A. A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by depressed mood or markedly diminished interest or pleasure in all, or almost all, activities.

B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

C. The disturbance is not better explained by another mental disorder (e.g., adjustment disorder, with depressed mood, in which the stressor is a serious medical condition).

D. The disturbance does not occur exclusively during the course of a delirium.

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Coding note: The ICD-10-CM code depends on the specifier.

[DSM-5-TR] Diagnostic Criteria for Depressive Disorder Due to Another Medical Condition 

Causality (etiology) is the most important variable for diagnosis. 
Associated conditions include: 

- Autoimmune disorders like  systemic lupus erythematosus, and deficiencies of certain vitamins, such as vitamin B12
- Endocrine conditions like Cushing’s syndrome and hypothyroidism
- Focal lesions such as cerebrovascular accident (CVA), Traumatic brain injury (TBI), and neoplasm 
- Huntington’s disease
- Multiple sclerosis
- Parkinson’s disease

Associated Features of Depressive Disorder Due to Another Medical Condition

Sex differences in prevalence depend somewhat on the sex difference associated with the medical condition i.e. common conditions for men and women.

Prevalence of Depressive Disorder Due to Another Medical Condition

Other possible disorders that could be causing symptoms include:

- Depressive disorders not due to another medical condition

- Medication-induced depressive disorder

- Delirium and major or mild neurocognitive disorder

- Adjustment disorders

- Demoralization

Differential Diagnosis to Depressive Disorder Due to Another Medical Condition

For CVAs, onset of depression can be acute (stroke) or weeks to months following the accident. 

Static brain injuries and other central nervous system diseases, mood symptoms may be episodic 

With Parkinson’s disease and Huntington’s disease, depression often precedes major motor and cognitive impairments.

In Cushing’s syndrome and hypothyroidism, depression can be an early symptom.

In pancreatic cancer, depression often precedes other features.

Development and Course of Depressive Disorder Due to Another Medical Condition

Depression is more likely to happen shortly after a CVA (stroke).
The location of the lesion in the brain is strongly linked to the risk of depression. Left frontal strokes pose the greatest risk, while right frontal lesions have the least risk. However, a lack of association  between the location of the brain lesion and the side of the brain it occurred on with depression that happens 2 to 6 months after a stroke suggests that later onset may be caused by different things, such as a major depressive disorder, adjustment disorder, or feeling demoralized.


Parkinson's disease and traumatic brain injury (TBI) can also increase the risk of depression.
In Parkinson's disease, early onset, severe motor symptoms, and longer disease duration are associated with depression.


In TBI, depression is more likely in women with prior history of depression, early psychiatric symptoms following the injury, lower brain volume, and unemployment.

Risk and Prognostic Factors of Depressive Disorder Due to Another Medical Conditon

Contributing factors include:
- Sex- and Gender-Related Issues

Related Diagnostic Issues of Depressive Disorder Due to Another Medical Condition

Biological markers depend on the underlying medical condition. For example, steroid levels in blood or urine can support the diagnosis of Cushing's disease, which is associated with manic or depressive syndrome.

Diagnostic Markers of Depressive Disorder Due to Another Medical Condition 

Medical conditions that are associated with the cause of depressive disorder due to another medical condition are called comorbid conditions. Individuals with various medical conditions, such as Cushing's disease, can experience delirium before or alongside depressive symptoms. It is common for individuals with depressive disorders, regardless of their cause, to also experience symptoms of anxiety, which are usually generalized.

Comorbid Diagnosis to Depressive Disorder Due to Another Medical Condition

Complications from pre-existing conditions like chronic illness can lead to the development of a Depressive Disorder Due to Another Medical Condition, which is a prominent and persistent period of low mood and interest. 

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The DSM-5-TR separates Depressive Disorders into the following specific disorders: 
- Disruptive Mood Dysregulation Disorder
- Major Depressive Disorder (MDD)
- Persistent Depressive Disorder (Dysthymia)
- Premenstrual Dysphoric Disorder
- Substance / Medication-Induced Depressive Disorder
- Depressive Disorder Due to Another Medical Condition
- Other Specified Depressive Disorder
- Unspecified Depressive Disorder
- Unspecified Mood Disorder
- Specifiers for Depressive Disorders


[DSM-5-TR] List of Depressive Disorders 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., Text revision). https://doi.org/10.1176/appi.books.9780890425596

DSM-5-TR

Disruptive Mood Dysregulation Disorder is primarily characterized by chronic, severe, and persistent irritability that manifests in temper outbursts and/or persistent irritable and angry moods amongst children and adolescents. These symptoms are present in a non-episodic format and are consistently present in the individual as opposed to going through episodic bouts of anger and irritability. 

Disruptive Mood Dysregulation Disorder

Major depressive disorder is a type of depressive disorder characterized by distinct episodes involving deep sadness and a loss of interest or enjoyment in previously pleasurable activities, among other related symptoms.

Major Depressive Disorder

Premenstrual Dysphoric Disorder or PMDD is categorized as a mood disorder. It is marked by a slew of symptoms that occur the week prior to the start of menses. Its existence as a disorder and its inclusion in the DSM is highly controversial. 

Premenstrual Dysphoric Disorder

A disorder that occurs when a specific substance causes depressed mood or markedly diminished interest or pleasure in all, or almost all, activities due to its physiological effects. 

Substance/Medication-Induced Depressive Disorder

Depressive Disorder Due to Another Medical Condition

Persistent depressive disorder, also known as dysthymia, is a depressive disorder identified by a long-term, chronic state of sadness.

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