Major Depression: Coexisting Conditions and Diagnosis

Major depression has a high rate of coexistence with other disorders (termed comorbidity) including panic disorder, post-traumatic stress disorder, generalizing anxiety disorder, agoraphobia, social phobia and substance abuse. Studies have concluded that marital conflict is frequently an excellent predictor of major depression, with some clinicians recommending marital therapy as the treatment choice for patients presenting with major depression associated with the marital discord. In the elderly, physical illness is highly correlated with major depression. Several other types of physical conditions associated with major depression include pharmacological (steroid use, amphetamine/cocaine/alcohol/sedative withdrawal), endocrine (hypothyroidism and hyperthyroidism, diabetes, Cushing's disease), infectious (general paresis, influenza, hepatitis, AIDS), or neurological (multiple sclerosis, Parkinson's disease, head trauma, cerebrovascular disorder). Also, major depression has been found to be highly correlated with personality disorders, although it is frequently difficult to make a diagnosis of personality disorder until the major depression has been alleviated.

Diagnosis of Major Depression:

In addition to a diagnosis of major depression, there are several DSM-IV psychological disorders of related interest. Dysthymic disorder is a milder form of depression in which symptoms are of a lower intensity for a longer period of time. In order to make a diagnosis of dysthymia, symptoms must persist on most days for a period of at least two years. Major depression may also be superimposed on dysthymia, resulting in a diagnosis of what has been referred to as "double depression". Double depression refers to the existence of dysthymia and a coexisting episode of major depression. Atypical depression refers to a form of depression characterized by mood reactivity in which the mood responds to pleasurable events, individuals may have significant weight gains or increases in appetite, hypersomnia, heavy feelings in arms and legs and/or sensitivity to rejection.

Major depression may also come in the form of bipolar I disorder, which refers to the presence of at least one manic episode at some time in the past, and the presence of one or more depressive episodes. At least one manic episode is absolutely required for a bipolar I disorder diagnosis. A manic episode is characterized by an elevated mood, rapid speech, flight of ideas, high level of distractibility, increased goal-directed activity or psychomotor agitation, grandiosity, decreased need for sleep, and/or engagement in pleasurable but obviously risky behaviors. Bipolar II disorder is similar to bipolar I disorder except that a past or present hypomanic (milder form of mania) episode is required. Finally, cyclothymic disorder consist of frequent but less severe symptoms of hypomania and depression.

Major depression has been called by the eminent psychologist Martin Seligman, the common cold of the psychological disorders.

Information provided by Leahy and Holland’s Treatment Plans and Interventions for depression and Anxiety Disorders

By Paul Susic MA Licensed Psychologist Ph.D. Candidate