Diagnosing Depression With the ICD-10 Classification System

Two different classification systems are currently in place to help health care providers to diagnose depression. In the US, most clinicians use the Diagnostic and Statistical Manual of Mental Disorders – DSM-5 text revision (DSM-5-TR). The DSM is used only to diagnose mental health conditions.

The second system is used internationally and can diagnose physical and mental health conditions. This system is called the International Classification of Diseases-10 (ICD-10).

The ICD-10 medical classification system was created by the World Health Organization (WHO) in 1990. Today, that system is used in 35 countries.

How Does the ICD-10 System Work?

A code is generated for each diagnosis in the ICD-10 database. The codes are used to bill insurance companies. The DSM does not generate diagnostic codes. Rather, it uses those provided by the ICD-10.

Diagnosing Depression

Features of depression in the ICD-10 are based on a concise set of symptoms and attributes. If a patient has those markers, they are diagnosed with the corresponding depressive disorder and assigned an appropriate code.

To meet the standards for depression ICD 10, patients must have a minimum of five predetermined symptoms for 14 days or more:

  • Chronic emotional pain most of the day every day
  • Loss of pleasure in living or a lack of interest in daily life
  • A perpetually gloomy mood
  • Unintentional weight loss or weight gain
  • A wildly fluctuating appetite almost every day
  • Unable to sleep or sleeping all day
  • Feeling either agitated or lethargic most of the time
  • A lack of energy and a lot of deep fatigue almost all day and almost every day
  • Near-chronic inability to make important decisions or to focus on pressing matters
  • Excessive, inappropriate guilt or feelings of worthlessness almost every day
  • Ongoing thoughts of death. Attempting suicide or drawing up a clear-cut plan to commit suicide

Diagnosing Depression With the ICD-10

Major depressive disorder (MDD) and dysthymic disorder are two common conditions that can be coded according to the ICD-10 criteria.

Major depressive disorder

Major depressive disorder is considerably more severe than dysthymic disorder. To receive a diagnosis of MDD in the ICD-10, an individual must have at least five of the above symptoms for at least two weeks.

The person must also be feeling either a loss of pleasure or a lack of interest in life. People with major depressive disorder typically suffer from unremitting despair.

Dysthymic disorder

Also known as persistent depressive disorder (PDD), dysthymic disorder is a less intense but longer-lasting form of depression.

To receive this diagnosis, a person must have had five of the characteristics listed above for two years or more. The attributes of PDD include a persistently hopeless mood, a lack of interest in life or an inability to feel pleasure.

PDD can be difficult to diagnose. People with this condition may believe that their symptoms are normal because it’s all they know. These individuals might not even realize they have a mental health disorder.

How the ICD-10 Depression Attributes Are Used

The ICD-10 depression markers are used for the following purposes:

  • To diagnose depression
  • To gather research data about the prevalence of depression
  • To track the course and outcome of depression
  • To help clinicians develop more effective treatment plans
  • To determine the efficacy of a treatment

Can the ICD-10 System be Used for Diagnostics?

The ICD-10 criteria for depression can enhance a clinician’s understanding of the patient’s condition. It can reveal additional information for diagnostic purposes.

However, these findings are only one piece of the puzzle, not the whole picture. More data must be collected from the patients using diagnostic assessment tools like interviews and questionnaires for a proper diagnosis.

The ICD-10 depression markers are not perfect. They have limitations. One drawback is that the system does not account for all possible depressive symptoms. The system can also misdiagnose patients who do not have depression.

The criteria for depression are derived from self-reporting patients. To be effective, the patients must accurately assess and communicate their symptoms. Unfortunately, some depressed people don’t even realize that they’re depressed. They only know that something is wrong.

It’s important for mental health professionals to understand that the ICD-10 classification system is just one tool among many that clinicians have at their disposal.

The ICD-10 classification system can be used to assess the condition of a depressed patient with at least some degree of accuracy.

What Are the Five Categories of Depression?

There are quite a few different categories and diagnoses for depression. Even so, they can all be broken down into five basic types. Each type has its own set of attributes and risk factors.

1. Major depression

This is the worst kind of depression. People with major depressive disorder live in a paralyzing and unremitting state of despondency and despair. Many of these people had happy and fulfilling lives before they were diagnosed with this condition.

Depressed individuals often lose interest in all the things they used to love. They might abandon their hobbies, avoid their friends and worry their loved ones.

These individuals frequently experience a deep and crushing lethargy that makes it hard to even walk across a room. Poor self-esteem is a common characteristic of major depression.

2. Persistent depressive disorder (PDD)

PDD, also called dysthymia, earned its name because it doesn’t give up. Other depressive disorders may come and go or only come on occasion. Persistent depressive disorder is basically always there.

The symptoms of PDD are ever-present in one form or another, and they usually persist for at least two years. The only saving grace is that the symptoms are relatively mild compared to those of major depression.

In spite of an ongoing depressive disorder, individuals with PDD can function reasonably well when carrying out the tasks of daily living. However, they don’t enjoy it very much.

Bipolar disorder

3. Bipolar disorder

Bipolar disorder used to be called manic-depressive disorder. As the name suggests, bipolar disorder is a condition in which person’s mood or energy shifts back and forth between states of intense activity and excitement and states of gloomy black depression.

The manic aspect of this condition can express itself in promiscuous behavior, carelessness, risky activities, poor financial decisions, bad judgement and unnecessary shopping sprees.

The person may have excessive energy, grandiose ideas, racing thoughts and little need for sleep. However, the manic phase can sometimes deteriorate into erratic behavior, argumentativeness, irritability and hostility.

Feelings in the manic phase are much more enjoyable than feelings in the depressive phase. Unfortunately, the feel-good energy does not last. Sooner or later it runs out, and the person revisits the ever-present dreariness.

In the full-blown depressive phase, the symptoms are almost identical to those seen in major depressive disorder. The person may experience self-loathing and guilt. Extreme sadness, hopelessness and helplessness are common symptoms of the depressed phase of bipolar disorder.

The desire to be active disappears, and the person may want nothing more than to sleep away the painful feelings.

4. Seasonal affective disorder (SAD)

People with SAD experience mood changes in response to changing seasons. Seasonal affective disorder is most likely to occur in the fall and winter when the days are short, sunshine is limited and the temperatures are cold. Insufficient sunlight and low concentrations of vitamin D in the body may be to blame.

5. Postpartum depression

This mood disorder is more prevalent than you might think. Postpartum depression affects one in seven moms after they give birth. A woman might feel so unhappy, exhausted and anxious that it interferes with the tasks of daily living.

Postpartum depression

The prevailing theory of postpartum depression is that the dramatic decrease in hormone levels after baby is born are responsible for the sad, anxious and depressed feelings.

Chemical reactions in the brain may set off mood swings. Insufficient sleep can interfere with recovery from childbirth. Chronic exhaustion can easily result in feelings of depression.

New moms are most likely to experience postpartum depression if any of the following are true:

  • Mom has had symptoms of depression before, during or after a previous pregnancy.
  • Mom has had previous experience with depression or bipolar disorder unrelated to pregnancy.
  • Mom has experienced a stressful life event during pregnancy or soon after giving birth. The event can be the death of a partner, loss of a job, experiencing domestic violence or contracting a serious illness.
  • Mom has mixed feelings about the pregnancy and little emotional support.
  • Drugs and alcohol are abused in the home.

Are you depressed? Recreate Life Counseling can help you find out. Most types of depression are treatable with cognitive psychotherapy and antidepressant medication. There’s no reason to suffer when you don’t have to.