Depressive Disorder Due to Another Medical Condition DSM-5 293.83 (ICD-10-CM Multiple Codes)
DSM-5 Category: Depressive Disorders
Introduction
Certain medical conditions can lead to a state of depression in an individual; this depression is termed by the DSM-5 as depressive disorder due to another medical condition. For example, hypothyroidism – which can result in weight gain – can induce clinical, psychiatric depression (Duntas and Maillis, 2013). Among the criteria of depressive disorder due to another medical condition (hereafter referred to as “depressive disorder”), delineated by the DSM-5, is the disruption of normal activities like those related to one’s occupation. Depression can be caused by a wide range of factors, and it is inherent in several medical illnesses, such as bipolar disorder. Yet a principle diagnostic characteristic of depressive disorder is that it is not the result of some mental disorder; it is, instead, a consequence of medical conditions that are not always linked to depression. Depressive disorder, moreover, can make an appearance in various forms. In depressive disorder with mixed features, for instance, signs of mania or hypomania can be observed in the patient.
Depression can stem from a fairly broad spectrum of medical conditions, from brain injury to Huntington’s disease (American Psychiatric Association, 2013). The correlation between a given medical condition and a depressive state varies in significance, but there is strong evidence that links depression with particular medical complications. The onset of this disorder differs depending on the medical condition under consideration. For example, depression usually occurs at the beginning of Huntington’s disease, and indeed, it is often the initial psychiatric condition of the disease.
Symptoms of Depressive Disorder Due to Another Medical Condition
Symptoms of depressive disorder due to another medical condition are contingent on the medical complication that the individual has. Broadly speaking, however, the depression symptoms are similar to those found in other depressive disorders, such as bipolar and major depressive disorder. In seeking for symptoms of depressive disorder, the crucial step is to determine if the individual has a non-neuropsychiatric medical condition.
As one of the symptoms that follow from this disorder, the DSM-5 notes that individuals with depressive disorder are not likely to find interest in many activities that were previously enjoyed. Additionally, if the mood disorders occur when the patient does not have delirium, then a diagnosis of depressive disorder due to another medical condition may be warranted.
Comorbidity
The DSM-5 lists some of the comorbid pathologies associated with depressive disorder due to another medical condition. There is considerable evidence that Parkinson’s disease can induce a state of depression (Ossowska and Lorenc-Koci, 2013). Unfortunately, since depression is only one of the numerous psychiatric symptoms of Parkinson’s disease – such as dementia and sleep disorders – it is often obscured by these other symptoms and therefore not diagnosed and not treated. The percentage of Parkinson’s disease patients affected by depression has not been completed and indisputably established; figures vary widely, from 4% up to 90% (Ossowska and Lorenc-Koci, 2013). A general consensus, however, is that at least 30% of Parkinson’s disease patients have a depressive condition.
Patients with Huntington’s disease, too, frequently have a depressive disorder of some kind. Studies on the progression of depression in Huntington’s disease have shown that it is negatively correlated with the increasing onset of motor symptoms (van Duijn et al., 2014). It should be noted, however, that the decrease in depression with the rise in motor symptoms was not statistically significant and thus it is possible that this result is not entirely correct. Du et al. (2013) explored the question of the mechanisms of depression in Huntington’s disease, and found molecular factors that contributed to the onset of depression, including elevated levels of expression of brain-derived neurotrophic factors. Depression is frequently observed in Huntington’s disease patients (more than 50% of patients with Huntington’s disease also have depressive conditions), but strikingly, it may develop years before any motor symptoms of Huntington’s disease are present (Du et al., 2013). This makes depression due to Huntington’s disease difficult to diagnose, since depression may be evident before any medical condition can be detected.
A cerebrovascular accident, known as a stroke in everyday parlance, is often accompanied by depression (Espárrago Llorca et al., 2012), and in particular, it impacts over 30% of stroke patients, making it the most common psychiatric disorder that follows a stroke (termed “post-stroke depression”). Patients with post-stroke depression are at a higher risk of mortality than post-stroke patients who have no depression (at least 1 in 10 cases of post-stroke depression report suicide ideation), and hallmarks of post-stroke depression include social isolation and sleep complications.
Other medical conditions that result in clinical depression have been briefly discussed by the DSM-5; these include Cushing’s disease, brain injury, and multiple sclerosis. Interestingly, at least one study has suggested that depression is a comorbid symptom of sickle cell anemia (Mahdi et al., 2010).
Treatment for Depressive Disorder Due to Another Medical Condition
The peer-reviewed literature contains a number of therapeutic approaches for treating depression due to a medical condition. Some evidence suggests that cognitive-behavioral therapy could be effective in treating depression in Parkinson’s disease (Dobkin et al., 2011). The Dobkin et al. (2011) study was structured around weekly sessions of cognitive behavioral therapy, and included a control group that did not undergo such therapy. The cognitive behavioral therapy method used in this study focused on reorienting thought processes, implementing exercise, and training the individuals to more ably relax themselves. The authors are careful to point out, however, that the cognitive behavioral therapy approach may not be sufficient to address the needs of patients with more severe forms of depression.
Stalder-Lüthy et al. (2013) has highlighted another means to treat depression due to a medical condition. The authors of this study conducted a literature search and review in an attempt to determine if psychological interventions were indeed viable approaches to treating depression in brain injury patients. They concluded that psychological interventions were indeed appropriate methods for minimizing depression in acquired brain injury; however, their study was not able to discover which psychological intervention strategies worked best. Nonetheless, it demonstrated the possibility of using psychotherapeutic techniques to treat depression, as opposed to a complete reliance on medication.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Dobkin, R.D., Menza, M., Allen, L.A., Gara, M.A., Mark, M.H., Tiu, J., Bienfait, K.L., Friedman, J. (2011). Cognitive-behavioral therapy for depression in Parkinson's disease: a randomized, controlled trial. The American Journal of Psychiatry, 168(10), 1066-1074.
Du, X., Pang, T.Y., Hannan, A.J. (2013). A Tale of Two Maladies? Pathogenesis of Depression with and without the Huntington's Disease Gene Mutation. Frontiers in Neurology, 4, 81.
Duntas, L.H., Maillis, A. (2013). Hypothyroidism and depression: salient aspects of pathogenesis and management. Minerva Endocrinologica, 38(4), 365-377.
Espárrago Llorca, G., Castilla-Guerra, L., Fernández Moreno, M.C., Ruiz Doblado, S., Jiménez Hernández, M.D. (2012). Post-stroke depression: an update. Neurologia, Epub ahead of print.
Mahdi, N., Al-Ola, K., Khalek, N.A., Almawi, W.Y. (2010). Depression, anxiety, and stress comorbidities in sickle cell anemia patients with vaso-occlusive crisis. Journal of Pediatric Hematology/Oncology, 32(5), 345-349.
Ossowska, K., Lorenc-Koci, E. (2013). Depression in Parkinson's disease. Pharmacological Reports, 65(6), 1545-1557.
Stalder-Lüthy, F., Messerli-Bürgy, N., Hofer, H., Frischknecht, E., Znoj, H., Barth, J. (2013). Effect of psychological interventions on depressive symptoms in long-term rehabilitation after an acquired brain injury: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 94(7), 1386-1397.
van Duijn, E., Reedeker, N., Giltay, E.J., Eindhoven, D., Roos, R.A., van der Mast, R.C. (2014). Course of irritability, depression and apathy in Huntington's disease in relation to motor symptoms during a two-year follow-up period. Neurodegenerative Diseases, 13(1), 9-16.
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