Depressive Disorder E001

Current RMA Instruments:

Changes from previous Instruments:

ICD Coding:

• ICD-9-CM: 311

Brief description:

This is a family of mental disorder which has depressive symptoms as a predominant persistent core element. To be a mental disorder there must be a clinically significant distress or impairment in social, occupational, or other important areas of functioning. The depressive disorder family includes:

• Dysthymic disorder (minor depression) (ICD-10 F34.1)
• Persistent depressive disorder (ICD-10 F34.1)
• Major depressive disorder (ICD-10 F32.1)
• Recurrent major depressive disorder (ICD-10 F33.9)
• Depressive disorder NOS (ICD-10 F32.9)
• Mood disorder (being depression) due to a general medical condition (ICD-10 F06.3)
• Premenstrual dysphoric disorder (ICD-10 N94.3)
• Substance/medication – induced depressive disorder (ICD-10 F19)
• Alcohol– induced depressive disorder (ICD-10 F10)
• Opioid– induced depressive disorder (ICD-10 F11)
• Amphetamine– induced depressive disorder (ICD-10 F15)
• Cocaine– induced depressive disorder (ICD-10 F14)
• Hallucinogen – induced depressive disorder (ICD-10 F16)

Confirming the diagnosis:

A report from a specialist psychiatrist that conforms with the Repatriation Commission Guidelines for Psychiatric Compensation Claims is required for diagnosis.

The relevant medical specialist is a psychiatrist.

Additional diagnoses covered by these SOPs

• Agitated depression
• Depressive disorder due to another medical condition
• Double depression – infers presence of minor depression (dysthymia) and major depressive disorder.
• Dysthymic disorder (or dysthymia)
• Major depressive disorder
• Major depressive episode
• Minor depression
• Mood disorder (being depression) due to a general medical condition
• Other specified depressive disorder or unspecified depressive disorder 
• Persistent depressive disorder
• Premenstrual dysphoric disorder
• Recurrent major depressive disorder
• Substance/medication-induced depressive disorder

Conditions not covered by these SOPs   

• Adjustment disorder with depressed mood* - Adjustment disorder SOP
• Bipolar disorder type 1* - Bipolar disorder SOP
• Bipolar disorder type 2* - Bipolar disorder SOP
• Bipolar disorder*
• Cyclothymia* - Bipolar disorder SOP
• Cyclothymic disorder* - Bipolar disorder SOP
• Disruptive mood dysregulation disorder^# 
• Grief or Bereavement^#  -This is not a disease or injury but a normal psychological reaction.
• Reactive depression* - Adjustment disorder SOP
• Schizoaffective disorder^#      
• Somatic symptom disorder*                               

* another SOP applies  - the SOP has the same name unless otherwise specified

^# non-SOP condition

Clinical onset

The clinical onset of a depressive disorder will be when the required diagnostic criteria were first fulfilled (DSM-5-TR), which may be some time after relevant symptoms first developed - i.e. if initially some symptoms of depression were present, but they were insufficient to meet the diagnostic criteria, then the clinical onset of the depressive disorder cannot be taken at that early stage. It is only once the symptoms fulfil the criteria that onset has occurred.

Clinical worsening

The natural history of depressive disorder varies according to the type of disorder and the individual patient.

For major depressive disorder, DSM-5 states “The course of major depressive disorder is quite variable, such that some individuals rarely, if ever, experience remission, while others experience many years with few or no symptoms between discrete episodes”. “Recovery typically begins within 3 months of onset for two in five individuals with major depression and within 1 year for four in five individuals”. “The risk of recurrence becomes progressively lower over time as the duration of remission increases”.

For minor depressive disorder (dysthymia, or persistent depressive disorder), DSM-5 states “Persistent depressive disorder often has an early and insidious onset and, by definition, a chronic course”. “…depressive symptoms are much less likely to resolve in a given period of time in the context of persistent depressive disorder than they are in major depressive disorder”.

Further comments on diagnosis

• Substance/medication – induced depressive disorder (ICD-10 F19) – In this case DSM-5 states that the depressive symptoms are associated with the use of the substance but the depressive symptoms persist beyond the expected length of the physiological effects, intoxication or withdrawal period of the substance.
• Mood disorder (being depression) due to a general medical condition (ICD-10 F06.3) – In this case DSM-5 states that this diagnosis applies when “there is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition” such as hypothyroidism, brain disease such as Parkinson’s disease. Note that in some cases a mood disorder due to a general medical condition and an idiopathic major depressive disorder or adjustment disorder co-exist.
• Premenstrual dysphoric disorder (ICD-10 N94.3) – In this case DSM-5 states “Symptoms must have occurred in most of the menstrual cycles during the past year and must have an adverse effect on work or social functioning”, “however, the presence of physical and/ or behavioural symptoms in the absence of mood and/ or anxious symptoms is not sufficient for a diagnosis” and “symptoms are of comparable severity (but not duration) to those of another mental disorder, such as a major depressive episode or generalised anxiety disorder”. The prevalence of this disorder is between 1.8% and 5.8% when based on twelve month prevalence. It is different from premenstrual syndrome and dysmenorrhea.