Depression or adjustment disorder with depressed mood?

In the presence of depressed mood accompanied by symptoms, diagnoses of major depression or adjustment disorder with depressed mood may be performed.

The diagnosis of adjustment disorder applies when the depressed mood and other symptoms develop in response to a stressful situation and that the diagnostic criteria of major depression are not met. When the criteria for major depression are met, the latter diagnosis prevails.

Here are the diagnostic criteria of major depression according to DSM IV (1):
At least five of the following symptoms have been present for a period of at least two weeks, at least one of these symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

1. Depressed mood most of the day, nearly every day, as indicated by the subject or observed by others.
2. Markedly diminished interest or pleasure in all or almost all activities almost all day almost every day.
3. loss or significant weight gain in the absence of regime, or decrease or increase in appetite nearly every day.
4. Insomnia or hypersomnia nearly every day.
5. psychomotor agitation or retardation nearly every day (observable by others, not limited to subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate or indecisiveness, nearly every day.
9. Recurrent thoughts of death (not just fear of dying) recurrent suicidal ideation without a specific plan or suicide attempt or specific plan for committing suicide.

The criteria of adjustment disorder:

A. Development of symptoms in the emotional and behavioral records, in response to one or more factor (s) identified stress (s) during the three months following the occurrence of it (them).

B. These symptoms or behaviors are clinically significant, as evidenced by:

• a marked distress, higher than was expected in response to stressors
• a significant impairment in social or occupational (or school).

C. The stress-related disturbance does not meet criteria for another disorder (for example, major depression, post traumatic stress disorder, acute stress disorder) and is not merely an exacerbation of a preexisting condition (for example, a personality disorder).

D. The symptoms are not an expression of mourning.

E. Once the stressor (or its consequences) has disappeared, the symptoms do not persist beyond 6 months.

The DSM IV identifies six subtypes of the disorder, an adaptation that are determined by the most predominant symptoms:

• With Depressed Mood
• With anxiety
• With both anxiety and depressive mood
• With Disturbance of Conduct
• With disruption of both emotions (depression, anxiety) and behavior
• Unspecified