Major Depressive - Dysthymia - Dysphoria

After discussing the symptoms of Depression, we can finally classify these two disorders:

• Major Depressive Disorder.
• Persistent Depressive Disorder (dysthymia).
  
  

Major Depressive Disorder is diagnosed when a subject presents for a period of two weeks at least five of the following symptoms:

• Depressed mood or markedly diminished interest/pleasure in many or all activities.
• Significant weight loss or gain and/or changes in appetite.
• Sleep disturbances.
• Psychomotor disturbances.
• Fatigue or loss of energy.
• Feelings of worthlessness or excessive guilt.
• Difficulty concentrating.
• Thoughts of death, suicidal ideation, or suicide attempts.

Persistent Depressive Disorder, as the name suggests, is a type of continuous depressive disorder, where the depressed mood is present for at least two years for most days. During the "depressive periods," at least two of the following symptoms must manifest:

• Significant weight loss or gain and/or changes in appetite.
• Sleep disturbances.
• Fatigue or loss of energy.
• Low self-esteem.
• Difficulty concentrating.
• Feelings of hopelessness.

Among depressive disorders, the diagnostic manual (DSM-5) includes Premenstrual Dysphoric Disorder. This disorder is characterized by presenting at least five symptoms in most menstrual cycles.

The symptoms of this disorder can be divided into two categories: dysphoria-related symptoms and depression-related symptoms. But what does Dysphoria mean?

To learn this new word, let's start with one we know: euphoria. A person is euphoric when it's particularly evident that they are feeling good, energetic, "radiating positivity," and managing their emotional state well. We've already encountered the prefix dis-; remember the word dyslexia? Dyslexia means having difficulty reading fluently. Let's connect dis- with -phoria, and we can say that we have Dysphoria when there is difficulty in managing an emotional situation, resulting in obviously exaggerated reactions.

The "dysphoric symptoms" of Premenstrual Dysphoric Disorder are:

• Marked affective lability.
• Marked irritability.
• Depressed mood.
• Marked anxiety.

(one of these symptoms must necessarily be present).

The "depressive symptoms" of Premenstrual Dysphoric Disorder are:

• Decreased interest in usual activities.
• Difficulty concentrating.
• Fatigue or loss of energy.
• Significant weight loss or gain and/or changes in appetite.
• Sleep disturbances.
• Feeling out of control.
• Breast tenderness, joint pain, or sensations of bloating.

(one of these symptoms must necessarily be present).

As usual, we know that, as with all mental disorders, the symptoms must cause significant distress in the individual's life and there is no other way to explain them (such as substance use).

Sources:
- American Psychiatric Association (2013) - Diagnostic and statistical manual of mental disorders (5th ed.).
- Bernhill, J. W. (2014) - DSM-5 Clinical Cases.

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