Wiki Prolonged single episode of MDD

Messages
2
Location
Proctor, MN
Best answers
0
I am wondering what your thoughts are on a prolonged single episode of major depressive disorder versus recurrent. I have seen providers use the single episode for an extended period of time for a patient stating it is a prolonged episode.
 
The term "prolonged' is irrelevant here.

Major depressive disorder (as well as some other disorders) are classified as single episode or recurrent. An episode is considered recurrent when there is an interval of at least 2 consecutive months between separate episodes. During that interval, the criteria is not met for a major depressive episode.

Criteria for an episode of MDD is at least five of the following lasting at least two weeks: depressed mood, lost of interest or pleasure in most or all activities, insomnia or hypersomnia, significant weight loss or gain or decrease or increase in appetite, psychomotor retardation or agitation, fatigue or low energy, poor concentration, thoughts of worthlessness or guilt, and recurrent thoughts about death or suicidal ideation.

An episode is said to be "in partial remission" when some of the symptoms for the immediately previous major depressive episode are present, but full criteria are not met, or there is a period of less than two months without any significant symptoms of major depression. To be "in full remission", is no significant symptoms for two full months.

Example:

All of 2018, all of 2019, and for 2020, Jan, Feb, March - 6 symptoms present: Major Depressive Disorder, Single Episode, (severity)
April - 4 symptoms present: MDD, Single episode, in partial remission
May - no symptoms present: MDD, Single episode, in partial remission
June - no symptoms present: MDD, Single episode, in partial remission
July - still no symptoms. Now MDD, single episode, in full remission, because two full months have passed (May 1 thru June 30, for example).
August - 7 symptoms. Now MDD, recurrent episode, (severity)
 
However, if the patient is on, and has been on medication, they are not in full remission until they are off the medication. Also, can it be a single episode if the patient is on medication? The patient may not have any symptoms because they are on the medication. To me, that is considered recurrent. I am interested in your thoughts on this.
 
I wasn't thinking about psychiatry, I was thinking about psychology. Sorry about that assumption.

For psychiatry, an illness isn't gone because it is controlled with medication. Think about diabetes. If you're diabetic, then hopefully your diabetes is controlled with medication, but you're still diabetic. I would agree that they would not be in remission until they are off the medication, so would add that point to the information above.

However, alot of people have MDD and start with psychology. They may be recurrent while in psychology. When they get to psychiatry, because talk-therapy just isn't doing the job alone, then they are still recurrent based on history.

I've done some research (and I don't have a DSM-V book, so cannot check there), but I cannot find how the use of medication changes (or might change) the diagnosis. In absence of any other documentation/instruction to the contrary (and trust me, there is ALOT of bad info out there, including one document that said if the first visit was single episode then the followup visits were recurrent episode - NO. JUST NO!), I stand by the idea that in order to go from single episode to recurrent, there needs to be a complete break in treatment (medication), without symptoms, and then the symptoms return. Alot of people do this, by the way; they may take meds for a few years, feel better, stop taking them, then gradually the symptoms return after 6 months to a year. That then becomes recurrent.

Good luck!
 
Top