Major depression

The patient can experience many symptoms, both physical and mental. The DSM-IV diagnostic criteria for depression are outlined in the following boxed section. These criteria can be extended to include:

• a feeling of not being able to cope with life

• continual tiredness

• loss of sense of humour

• tension and anxiety

• irritability, anger or fearfulness

• somatic symptoms such as headache, constipation, indigestion, weight loss, dry mouth and unusual pains or sensations in the chest or abdomen

The symptoms may vary during the day, but are usually worse on waking in the morning. Some patients have psychotic features, usually only delusions but sometimes also hallucinations, and may be misdiagnosed as schizophrenic.

In practice the DSM-IV classification seems too rigid and the experienced doctor has to consider the global constellation of symptoms. Better management follows early diagnosis and intervention before the formal criteria for major depression develop.

DSM-IV diagnostic criteria for major depression

At least five of the following symptoms for 2 weeks (criterion 1 or 2 essential)


Depressed mood


Loss of interest or pleasure


Significant appetite or weight loss or gain (usually poor appetite)


Insomnia or hypersomnia (usually early morning walking)


Psychomotor agitation and retardation


Fatigue or loss of energy


Feelings of worthlessness or excessive guilt


Impaired thinking or concentration; indecisiveness


Suicidal thoughts/thoughts of death

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