Depressive Episode Quiz
Test your knowledge of the key symptoms and criteria of a major depressive episode. This quiz is for informational purposes only and is not a substitute for professional medical advice.
Major Depressive Episode (MDE): Practice Guide for Exam-Style Questions
Understanding the precise diagnostic criteria for a Major Depressive Episode (MDE) is crucial for clinical assessments and exams. This guide breaks down the core components, common areas of confusion, and key memory aids to help you master the material.
Defining the Core Symptoms: Mood and Anhedonia
To meet the criteria for MDE, at least one of two primary symptoms must be present nearly every day for two weeks. Think of these as the gatekeepers for the diagnosis. Without one of these, it’s not an MDE.
- Depressed Mood: This is more than just sadness. It’s a persistent low mood for most of the day. In children and adolescents, this can manifest as irritability.
- Anhedonia: A markedly diminished interest or pleasure in almost all activities. This is often described as a feeling of emptiness or being unable to enjoy things that were once pleasurable.
The Two-Week Duration Criterion
This is a firm rule. The cluster of symptoms must be present during the same two-week period. This distinguishes a clinical episode from a few bad days. The symptoms must also represent a change from the person’s previous level of functioning.
Counting to Five: The SIGECAPS Mnemonic
A total of five or more symptoms are required for a diagnosis (including one of the two core symptoms). A popular mnemonic to remember the main symptom categories is “SIGECAPS”.
- Sleep: Insomnia (difficulty sleeping) or hypersomnia (sleeping too much).
- Interest: Loss of interest or pleasure (anhedonia).
- Guilt: Feelings of worthlessness or excessive/inappropriate guilt.
- Energy: Fatigue or loss of energy nearly every day.
- Concentration: Diminished ability to think, concentrate, or make decisions.
- Appetite: Significant weight loss/gain (e.g., a 5% change in a month) or decrease/increase in appetite.
- Psychomotor: Observable psychomotor agitation (restlessness) or retardation (slowing down).
- Suicidality: Recurrent thoughts of death or suicidal ideation.
Understanding Psychomotor Changes
This symptom is unique because it must be observable by others, not just a subjective feeling. Psychomotor retardation involves slowed speech, thought, and body movements. Agitation involves purposeless, restless activity like pacing or hand-wringing.
Memory Aid: Remember that many symptoms of MDE are “either/or.” A person can have insomnia OR hypersomnia; weight loss OR weight gain; agitation OR retardation. This clinical variability is a common topic in exam questions.
Cognitive Symptoms: Concentration and Indecisiveness
Often called the “cognitive triad,” depressive symptoms heavily impact thinking. Patients report feeling “foggy” or unable to make simple choices. This is not just distraction; it’s a marked decline in executive functioning that can severely impair work or school performance.
Common Traps in MCQ Exams
Be prepared for questions that test your ability to differentiate MDE from similar states or to apply criteria precisely.
- Grief vs. MDE: While grief can include intense sadness, it’s typically characterized by feelings of emptiness and loss, often coming in waves. In MDE, the depressed mood and anhedonia are more persistent.
- Medical Rule-Outs: Always consider if symptoms are a direct physiological effect of a medical condition (like hypothyroidism) or a substance (like alcohol or certain medications).
- Ignoring Functional Impairment: The symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. A person with five symptoms who is still functioning perfectly does not meet the criteria.
- Forgetting the “Nearly Every Day” Clause: Most symptoms must occur nearly every day, not just a few times during the two-week period.
- Counting Symptoms Incorrectly: Ensure you have at least one of the two core symptoms plus enough others to total five or more.
FAQ: Common Diagnostic Questions
What’s the required total number of symptoms?
Five or more symptoms from the criteria list must be present during the same 2-week period. One of these must be either depressed mood or loss of interest/pleasure (anhedonia).
Can someone have depression without feeling sad?
Yes. A diagnosis can be made if the person experiences anhedonia (loss of interest/pleasure) as their core symptom, even if they don’t report a subjectively “sad” mood. This is particularly important for exams.
How is weight change counted as a symptom?
It can be a significant change in appetite or a change of more than 5% of body weight in a month when not dieting. Both an increase and a decrease qualify.
What is the difference between psychomotor agitation and retardation?
Retardation is a noticeable slowing down of thought, speech, and physical movement. Agitation is the opposite: an increase in restless, purposeless activity like pacing, fidgeting, or hand-wringing. It must be observable by others.
Does a recent loss or bereavement exclude an MDE diagnosis?
No. While grief is a normal response, if an individual meets the full criteria for an MDE (5+ symptoms, functional impairment) following a loss, a diagnosis can still be made. The clinical picture determines the diagnosis, not the context alone.
Why is functional impairment so important?
This criterion helps separate a clinical disorder from normal human sadness or distress. To be diagnosed, the symptoms must be severe enough to cause real problems in the person’s life, such as struggling at work, withdrawing from relationships, or being unable to manage daily responsibilities.
Key Takeaways for Diagnosis
To correctly identify an MDE in a clinical vignette or exam question, always check for these five points in order.
- Core Symptom Check: Is depressed mood OR anhedonia present?
- Duration Check: Have the symptoms been present for at least two weeks?
- Symptom Count: Are there a total of five or more symptoms from the list?
- Rule-Out Check: Are the symptoms better explained by a substance, medication, or another medical condition?
- Impairment Check: Is there clinically significant distress or impairment in functioning?
This content is for informational and educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
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