Depressive Disorder Due to Another Medical Condition

Primer

Depressive Disorder Due to Another Medical Condition is a mood disorder diagnosis where there is a prominent and persistent period of depressed mood or markedly diminished interest/pleasure thought to be related to the direct physiological effects of another medical condition.

Epidemiology
  • The epidemiology of this diagnostic label is not well understood, but rates depend on the specific medical condition.
Prognosis
  • The overall prognosis depends on the medical condition that is contributing to the depressive disorder.
Risk Factors

DSM-5 Diagnostic Criteria

Criterion A

A prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all, or almost all, activities that predominates in the clinical picture.

Criterion B

There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

Criterion C

The disturbance is not better explained by another mental disorder (e.g. - adjustment disorder, with depressed mood, in which the stressor is a serious medical condition).

Criterion D

The disturbance does not occur exclusively during the course of a delirium.

Criterion E

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specifiers

Specifier

Specify if:

  • With depressive features: Full criteria are not met for a major depressive episode.
  • With major depressive-like episode: Full criteria are met (except Criterion C) for a major depressive episode.
  • With mixed features: Symptoms of mania or hypomania are also present but do not predominate in the clinical picture.

Approach

Differential Diagnosis

  • Depressive disorders not due to another medical condition
    • Determination of whether a medical condition accompanying a depressive disorder is causing the disorder depends on:
      • The absence of an episode(s) of depressive episodes prior to the onset of the medical condition
      • The probability that the medical condition has a potential to cause a depressive disorder
      • The course of the depressive symptoms after the development of the medical condition, and whether the symptoms also remit when the medical disorder is treated or remits.
  • Medication-induced depressive disorder
    • An important caveat is that some medical conditions that are treated with medications (e.g. - steroids or alpha-interferon) can also induce depressive or manic symptoms. This can complicate the clinical picture and make diagnosis challenging. In these cases, expert clinical judgment or longitudinal evaluation is the best way to make the diagnosis.
  • Adjustment disorders
    • The diagnosis of a medical condition is in itself a major life stressor that could bring on either an adjustment disorder or an episode of major depression, as opposed to the underlying pathophysiology of the medical condition itself.

References

1) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.