John Brown went to visit his physician complaining about a backache. According to medical records Mr. Brown had visited his physician about 2 weeks ago for the same backache, in which the physician had requested a series of scans and x-rays to see if their were any injuries. The scans and x-rays came back negative without any injuries and he was simply prescribed painkillers to sooth the pain. The physician had noticed in his medical records that since his last visit, 2 weeks ago, Mr. Brown had lost a remarkable 20 pounds. This was obviously very alarming to the physician because this was a sign that there could have been something physiologically wrong with Mr. Brown. Before preceding with any sort of treatment or diagnosis the physician asked Mr. Brown if he was under any sort of diet or stress that can possibly explain the rapid weight loss. Mr. Brown response to the physician was a series of symptoms he was feeling. He said he had recently lost his appetite, the backache had continued non stop, the pain medication was not helping, he felt fatigue and weak most of the day on a daily basis, had difficulty sleeping at night, would wake up 3 hours earlier than usual. He has also been frequently calling out sick of work due to his weakness, and is having a difficult time concentrating even on simple everyday task like showering, and has just had an overall feeling of “down in the dumps”. These symptoms that Mr. Brown spoke of were far from his usual behavior and lifestyle. Mr. Brown was retired and has dedicated the rest of his life to wood shop. He would go out for a game of pool. Overall he is in general good health and extremely social for a 69 year old retiree. A key statement that Mr. Brown made caught the attention of the physician. Mr. Brown stated the feeling of being “down in the dumps” which made the physician think that depression may be a key factor in Mr. Brown’s symptoms. The physician’s treatment was to send Mr. Brown to a consultation with a psychologist as soon as possible. On his first consultation it was clear to the psychologist that Mr. Brown was suffering from some sort of mood disorder. But narrowing down Mr. Brown’s specific disorder would take about 2 or 3 more session to fully understand what Mr. Brown was feeling and suffering. So Mr. Brown was schedule for 3 sessions in a two-week time frame. He would express all the symptoms he said to his physician and he would make it clear to his psychologist that he had no real interest in wanting to leave his house to assist his sessions. On her fourth visit Mr. Brown was diagnosed with a depressive disorder. And by his sixth he was clinically diagnosed with 296.2x Major Depressive Disorder, Single Episode. The psychologist with the help of the DSM-IV- TR diagnostic criteria determined this diagnosis for Major Depressive Disorder, Single Episode. Diagnostic Criteria for 296.2x Major Depressive Disorder, Single Episode
A. Presence of a single Major Depressive Episode: Five (or more) of the following symptoms have been present during the same two week period and represent a change from previous functioning; at least one the symptoms is either (1) depressed mood, or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly due to a general medical condition, or mood incongruent delusions or hallucinations.

1) Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g. feels sad or empty) or observation made by others (e.g. appears tearful). Note: In children and adolescents, can e irritable mood. 2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others) 3) Significant weight loss when not dieting or weight gain (e.g. a change of more than 5% of body weight in a month), or decrease or increase in