Depressive Disorder

In response to trauma, there may be occasions where an individual presents with low positive emotions and general dysphoria, and there is a lack of an anxious or reactivity response.

An individual may present with and report some symptoms associated with PTSD, however due to there being comorbidity of symptoms between PTSD and major depression, there are times where those symptoms may be better accounted for by a depressive disorder, as opposed to PTSD.

It’s treatable!

Remember, mental health conditions are treatable. See the Therapeutic Response section to learn more.

Symptoms

Major depression is characterized by the presence of five (or more) of the following symptoms during the same two-week period that represent a change from previous functioning, and at least one of the symptoms is either depressed mood or loss of interest or pleasure.

• Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful).
• Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
• Significant weight loss when not dieting, weight gain, or decrease or increase in appetite nearly every day.
• Insomnia or hypersomnia nearly every day.
• Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
• Fatigue or loss of energy nearly every day.
• Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
• Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
• Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Development and course of symptoms

• Major depressive disorder may first appear at any age, with onset increasing with puberty.
• The course of major depressive disorder is quite variable, such that some individuals rarely, if ever, experience remission, while others experience many years with few or no symptoms between episodes of depression.
• Chronic depressive symptoms substantially increase the likelihood of underlying personality, anxiety, and substance use disorders and decreases the likelihood that treatment will be successful in full symptom recovery.
• Recovery typically begins within three months of onset for two in five individuals with major depression and within one year for four in five individuals.
• Recency of onset is a strong indicator of probability of recovery, and many individuals who have been depressed only for several months can be expected to recover spontaneously.
• Features associated with lower recovery rates, other than current episode duration, include psychotic features, prominent anxiety, personality disorders, and symptom severity.
• The risk or major depression reoccurrence is higher in individuals whose preceding episode was severe, in younger individuals, and in individuals who have already experienced multiple episodes.
• The persistence of even mild depressive symptoms during remission is a powerful predictor of recurrence.

Risk and prognostic factors

• Individual temperament — general negativity.
• Exposure to prior trauma, especially in childhood.
• Environment — exposure to stressful and adverse events.
• Genetic predisposition.
• Prior or concurrent mental health diagnoses.

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