Describe the clinical features for diagnosing a case of Depression.

Diagnostic Criteria for Major Depressive Disorder (MDD)

The diagnosis of MDD requires the presence of five or more symptoms during the same 2-week period, and represent a change from previous functioning. At least one of the symptoms must be either depressed mood or loss of interest or pleasure (anhedonia). These symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

I. Emotional Symptoms

• Depressed Mood: A pervasive feeling of sadness, emptiness, or hopelessness. This is often described by patients as feeling “down,” “blue,” or “empty.”
• Anhedonia: A marked diminution of interest or pleasure in all, or almost all, activities that are normally enjoyable.
• Irritability: Increased irritability, frustration, or restlessness, particularly common in children and adolescents.
• Anxiety: Frequently co-occurs with depression, manifesting as excessive worry, nervousness, or panic attacks.

II. Cognitive Symptoms

• Difficulty Concentrating: Problems focusing, remembering things, or making decisions.
• Negative Thoughts: Recurring negative thoughts about oneself, the world, and the future. This can include feelings of worthlessness, guilt, and hopelessness.
• Suicidal Ideation: Thoughts of death or suicide, with or without a specific plan. This requires immediate assessment and intervention.

III. Behavioral Symptoms

• Psychomotor Agitation or Retardation: Observable restlessness or slowed movements. Agitation can manifest as pacing or fidgeting, while retardation can present as slowed speech and movements.
• Social Withdrawal: Decreased social interaction and a tendency to isolate oneself from friends and family.
• Fatigue: Persistent feelings of tiredness and lack of energy, even after adequate sleep.

IV. Physical Symptoms

• Changes in Appetite or Weight: Significant weight loss when not dieting or weight gain, or a decrease or increase in appetite nearly every day.
• Sleep Disturbances: Insomnia (difficulty falling or staying asleep) or hypersomnia (excessive sleepiness).
• Physical Complaints: Unexplained aches, pains, headaches, or digestive problems.

V. Severity and Duration

The severity of symptoms is categorized as mild, moderate, or severe, based on the number and intensity of symptoms, and the degree of functional impairment. The symptoms must be present for at least two weeks to meet the diagnostic criteria for MDD.

Differential Diagnosis

It’s crucial to differentiate depression from other conditions that can present with similar symptoms, such as:

• Bipolar Disorder: Depression is a phase of bipolar disorder, but it’s characterized by alternating periods of mania or hypomania.
• Adjustment Disorder: Depressive symptoms that develop in response to a specific stressor.
• Grief: Normal grief reactions can resemble depression, but they typically diminish over time.
• Medical Conditions: Certain medical conditions (e.g., hypothyroidism, vitamin deficiencies) can cause depressive symptoms.

Symptom Category	Examples
Emotional	Sadness, hopelessness, anhedonia, irritability
Cognitive	Difficulty concentrating, negative thoughts, suicidal ideation
Behavioral	Social withdrawal, psychomotor changes, fatigue
Physical	Appetite/weight changes, sleep disturbances, unexplained pain