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What are the DSM 5 diagnostic criteria for depressive disorder due to another medical condition?
- A. A prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all, or almost all, activities that predominates in the clinical picture.
- B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.
- C. The disturbance is not better explained by another mental disorder (e.g., adjustment disorder, with depressed mood, in which the stressor is a serious medical condition).
- D. The disturbance does not occur exclusively during the course of a delirium.
- E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specifiers (if desired):
- With depressive features: Full criteria for a major depressive episode are not met.
- With major depressive-like episode: Full criteria for a major depressive episode are met (except the cause is medical).
- With mixed features: Includes manic or hypomanic symptoms that do not meet criteria for a manic/hypomanic episode.
Examples of Medical Conditions That May Cause Depression
- Neurological: Stroke, Parkinson’s disease, Huntington’s disease, traumatic brain injury, multiple sclerosis, epilepsy
- Endocrine: Hypothyroidism, Cushing’s syndrome
- Infectious: HIV/AIDS, hepatitis
- Autoimmune: Lupus (SLE)
- Metabolic: Vitamin B12 deficiency
- Neoplastic: Brain tumors
- Cardiovascular: Myocardial infarction, heart failure
Clinical Tip
- Diagnosis requires establishing a causal link between the medical condition and depressive symptoms—not just co-occurrence.
- Tools like temporal correlation, symptom onset, and resolution with medical treatment help determine causality.
Depressive Disorder Due to Another Medical Condition is a mood disorder diagnosis where there is a prominent and persistent period of depressed mood or markedly diminished interest/pleasure thought to be related to the direct physiological effects of another medical condition.
Major depression, as well as other depressive disorders, is commonly comorbid with other medical illnesses, particularly chronic and systemic medical illnesses. The co-occurrence of the disorders is so common that it challenges our notions of the meaning of comorbidity and our desire to neatly separate psychiatric and medical illnesses.
The overlap between symptoms of physical illness and the neurovegetative symptoms of major depression and the initial normative emotional response to physical illness add to the challenge of accurate diagnosis and timely treatment of depression in the medically ill. We review the literature on the comorbidity of depression and the various medical illnesses, including diagnostic and treatment approaches.
The differential diagnosis for major depression among medically ill patients should include delirium and medication-induced symptoms. We suggest that major depression itself may be best conceptualized as a systemic illness whose pathophysiology overlaps with other systemic medical illnesses.
The initial treatment strategies for major depression in medical illness are like those for the general population; however, the comorbid medical illnesses may interfere with remission.
Sources
Thom R, Silbersweig DA, Boland RJ. Major Depressive Disorder in Medical Illness: A Review of Assessment, Prevalence, and Treatment Options. Psychosom Med. 2019 Apr;81(3):246-255. doi: 10.1097/PSY.0000000000000678. PMID: 30720699. https://pubmed.ncbi.nlm.nih.gov/30720699/
