Abnormal Psychology

Mood Disorders and Suicide 195

emerging as a major depressive episode. An untreated MDE

typically lasts approximately 4 months or longer (American

Psychiatric Association, 2000). The more severe the de-

pression, the longer the episode is likely to last (Melartin

et al., 2004). About two thirds of people who have an

MDE eventually recover from the episode completely and

return to their previous level of functioning—referred to

as the premorbidlevel of functioning. About 20–30% of

people who have an MDE fi nd that their symptoms lessen

over time to the point where they no longer meet the cri-

teria for an MDE but don’t completely resolve and may

persist for years. One suggestion for DSM-V addresses

the fact that some symptoms—but not enough for a

diagnosis—persist for months or years: Evaluate depres-

sive symptoms on two continua—how severe and how

chronic the symptoms are—rather than with the current

categorical system of whether or not symptoms meet the

criteria (Klein, 2008).

What distinguishes depression from simply “having the blues”? One distin-

guishing feature is the number of symptoms. People who are sad or blue generally

have fewer than fi ve of the symptoms listed in the DSM-IV-TR diagnostic criteria

for a major depressive episode (see Table 6.2). In addition, someone who is truly

depressed has severe symptoms for a relatively long period of time and is unable

to function effectively at home, school, or work. Moreover, pervasive hopelessness

and loss of pleasure are usually absent in normal sadness.

Major Depressive Disorder

According to DSM-IV-TR, once someone’s symptoms meet the criteria for a ma-

jor depressive episode, he or she is diagnosed as having major depressive disorder

(MDD)—fi ve or more symptoms of an MDE lasting more than 2 weeks. Thus, once

Kay Jamison had her fi rst major depressive episode, she had the diagnosis of MDD,

single episode. Unfortunately, more than half of those who have had a single depres-

sive episode go on to have at least one additional episode, noted in DSM-IV-TR

as MDD, recurrent depression. Some people have increasingly frequent episodes

over time, others have clusters of episodes, and still others have isolated depressive

episodes followed by several years without symptoms (American Psychiatric

Association, 2000; McGrath et al., 2006). Research suggests that periods of re-

mission last longer earlier in life. That is, as people with recurrent MDD grow older,

they are free of depression for increasingly shorter periods (American Psychiatric

Association, 2000).

MDD is very common in the United States: Up to 20% of Americans will

experience it sometime in their lives (American Psychiatric Association, 2000;

Kessler et al., 2003). Unfortunately, the documented rate of depression in the United

States in increasing (Lewinsohn et al., 1993), perhaps because of increased stressors

in modern life or decreased social support; in addition, at least part of this increase

may simply refl ect higher reporting rates. By 2020, depression will probably be

ranked second among disabling diseases in the United States (right after heart dis-

ease; Schrof & Schultz, 1999); it is currently associated with more than $30 billion

dollars of lost productivity among U.S. workers annually (Stewart et al., 2003).

Evidence also suggests that the risk of developing depression is increasing for

eachage cohort, a group of people born in a particular range of years. The risk

of developing depression is higher among people born more recently than those

born previously. In addition, if someone born more recently does develop depres-

sion, that individual probably will fi rst experience it earlier in life than someone in

an older cohort (American Psychiatric Association, 2000). Table 6.3 provides more

facts about MDD.

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Normal bereavement has characteristics that

are similar to symptoms of a major depressive

episode: sad thoughts and feelings, problems

in concentrating, and changes in appetite and

sleep. However, bereaved people are not gener-

ally overcome with feelings of hopelessness or

anhedonia.

Major depressive disorder leads to lowered pro-

ductivity at work—both from missing days at work

and from presenteeism, being present at work

but less productive than normal (Adler et al.,

2006; Druss, Schlesinger, & Allen, 2001; Stewart

et al., 2003). For people whose jobs require high

levels of cognitive effort, even mild memory or

attentional diffi culties may disrupt their ability to

function adequately at work.

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