Chapter 40
Mood, Anxiety, ADHD & Insomnia
Mood, anxiety, ADHD and sleep in one chapter
Major Depressive Disorder — Defined
Major depressive disorder (MDD) is a mood disorder in which the patient has one or more episodes of major depression but has NO history of mania, mixed, or hypomanic episodes. A major depressive episode requires at least FIVE persistent symptoms for at least 2 weeks.
MDD is unipolar: depression without any history of mania or hypomania. If a manic or hypomanic episode has ever occurred, the diagnosis is bipolar, not MDD — a distinction that completely changes treatment. Diagnosis uses DSM-IV-TR: at least five symptoms for at least 2 weeks, causing social or occupational impairment, not explained by a medical condition or substance.
The MDD vs Bipolar Line
The single fact that defines MDD is the ABSENCE of any manic/hypomanic history. Always screen for past mania before starting an antidepressant — giving an antidepressant to an undiagnosed bipolar patient can trigger mania.
📖 “MDD: one or more major depressive episodes, no history of mania/mixed/hypomania. Episode = >=5 symptoms >=2 weeks, impairs functioning, not medical/substance.”