Research and Application Assignment : Major Depressive Disorder

Course: SSW 209 - Mental Health Foundations

Proffessor / Instructor: Phillip Burge

Student Name: Elizabeth Miriti

Humber college
RESEARCH AND APPLICATION ASSIGNMENT MDD
Section A: Diagnostic Features
Diagnostic Criteria

MAJOR DEPRESSIVE DISORDER

A. Five (or more) of the following symptoms have been present during the same 2-week period
and represent a change from previous functioning; at least one of the symptoms is either
(1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical condition.
1. 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). (Note: In
children and adolescents, can be an irritable mood.)
2. 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). Major Depressive
Disorder 3. Significant weight loss when not dieting or weight gain (e.g., a change of more than
5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In
children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely
subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional)
nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by
subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a
specific plan, or a suicide attempt or a specific plan for committing suicide.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or

other important areas of functioning.

C. The episode is not attributable to the physiological effects of a substance or another medical
condition.
Note: Criteria A–C represent a major depressive episode.
Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural
disaster, a serious medical illness or disability) may include the feelings of intense sadness,
rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which
may resemble a depressive episode. Although such symptoms may be understandable or
considered appropriate to the loss, the presence of a major depressive episode in addition to the
normal response to a significant loss should also be carefully considered. This decision
inevitably requires the exercise of clinical judgment based on the individual’s history and the
cultural norms for the expression of distress in the context of loss.

D. The occurrence of the major depressive episode is not better explained by schizoaffective
disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and
unspecified schizophrenia spectrum and other psychotic disorders.
E. There has never been a manic episode or a hypomanic episode.
Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are
substance-induced or are attributable to the physiological effects of another medical condition.

Depressive Disorders Coding and Recording Procedures The diagnostic code for major
depressive disorder is based on whether this is a single or recurrent episode, current severity,
presence of psychotic features, and remission status. Current severity and psychotic features are
only indicated if full criteria are currently met for a major depressive episode. Remission
specifiers are only indicated if the full criteria are not currently met for a major depressive
episode.
Codes are as follows:
Severity/course specifier Single episode Recurrent episode*
Mild (p. 188) 296.21 (F32.0) 296.31 (F33.0)
Moderate (p. 188) 296.22 (F32.1) 296.32 (F33.1)
Severe (p. 188) 296.23 (F32.2) 296.33 (F33.2)
With psychotic features** (p. 186) 296.24 (F32.3) 296.34 (F33.3)
In partial remission (p. 188) 296.25 (F32.4) 296.35 (F33.41)
In full remission (p. 188) 296.26 (F32.5) 296.36 (F33.42)
Unspecified 296.20 (F32.9) 296.30 (F33.9)
*For an episode to be considered recurrent, there must be an interval of at least 2 consecutive
months between separate episodes in which criteria are not met for a major depressive episode.
The definitions of specifiers are found on the indicated pages. **If psychotic features are present,
code the “with psychotic features” specifier irrespective of episode severity. In recording the
name of a diagnosis, terms should be listed in the following order: major depressive disorder,
single or recurrent episode, severity/psychotic/remission specifiers, followed by as many of the
following specifiers without codes that apply to the current episode. Specify: With anxious
distress (p. 184) With mixed features (pp. 184–185) With melancholic features (p. 185) With
atypical features (pp. 185–186) With mood-congruent psychotic features (p. 186) With mood-
incongruent psychotic features (p. 186) With catatonia (p. 186). Coding note: Use additional
code 293.89 (F06.1). With peripartum onset (pp. 186–187) With seasonal pattern (recurrent
episode only) (pp. 187–188)

Diagnostic Features
The criterion symptoms for major depressive disorder must be present nearly every day to be
considered present, with the exception of weight change and suicidal ideation. Depressed mood
must be present for most of the day, in addition to being present nearly every day. Often
insomnia or fatigue is the presenting complaint, and failure to probe for accompanying
depressive symptoms will result in underdiagnosis. Sadness may be denied at first but maybe
elicited through interview or inferred from facial expression and demeanor. With individuals
who focus on a somatic complaint, clinicians should determine whether the distress from that
complaint is associated with specific depressive symptoms. Fatigue and sleep disturbance are
present in a high proportion of cases; psychomotor disturbances are much less common but are
indicative of greater overall severity, as is the presence of delusional or near-delusional guilt.
Major Depressive Disorder
 The essential feature of a major depressive episode is a period of at least 2 weeks during which
there is either depressed mood or the loss of interest or pleasure in nearly all activities (Criterion
A). In children and adolescents, the mood may be irritable rather than sad. The individual must
also experience at least four additional symptoms drawn from a list that includes changes in
appetite or weight, sleep, and psychomotor activity; decreased energy; feelings of worthlessness
or guilt; difficulty thinking, concentrating, or making decisions; or recurrent thoughts of death or
suicidal ideation or suicide plans or attempts. To count toward a major depressive episode, a
symptom must either be newly present or must have clearly worsened compared with the
person’s pre-episode status. The symptoms must persist for most of the day, nearly every day, for
at least 2 consecutive weeks. The episode must be accompanied by clinically significant distress
or impairment in social, occupational, or other important areas of functioning. For some
individuals with milder episodes, functioning may appear to be normal but requires markedly
increased effort.
The mood in a major depressive episode is often described by the person as depressed, sad,
hopeless, discouraged, or “down in the dumps” (Criterion A1). In some cases, sadness may be
denied at first but may subsequently be elicited by an interview (e.g., by pointing out that the
individual looks as if he or she is about to cry). In some individuals who complain of feeling
“blah,” having no feelings, or feeling anxious, the presence of a depressed mood can be inferred
from the person’s facial expression and demeanor. Some individuals emphasize somatic
complaints (e.g., bodily aches and pains) rather than reporting feelings of sadness. Many
individuals report or exhibit increased irritability (e.g., persistent anger, a tendency to respond to
events with angry outbursts or blaming others, an exaggerated sense of frustration over minor
matters). In children and adolescents, an irritable or cranky mood may develop rather than a sad
or dejected mood. This presentation should be differentiated from a pattern of irritability when
frustrated.
Loss of interest or pleasure is nearly always present, at least to some degree. Individuals may
report feeling less interested in hobbies, “not caring anymore,” or not feeling any enjoyment in
activities that were previously considered pleasurable (Criterion A2). Family members often
notice social withdrawal or neglect of pleasurable avocations (e.g., a formerly avid golfer no
longer plays, a child who used to enjoy soccer finds excuses not to practice). In some
individuals, there is a significant reduction from previous levels of sexual interest or desire.
Appetite change may involve either a reduction or an increase. Some depressed individuals
report that they have to force themselves to eat. Others may eat more and may crave specific
foods (e.g., sweets or other carbohydrates). When appetite changes are severe (in either
direction), there may be a significant loss or gain in weight, or, in children, a failure to make
expected weight gains may be noted (Criterion A3).
Sleep disturbance may take the form of either difficulty sleeping or sleeping excessively
(Criterion A4). When insomnia is present, it typically takes the form of middle insomnia (i.e.,
waking up during the night and then having difficulty returning to sleep) or terminal insomnia
(i.e., waking too early and being unable to return to sleep). Initial insomnia (i.e., difficulty falling
asleep) may also occur. Individuals who present with oversleeping (hypersomnia) may
experience prolonged sleep episodes at night or increased daytime sleep. Sometimes the reason
that the individual seeks treatment is for the disturbed sleep. Psychomotor changes include
agitation (e.g., the inability to sit still, pacing, handwringing; or pulling or rubbing of the skin,
clothing, or other objects) or retardation (e.g., slowed speech, thinking, and body movements;
increased pauses before answering; speech that is decreased in volume, inflection, amount, or
variety of content, or muteness) (Criterion A5).
The psychomotor agitation or retardation must be severe enough to be observable by others and
not represent merely subjective feelings. Decreased energy, tiredness, and fatigue are common
(Criterion A6). A person may report sustained fatigue without physical exertion. Even the
smallest tasks seem to require Depressive Disorders substantial effort. The efficiency with which
tasks are accomplished may be reduced. For example, an individual may complain that washing
and dressing in the morning are exhausting and take twice as long as usual.
The sense of worthlessness or guilt associated with a major depressive episode may include
unrealistic negative evaluations of one’s worth or guilty preoccupations or ruminations over
minor past failings (Criterion A7). Such individuals often misinterpret neutral or trivial day-to-
day events as evidence of personal defects and have an exaggerated sense of responsibility for
untoward events. The sense of worthlessness or guilt may be of delusional proportions (e.g., an
individual who is convinced that he or she is personally responsible for world poverty). Blaming
oneself for being sick and for failing to meet occupational or interpersonal responsibilities as a
result of the depression is very common and, unless delusional, is not considered sufficient to
meet this criterion.
Many individuals report impaired ability to think, concentrate or make even minor decisions
(Criterion A8). They may appear easily distracted or complain of memory difficulties. Those
engaged in cognitively demanding pursuits are often unable to function. In children, a
precipitous drop in grades may reflect poor concentration. In elderly individuals, memory
difficulties may be the chief complaint and may be mistaken for early signs of dementia
(“pseudodementia”). When the major depressive episode is successfully treated, the memory
problems often fully abate. However, in some individuals, particularly elderly persons, a major
depressive episode may sometimes be the initial presentation of irreversible dementia.
Thoughts of death, suicidal ideation, or suicide attempts (Criterion A9) are common. They may
range from a passive wish not to awaken in the morning or a belief that others would be better
off if the individual were dead, to transient but recurrent thoughts of committing suicide, to a
specific suicide plan. More severely suicidal individuals may have put their affairs in order (e.g.,
updated wills, settled debts), acquired needed materials (e.g., a rope or a gun), and chosen a
location and time to accomplish the suicide. Motivations for suicide may include a desire to give
up in the face of perceived insurmountable obstacles, an intense wish to end what is perceived as
an unending and excruciatingly painful emotional state, an inability to foresee any enjoyment in
life, or the wish to not be a burden to others. The resolution of such thinking may be a more
meaningful measure of diminished suicide risk than the denial of further plans for suicide.
The evaluation of the symptoms of a major depressive episode is especially difficult when they
occur in an individual who also has a general medical condition (e.g., cancer, stroke, myocardial
infarction, diabetes, pregnancy). Some of the criterion signs and symptoms of a major depressive
episode are identical to those of general medical conditions (e.g., weight loss with untreated
diabetes; fatigue with cancer; hypersomnia early in pregnancy; insomnia later in pregnancy or
the postpartum). Such symptoms count toward a major depressive diagnosis except when they
are clearly and fully attributable to a general medical condition. Nonvegetative symptoms of
dysphoria, anhedonia, guilt or worthlessness, impaired concentration or indecision, and suicidal
thoughts should be assessed with particular care in such cases. Definitions of major depressive
episodes that have been modified to include only these nonvegetative symptoms appear to
identify nearly the same individuals as do the full criteria.
SECTION B: DISCUSSION OF TOPIC

Causes

Major Depressive Disorder (MDD), more commonly known by one word, depression, is now

one of the most common mental disorders in Canada. Furthermore, according to the World

Health Organization in 2008, depression is one of the primary triggers of the burden of disease,

which impacts the individual's life and the lives of their family and the wider community. For

decades, depression has been the focus of many researchers in the medical and social sciences

field. However, many continue to argue that the cause of depression is still unknown. However,

many studies have argued that common triggers or risk factors for depression include stress, the

death of a loved one, trauma, consequential life changes, and family history. The section of this

paper seeks to present various schools of thought regarding the cause of Major Depressive

Disorder and their categories.

According to ____________, Major Depressive Disorders causes can fall into two categories:

1) Biological Factors

2) Enviromental Factors

Biological Factors 

Biological Factors mainly include a family’s genetic history of mental health illness or disability.

Furthermore, it has been argued that genetic factors and stressful life events can cause

depression. An essential demonstration of this effect would be based on techniques that allow

investigators to identify specific genes, one of which is the serotonin transporter (5-HTT) gene

which is often a focus when studying the cause of depression. Research has shown that
significant changes in brain activity are almost always associated with major depressive disorder.

In addition, studies have made important observations of decreased activity on the left frontal

lobe during depression and increased activity following mood stabilisation. These discrepancies

between the over-active and under-active regions of the brain are the biological effect of major

depressive disorder. Many researchers have used this to measure depression and how it

communicates in our bodies. 

Enviromental Factors

Environmental Factors focus on things that happen in our soundings. A significant increase in

the cost of living can cause a person to feel depressed over their inability to make ends meet. The

passing of a loved one can have a long-lasting effect on an individual as they try to cope with

their loss. The endurance of the pain, sorrow and prolonged sadness can grow into something

debilitating. Even more recent events like the economic depression and the COVID-19 pandemic

have caused many to feel depressed due to lost jobs and people being forced to isolate

themselves from their loved ones. Everyone's life has the potential for despair. Some people can

work their way through it. In contrast, others become overwhelmed, often reaching higher levels

of intensity while interfering with a person's ability to function and enjoy life.

Since there is an ongoing argument regarding the cause of depression, this paper will first

consider some of the signs and symptoms of Major Depressive Disorder.

Erratic changes in an individual's mood are often considered signs of a major depressive episode

as depression. These moods can change from sad to hopeless to discouraged or "down in the

dumps" (Criterion A1). In some cases, sadness may be denied at first but may subsequently be

elicited by an interview (e.g., by pointing out that the individual looks as if they are about to cry).

In some individuals who complain of feeling "blah," having no feelings, or feeling anxious, the

presence of a depressed mood can be inferred from the individual's facial expression and

demeanour. Some individuals emphasize somatic complaints (e.g., bodily aches and pains) rather

than reporting feelings of sadness. Many individuals report or exhibit increased irritability (e.g.,

persistent anger, a tendency to respond to events with angry outbursts or blaming others, and an

exaggerated frustration over minor matters). In children and adolescents, an irritable or cranky

mood may develop rather than a gloomy mood. This presentation should be differentiated from a

pattern of irritability when frustrated.

There are several types of disorders that fall under major depressive disorders:

Postpartum Depression affects women after childbirth and causes extreme anxiety and sadness,

making it difficult for mothers to care for themselves and/ or their babies.

Psychotic Depression is a form of depression with psychosis that may include delusions and/ or

hallucinations where the person is both depressed and out of touch with reality.

Seasonal Affective Disorder is a mood disorder directly caused by the time of the year, most

often occurring in the winter months when sunlight is not as readily available.

Melancholic Depression is a form of depression in which people exhibit a complete loss of

pleasure in all or almost everything

Causes of Major Depression

Though it has been argued that the cause of depression is unclear, many doctors and researchers

have identified several causes. Many of these causes can be linked to many internal or biological

factors, while others are linked to environmental events or factors that affect an individual. The

following seeks to provide an overview of some of the major causes identified. 

Neurotransmitters

Researchers have argued that the release and reuptake of neurotransmitters in an individual's

brain have a correlation to their mood. An imbalance of neurotransmitters (NTs) has been to

depression. However, this notion is difficult to prove since measuring the concentrations of these

neurotransmitters in the brain is very difficult. Nonetheless, that is known is that antidepressants

act on these neurotransmitters as well as their receptors, and this has provided positive results in

support of the notion that an imbalance of the neurotransmitters (NTs) has been to depression. 

Childhood Trauma

Childhood trauma often results in long-lasting depression, mainly if that trauma is not addressed

early. There are events of the past that stay with us forever. Adverse events such as rape, abuse,

neglect, parents' passing, drug use, or even being bullied in school can have a lasting effect.

These events can also lead to a child feeling suicidal. A large percentage of suicidal deaths is

because of depression. Therefore, it is reasonable to say that trauma is a cause of depression. 

Major Life Events

Many events in an individual's personal life act as triggers of depression. Losing a loved one is

one of the most painful experiences for many. Some can find ways to deal with their loss, while

others struggle and find themself in a state of prolonged depression. Other events, such as taking

on a high-stress job or even dealing with challenging financial situations, can lead to feeling

helpless and lost. All of this can lead to depression. Again, this may be for a short time. Some

can recover quickly. A robust support system also serves as a great help in such situations, which

results in less stress. However, without the proper support or even therapy, this can develop into

a major depressive disorder requiring medical attention. 

Hormonal Changes

Rapid hormonal changes, often seen in pregnant woman, is another cause of major depression.

Women often express this during their monthly period, pregnant or entering menopause. It is

essential to be mindful of this because it may start as mild depression. Still, if not treated, it can

lead to significant depression and ultimately affect personal and professional lives. 

The sense of worthlessness or guilt

Everyone, at some point, feels a sense of worthlessness or guilt based on an experience. If this

feeling is prolonged, it is often a sign of a major depressive disorder. Research has shown that a

sense of guilt and worthlessness causes depression. Therefore, conscious of these feelings is

essential, as they can cause depression. In many cases, the overwhelming sense of worthlessness

or guilt may be of delusional proportions. Some may blame themselves for their illness or for not

being able to achieve specific goals or obligations; this is very common; however, it can
sometimes lead to a delusional feeling that consumes their life. At that point, medical attention

may be required. 

If one were to measure disability in terms of the number of years lived, severe impairments, and

harsh social circumstances that trigger depression, an example would be someone involved in an

unsuccessful marriage and may eventually become depressed or withdrawn. Psychological

examples for mood disorders mainly focus on individual differences, and their primary concerns

are severe and disabling forms of depression.

Challenging experiences determine why some people develop significant depression while others

do not experience. Factors responsible for severe failures in psychological and biological

systems that regulate mood would be findings to explain this.

Depression accounts for almost ten per cent of all disabilities. Experts predict this number will

increase significantly, especially among the younger generation. According to Moussavi et al.

(2007), depression is the leading cause of disability worldwide. If not addressed, depression will

become the most severe pandemic known to me. 

Impacts

Depression can be referred to to a mood or clinical syndrome, combination of emotional

cognitive and behavioural symptoms, and the feelings associated can be referred to a depressed

mood which include disappointment and despair.

One of the common signs of depressed mood is in people experiencing long-term sadness and

hopelessness especially in the event of losing a loved one they say that the feeling drowning as

well as suffocating them.

The impacts of Major depressive disorders is frequently a chronic recurrent condition in which

episodes of severe symptoms may be alternative with periods of recurring especially with a

feeling of “you feel absolute worthlessness. You feel there is no hope for the future” (watch

video ‘Major Depression: Everett” on MyPsychLab.Notice the importance and persistence of the

negative way in which he views himself and his abilities.)

In more recent times due to the Covid pandemic and economic recession, we have seen an

increase in the number of individuals feeling a sense of hopelessness and long-term sadness,

this issue has been a major concern for many international organizations including the World

Health Organization.

Other signs such as Anxiety restlessness irritability have become very common even amongst

young children.

With a lot of people losing their jobs, there are feelings of guilt and worthlessness, especially

with the youth who are starting off their lives

Fatigue and lack of energy is a concerns with a number of people not able to cope with their

daily life as well as interference of their social life, they seem always tired and not able to meet

socially fatigue wears them down.

Trouble concentrating, remembering, or making decisions is common with older or seniors in the

community where one seems to have difficulty remembering simple things that they recently did

or put away some stuff and now can't recall where it is, or simple things like their pin numbers

for their bank cards, daughters birthday.

Sleep issues such as insomnia, waking up very early, sleeping too many times in a day, or

staying long hours at night without sleeping