When we consider the symptoms in the DSM criteria for Major Depression, note that other diseases
could present with some of these symptoms.
So, we need to think about other potential explanations for the symptoms that the person
I want to focus on one particular exclusion Criterion though, which specifies that we
need to be sure that the symptoms are not able to be explained by the physiological
effects of a substance or another medical condition.
If there is reason to believe that a person’s symptoms may be explained by the direct physiological
effects of substance use or a medical condition, appropriate investigations (whether this be
a tox screen or blood tests) should be conducted to rule out these possible causes.
People might show symptoms such as change in appetite, change in sleep patterns, difficulty
concentrating, reduced interest in previously enjoyed activities, and/or persistent sense
of sadness as a result of a medical condition.
For example, weight loss with untreated diabetes or fatigue, as a consequence of cancer.
People might also demonstrate some of these symptoms as a direct result of substance use.
As with all of the mental illness diagnoses, we need to be mindful in thinking about, "Is
the diagnosis we are considering –– in this case, Major Depressive Disorder––
the most accurate way of explaining or thinking about this presentation?"
For the same reason, this criterion also asks clinicians to consider whether the symptoms
would be better explained as a response to loss or grief.
Loss can take many forms – it could be a death, it could be financial ruin or the end
of a relationship.
In the context of considering a diagnosis of Major Depression, we need to be very mindful
of the possibility that the symptoms might be better accounted for by grief.
The last thing we want to do is pathologise a very normal process by slapping a diagnostic
label on it.
In some cases, however, the presenting symptoms persist for a long period of time, and in
these cases, the grief may have become a depressive disorder.