1721–31.CrossRefGoogle ScholarPubMed
Wittchen, HU, Jacobi, F. Size and burden of mental disorders in Europe – a critical review and appraisal of 27 studies. European Neuropsychopharmacology 2005;15(4):357–76.CrossRefGoogle ScholarPubMed
Baxter, AJ, Scott, KM, Ferrari, AJ, et al. Challenging the myth of an “epidemic” of common mental disorders: trends in the global prevalence of anxiety and depression between 1990 and 2010. Depression and Anxiety 2014;31(6):506–16.CrossRefGoogle ScholarPubMed
Maki, PM, Kornstein, SG, Joffe, H, et al. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause 2018;25(10):1069–85.Google ScholarPubMed
Steinert, C, Hofmann, M, Kruse, J, et al. The prospective long-term course of adult depression in general practice and the community. A systematic literature review. Journal of Affective Disorders 2014;152–154:65–75.CrossRefGoogle ScholarPubMed
Baldessarini, RJ, Faedda, GL, Offidani, E, et al. Antidepressant-associated mood-switching and transition from unipolar major depression to bipolar disorder: a review. Journal of Affective Disorders 2013;148(1): 129–35.CrossRefGoogle ScholarPubMed
GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020;396(10258):1204–22.Google Scholar
Too, LS, Spittal, MJ, Bugeja, L, et al. The association between mental disorders and suicide: a systematic review and meta-analysis of record linkage studies. Journal of Affective Disorders 2019;259:302–13.CrossRefGoogle ScholarPubMed
Bostwick, JM, Pankratz, VS. Affective disorders and suicide risk: a reexamination. American Journal of Psychiatry 2000;157(12):1925–32.CrossRefGoogle Scholar
Plana-Ripoll, O, Pedersen, CB, Agerbo, E, et al. A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study. Lancet 2019;394(10211):1827–35.CrossRefGoogle ScholarPubMed
Furukawa, TA. Assessment of mood: guides for clinicians. Journal of Psychosomatic Research 2010;68(6):581–9.CrossRefGoogle ScholarPubMed
Zigmond, AS, Snaith, RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 1983;67(6):361–70.CrossRefGoogle ScholarPubMed
Spitzer, RL, Kroenke, K, Williams, JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine 2006;166(10):1092–7.CrossRefGoogle ScholarPubMed
Forty, L, Kelly, M, Jones, L, et al. Reducing the Hypomania Checklist (HCL-32) to a 16-item version. Journal of Affective Disorders 2010;124(3):351–6.CrossRefGoogle ScholarPubMed

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