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January 10, 2020

Optum | Major Depressive Disorder Algorithm

First determine if all of the following apply:

  • Symptoms do not meet criteria for a mixed episode (for example, bipolar disorder)
  • Symptoms cause clinically significant distress or impairment in social, occupational or other important areas of concern
  • Symptoms are not due to direct effect of a substance or another medical condition
  • Symptoms are no better explained by schizophrenia, delusional disorder, or other specified schizophrenia and psychotic disorders
  • Symptoms are not more appropriately classified as a response to a significant loss (that is, bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability)
  • Symptoms have been present during the same two-week period and represent a change from previous functioning
  • There has never been a manic episode or hypomanic episode

If all the above are true, move to the next section.

Must have one or both of these symptoms:

  • Depressed mood most of the day and nearly every day, self-reported or observed by others or
  • Markedly diminished interest or pleasure in all, or almost all, activities on most days, nearly every day, self-reported or reported by others

Must have either one or both of the above symptoms plus three or four of these to make a total of five or more symptoms:

  • Significant weight loss (not due to dieting) or gain (for example, 5% change in one month); or decrease or increase in
    appetite nearly every day
  • Insomnia or hypersomnia nearly every day
  • Psychomotor agitation or retardation nearly every day, observable by others
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day:
    • May be delusional
    • Not merely self-reproach or guilt about being sick
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day (self-reported or observed by others)
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide
    attempt or a specific plan for committing suicide

If you have a minimum of five total symptoms, your patient meets the requirement for the diagnosis of major depressive disorder per DSM-5.1.

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