Regarding the diagnostic and treatment considerations in Major Depressive Disorder, all of the following statements are true EXCEPT:

Explanation

## DSM-5 Specifiers and Clinical Features in Major Depressive Disorder ### Correct Statements **Key Point:** Understanding MDD specifiers and their clinical implications is essential for appropriate risk stratification and treatment selection. | Specifier/Feature | Diagnostic Criteria | Clinical Implication | |-------------------|-------------------|----------------------| | **Psychotic features** | Delusions or hallucinations during mood episode | ↑ Suicide risk; requires antipsychotic + antidepressant | | **Melancholic features** | Loss of pleasure (anhedonia) + lack of mood reactivity | ↑ Severity; may respond better to TCAs/ECT than SSRIs | | **Seasonal pattern** | Onset/remission in specific season for ≥2 years | Treat with light therapy + antidepressants | | **Peripartum-onset** | Onset during pregnancy or within 4 weeks postpartum | ↑ Recurrence; continue medication postpartum | ### Why "Melancholic Features" Definition is INCORRECT **High-Yield:** Melancholic features are characterized by: 1. **Anhedonia** — loss of pleasure in all or almost all activities 2. **Loss of mood reactivity** — mood does NOT improve in response to positive events ~~Preserved capacity to feel pleasure~~ — This is the **opposite** of melancholia. Melancholic depression is defined by **inability to experience pleasure** and **lack of environmental responsiveness**. **Clinical Pearl:** Melancholic depression: - Typically responds better to biological treatments (TCAs, ECT) than to psychotherapy alone - Associated with neurovegetative symptoms (early morning awakening, diurnal mood variation, psychomotor changes) - Often requires higher antidepressant doses ### Why the Other Options Are Correct 1. **Psychotic features** — Psychotic MDD has higher suicide risk; antipsychotics are standard augmentation alongside antidepressants. 2. **Seasonal pattern** — DSM-5 requires ≥2 consecutive years of seasonal onset/remission; light therapy is first-line. 3. **Peripartum-onset** — High recurrence risk (50–80% if untreated); antidepressants should continue through postpartum period.