Patients complain of varying sleep disturbances with a depressive episode, which may include insomnia (inability to fall asleep and/or stay asleep) and hypersomnia (excessive sleepiness).
When somebody states they no longer have interest or take pleasure in activities they enjoyed in the past, this is called anhedonia. This is an important criterion because either anhedonia or a depressed mood must be present along with a minimum of four other symptoms to diagnose an MDE.
People with MDD may express feelings of guilt or regret about their own or someone else’s actions or feelings. They may feel there is no way to rectify past events, and thus feel hopeless or worthless.
When asked to describe their energy levels throughout the day, patients may endorse low or nonexistent levels. They may feel fatigued despite obtaining adequate or excessive amounts of sleep.
Patients with MDD may be unable to carry out their daily work or school tasks due to an inability to focus or difficulty making decisions.
Appetite changes go full spectrum in major depression; patients gain weight rapidly from excessive eating or they lose weight unintentionally from poor appetite or a disinterest in food. These changes can be quantified by determining if there is a > 5% change in weight in a month.
Examples of psychomotor retardation include slowed or decreased speech and movements; examples of psychomotor agitation include constantly fidgeting with clothes or objects, pacing back and forth, and handwringing. Either of these manifestations must be observed by a third-party to meet this criterion.
During an MDE, patients may become preoccupied with recurrent thoughts about death and self-harm. Any form of a suicide attempt reported by a patient, regardless of actual lethality, meets criteria and must be taken seriously. Although an suicidal attempt does not need to be made to meet this criterion, recurrent suicidal thoughts are enough.
Psychiatric diseases are classified by clinicians according to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the most recent edition of which is the DSM-V. The DSM-V states that for the diagnosis of major depression to be fulfilled, 5 of the SIG E CAPS criteria must be present for a minimum of 2 weeks; one of which must be depressed mood or anhedonia.
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