Section 08about 6 min · no rush

A gentle note before you read: symptom lists make almost everyone recognise themselves somewhere. That is a normal effect of reading, not a diagnosis. If something here sits on your mind, a conversation with a professional helps more than re-reading.

08

Depressive disorders

The curriculum's second named type of mental illness, and a leading cause of disability worldwide.

If you or someone you love is thinking about death or suicide: call 1166 or 1660 012 1600 now, or 112 / 100 in an emergency. Asking about it directly is safe, and it helps.

Major Depressive Disorder (MDD)

CTEVT PSC curriculum296.2x/3x · F32–F33

At least two weeks of depressed mood or loss of pleasure, plus enough companion symptoms to reach five.

In plain words: Two weeks or more of feeling low or empty, or losing interest in everything, with sleep, appetite, energy and hope all worse.

DSM-5 Criteria
  1. 5 or more of the 9 symptoms below, during the same 2-week period, a change from before, and at least one is (1) depressed mood or (2) anhedonia.
  2. Clinically significant distress or impairment.
  3. Not attributable to a substance or medical condition.
  4. Not better explained by a schizophrenia-spectrum disorder.
  5. There has never been a manic or hypomanic episode (if there has, the diagnosis is bipolar disorder).

Key specifiers: with anxious distress · with melancholic features · with psychotic features · with peripartum onset (pregnancy or within 4 weeks of delivery: "postpartum depression") · with seasonal pattern. Severity: mild / moderate / severe.

International

WHO ranks depression among the leading causes of disability worldwide: over 330 million people affected. Women are affected about 1.5 times as often as men. The "with peripartum onset" specifier matters everywhere: postpartum depression affects more than 1 in 10 mothers globally and is routinely missed.

Nepal

The Nepali client says "man dukhcha", "man bhari bhayo", "jiu galyo": the heart-mind hurts, the body has wilted, not "I am depressed". Suicide is the sharpest edge: studies since the 2008/09 maternal mortality review have repeatedly flagged suicide as a leading cause of death among Nepali women of reproductive age. The National Mental Health Survey 2020 found major depressive disorder in 2.9% of adults at some point (95% CI 2.3 to 3.7) and in 1.0% currently; most are never counted. See Nepal in numbers for the full figures.

Every depression assessment includes a direct, calm suicide question: asking does not plant the idea. Watch new mothers especially: family attention goes to the baby, and the mother's withdrawal is read as tiredness.

Persistent Depressive Disorder · and the bipolar boundary

CTEVT PSC curriculum300.4 · F34.1

Persistent depressive disorder (dysthymia): depressed mood most of the day, more days than not, for 2 years or more (1 year in children or adolescents, where mood can be irritable), with 2+ of the following.

Symptoms include: poor appetite or overeating, insomnia or hypersomnia, low energy, low self-esteem, poor concentration or indecisiveness, and hopelessness. Never symptom-free for more than 2 months. The client who says "I have been like this my whole life."

A manic episode (at least one week, or any duration if hospitalised) makes it Bipolar I; a milder hypomanic episode (at least four days, no marked impairment) plus major depression makes it Bipolar II.

Antidepressants alone can flip an unrecognised bipolar client into mania: this question is a safety question, and a referral trigger.

Low mood "nothing feels worth it" Less activity stay in bed, cancel, scroll Fewer good moments no mastery, no pleasure Guilt & self-blame "I am lazy, useless" behavioural activation breaks it here one small activity, scheduled, done regardless of mood Action does not wait for motivation; in depression, motivation follows action
The depression spiral. Each link feels reasonable from inside ("I will go out when I feel better"), yet each turn tightens the next. Behavioural activation attacks the easiest link to move: the activity, not the mood; the steps a counselor uses are on Techniques step by step.
A skill to try · two minutes

One tiny scheduled action. Pick something five minutes small: wash one cup, step onto the balcony, message one person. Give it a time ("after tea") and do it whether or not the mood agrees; the spiral diagram above shows why action comes first. Tonight, name one thing that went okay.

A coping skill, not a treatment: it supports care, it does not replace it.

A worked example: A 32-year-old named Sita, a mother of two, has lost interest in playing with her children and feels most drained in the afternoons. Her counselor confirms that low mood, poor sleep, and loss of pleasure have lasted over three weeks, meets the five-symptom threshold, and rules out bipolar disorder before beginning treatment.

Key points
  1. Depression is at least two weeks of low mood or lost pleasure plus enough other symptoms to reach five, with daily life affected.
  2. Always ask about thoughts of death; asking never plants the idea, and it opens the door to help.
  3. Behavioural activation (small planned activity) and talking treatments work; in Nepal it often shows as aches, tiredness and 'man dukhcha'.
Quick check

Three friendly questions to settle what you just read. This is reassurance, not a test: a wrong tap is part of learning, and you can try again.

MDD requires how many of the nine symptoms, for how long?

Before calling it depression, always ask about:

Asking a client directly about suicide:

Learn more

Pick one, not all: these are chosen to be light, not exhaustive.

Video · 4 minWhat is depression? (TED-Ed, Helen Farrell): The clearest four minutes on MDD anywhere.
ArticleWHO fact sheet: Depression; Global burden and treatment gap in two pages.
Book chapterFeeling Good (David Burns): ch. 1–3: CBT for depression, written for the client; easy read.
DocumentaryStephen Fry: The Secret Life of the Manic Depressive; The bipolar boundary, lived; pairs with the callout above.

In the flow? The next chapter is one click below. Tired? Stopping here is also progress.