DSM-5 Criteria and Depression Severity: Implications for Clinical Practice

Abstract

Background: Depression diagnosis requires five or more symptoms (Diagnostic and Statistical Manual of Mental Disorders-DSM-5). One of them must be either Depressed mood or Anhedonia, named main criteria. Although the secondary symptoms can be divided into somatic and non-somatic clusters, the DSM-5 identify depression in all or none fashion. In contrast, depression severity is a continuous variable. Therefore, it is commonly assessed with scales such as the Hamilton Depression Rating Scale (HAMD). Previously, we reported that patients with moderate depression (MD) exhibit greater impairments in cardiac-autonomic modulation than severely depressed (SD) patients. However, clinicians usually do not use scales.Objective: To verify whether the DSM-5 symptoms would be able to discriminate SD from MD and MD from non-depressed (ND) subjects.Material and Methods: Depression was diagnosed based on the Structured Clinical Interview for DSM-5® Disorders. The HAMD evaluated depression severity. In depressed subjects, MD and SD were defined considering the HAMD scores. ND was defined considering both the absence of DSM-5 criteria for depression and the HAMD score. Among 782 outpatients, 46 SD were found. MD and ND subjects were randomly sampled to match the demographic variables of the SD group.Results: Discriminant analysis showed that Depressed Mood was the most reliable symptom to discriminate ND from MD. Anhedonia discriminated SD from MD. Among the secondary DSM-5 criteria, the somatic cluster discriminated ND from MD and the non-somatic cluster SD from MD patients.Discussion: The presence of the somatic cluster in MD may indicate decreased vagal tone and/or increased sympathetic tone, leading to higher cardiovascular risk. As SD is associated with the non-somatic cluster, these patients are at risk of committing suicide. The DSM-5 symptoms exhibited by the patient may help the choice of adequate pharmacological treatment. This would avoid the use of antidepressants that unnecessarily increase cardiac risk in MD. When the symptom cluster suggests SD, the treatment must focus on the prevention of suicide.Conclusions: Depression severity may be inferred based on the DSM-5 criteria. The presence of the Anhedonia main criterium accompanied by non-somatic criteria indicate SD. The Depressive Mood criterium followed by somatic criteria suggest MD.

Gender Differences in Developing Biomarker-Based Major Depressive Disorder Diagnostics

“…Traditionally, the diagnosis of major depressive disorder is based on a clinical interview in which subjectively experienced and in part observable symptoms are identified and categorized according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD) [3,4]. However, the diagnosis of major depressive disorder as produced by these systems is a syndrome diagnosis that harbors high heterogeneity and shows considerable overlap with other psychiatric disorders and physical disease [5].…”

Mental Ill-Health and Heart Failure Comorbidity

“…The Diagnostic and Statistical Manual of Mental Disorders (DSM-V), requires five or more symptoms to be present within a 2 w period to make a diagnosis of depression. One of the symptoms must be from the main criteria; which is either a depressed mood or anhedonia [14]. Symptoms may be grouped as somatic or non-somatic.…”

“…The non-somatic symptoms include depressed mood, anhedonia, feelings of worthlessness/excessive guilt, and suicide ideation. Severe depression is more associated with the non-somatic group of symptoms, where moderate depression is associated with the somatic cluster of symptoms [14]. Theories of the pathology of depression have been explored and the most widely accepted hypothesis has been that depression results from an underactivity of monoamine neurotransmitters in the synaptic cleft.…”

Cardiac autonomic modulation related to prayer may contribute to the reduced cardiovascular mortality associated with religiosity/spirituality

“…The personal prayer of patients has been shown to positively correlated with their physical and mental well-being [45,46]. Besides the fact that prayer may be a resource to positively transform the patient's experience of their illness, this spiritual practice has been linked with higher levels of cardiac autonomic control, a condition that in turn has been associated with a reduced risk of cardiac arrhythmias and cardiovascular mortality [47][48][49][50][51][52][53][54]. This may be explained because the heart autonomic nervous system (ANS) is a crucial component in the physiological function and pathological responses of the cardiovascular system.…”