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Paul Amos

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Your input is requested on UK CRS request to remove the synonym 'depressive episode' from 35489007 |Depressive disorder (disorder)|: https://request.ihtsdotools.org/#/requests/view/743345


Reference provided: https://www.verywellmind.com/what-is-a-major-depressive-episode-379847

The definition provided in the CRS request ("a depressive episode is a period of depression that persists for at least two weeks") closely matches the ICD-11 description for a 'Single episode depressive disorder' :
https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f578635574

We would be grateful for your opinion

Contributors (5)

17 Comments

  1. Laura Fochtmann

    I certainly wouldn't use a reference from verywellmind.com to support a change in synonyms.   However, I do think that the request to remove this as a synonym is reasonable.

    Depending on how various mappings are set up, having "depressive episode" as synonymous with "depressive disorder" could lead to inaccuracies.  

    If you have a current depressive episode (as defined in the ICD description or DSM), you will have some sort of mood disorder diagnosis.  The problem is that it could be:

    • Single episode depressive disorder
    • Recurrent depressive disorder
    • Bipolar type I disorder 
    • Bipolar type II disorder

    Thus, a depressive episode implies that you have a mood disorder but it doesn't mean that you have a depressive disorder or a single episode depressive disorder.

    There may be times when it's clear that someone has a depressive episode but you've not been able to get enough longitudinal history to determine, which of the above disorders is present.  So it's not unreasonable to have a way to document depressive episode without having to be more specific. 




  2. Paul Amos

    Hi Laura Fochtmann , many thanks for your constructive feedback.

    We do not currently have a stand alone concept 'depressive episode'. As you have suggested that it might be helpful to record this as an interim measure until a formal diagnosis can be made, would you consider this to be labelled as a 'disorder' or a finding/situation'?

    1. Laura Fochtmann

      I wouldn't view a depressive episode as a disorder, in and of itself.  It's not really a finding either but I think it's closer to being a finding than a disorder.  Also, grouping it with disorders will lead to errors in inferences and hierarchy as noted already above.

  3. Vikas Gaur

    Hello Paul,

    I totally agree with Laura here. Depressive episode can occur in patient suffering from Major Depression as well as in patients suffering from Bipolar Type l or Bipolar Type ll Disorder also. Therefore it should not be used as a synonym for Depressive disorder.

    In my view, it can be included under children category as a disorder.

    Depressive disorder (disorder)

    SCTID: 35489007

    Children

    Depressive episode (disorder)

    Recurrent Depressive Disorder (Recurrent depressive disorder is characterized by a history or at least two depressive episodes)

    1. Laura Fochtmann

      See my remarks above.  I don't view depressive episode as a disorder and think that confuses matters.

      1. Vikas Gaur

        Laura, that is the main reason why Depressive episode can be included under children category but not as a synonym.

        If a patient has a history of depressive episode, this imply that patient suffered from depression (a disorder) in past. It does not matter whether currently, his diagnosis is Bipolar disorder or Major Depression.

        Depressive Disorder is a primitive term and has 33 children as mentioned below. In my view, both depressive episode (Single Depressive episode) and Recurrent Depressive Disorder (> 2 Depressive episodes), can be added under children category (disorder).


        Children (33)


        1. Laura Fochtmann

          These don't seem like they should all be children of depressive disorder.  Indeed, "on examination-depressed" shouldn't be a disorder at all, as it is a finding. Other aspects of this hierarchical tree also seem to need revision.

          The fact that a depressive episode can be part of multiple disorders implies that it's not a disorder in and of itself.  If the patient has a history of a depressive episode, it implies that they had some sort of mood disorder (or affective disorder depending on what your preferred term is) but doesn't identify which one. Yet it's very important clinically and  for research to identify which disorder the patient has (i.e., bipolar disorder vs. depressive disorder) rather than calling any depressive episode a disorder.  

          1. Vikas Gaur

            I agree that the list requires a revision and also on examination-depressed should be a finding and not a disorder but that is not what we are discussing here. 

            @ Laura -"The fact that a depressive episode can be part of multiple disorders implies that it's not a disorder in and of itself."


            There are certain obvious differences between ICD 10 and DSM V. This request to remove the synonym 'depressive episode' is from U.K where ICD 10 is being used.

            ICD 10 does not have any Depressive Disorder category as such but ICD 10 has a Depressive episode (F 32) category which is further classified as

            F 32. 0 - Mild depressive episode

            F 32. 1  - Moderate depressive episode

            F 32.2 - Severe depressive episode

            F 32.3 - Severe depressive episode with psychotic symptoms

            F 32.8 - Other depressive episodes

            F 32.9 - Depressive episode, unspecified.

            So according to ICD 10 - Depressive episode is a disorder.


            According to ICD 11 - The new category are as follows. You can find the word episode mentioned here also.


            Depressive disorders  




            		 6A70 Single episode depressive disorder  




            		 6A71 Recurrent depressive disorder  


            6A70 Single episode depressive disorder - Single episode depressive disorder is characterized by the presence or history of one depressive episode when there is no history of prior depressive episodes. A depressive episode is characterized by a period of almost daily depressed mood or diminished interest in activities lasting at least two weeks accompanied by other symptoms such as difficulty concentrating, feelings of worthlessness or excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, psychomotor agitation or retardation, and reduced energy or fatigue. There have never been any prior manic, hypomanic, or mixed episodes, which would indicate the presence of a bipolar disorder.


            @Laura - "Yet it's very important clinically and  for research to identify which disorder the patient has (i.e., bipolar disorder vs. depressive disorder) rather than calling any depressive episode a disorder.  "

            I agree, and that is why, we can use term depressive episode under children category. The Parent diagnosis could be "Depressive Disorder" or "Bipolar Affective Disorder". This will help the researcher in identifying which disorder the patient has in a much better way and will also help in recording the finer details.

  4. Piper Allyn Ranallo

    Based on the above discussion and confusion about how the depressive disorder concept is currently modeled in SNOMED, it seems to make sense for the CRG to review this sub-hierarchy and related concepts before making a final decision.  I will add this topic to the agenda for today's (Aug 19, 2019) meeting.

    Clarification:  The goal will be to decide  how the concept |Depressive episode| should be represented in SNOMED. We have consensus that 'depressive episode' is not synonymous with |Depressive disorder| - we need to determine whether a concept for depressive episode currently exists in SNOMED with a different FSN. This information will help the terminologist make the necessary changes when they remove the term as a synonym for |Depressive disorder|.

  5. Paul Amos

    Hi Piper,

    Many thanks indeed for progressing this query.

    Kind regards

    Paul

  6. Paul Amos

    Hi Piper Allyn Ranallo


    Jim has asked that i pass on this message regarding the semantic tag for "depressive disorder": "Depressive episode is almost by definition an occurrence and is thus a finding."

    1. Piper Allyn Ranallo

      Paul Amos and Jim Case - 

      Laura Fochtmannsaid the same thing when we discussed this - that depressive episode will be a finding, not a disorder.  Sounds like we're all on the same page on this one!




  7. Piper Allyn Ranallo

    Laura Fochtmann, Michael First, et al:

    Per discussion, proposing new concept "Depressive episode (finding)" in the clinical finding hierarchy under mood findings as an immediate child (subtype) of "depressed mood (finding)" as follows

    Per discussion, the essence of a depressive episode - and the thing that distinguishes it from a depressive mood state (depressed mood) -  is that it is not transient and is always and necessarily associated with additional findings (either cognitive, physical, or other emotional).  

    Questions for clinicians/scientists: 

    • Does the finding 'lack of interest/pleasure' always and necessarily reflect something going on with the motivation/drive function? 
    • Does the construct 'mood function' include motivation function or does it refer only to 'feeling' states?– i.e., is a mood function always and necessarily also a motivation function, or are these two distinct functions? 
    • Is a depressive mood episode qualitatively different from a depressive mood state, or is the difference primarily one of duration and severity? 

      Question for Paul Amos- the thing that differentiates 'depressed mood' from 'depressive episode' is duration (it's not a transient state, lasts >= 2 weeks) and is always and necessarily associated with either cognitive, physical, or other emotional symptoms.  What is the best way to capture this meaning in the definition (is it possible)?


  8. Paul Amos

    Hi Piper Allyn Ranallo, thank you for your query.

    As you will know our modelling environment does not currently enable us to model the duration or state >= to XXX.

    In addition where the 'always and necessarily associated with' components involve a choice of criteria we are not able to model this either.

    I would propose that we add the definition of each of 'depressed mood' and 'depressive episode' to each concept adding that where additional criteria are required to confirm the diagnosis, such as cognitive, physical, or other emotional symptoms, these should be recorded as separate observables/findings concepts along with the diagnosis.

  9. Nicola Ingram

    Hello Piper Allyn Ranallo

    Can you update me on the status of this query - is this resolved per decision to add  "Depressive episode (finding)" in the clinical finding hierarchy under mood findings as an immediate child (subtype) of 366979004 |Depressed mood (finding)|.

    If so, I will author the new concept and progress my CRS request https://request.ihtsdotools.org/#/requests/view/743345


    Thank you for your input and detailed discussion,

    Nicki

  10. Nicola Ingram

    I have now authored a new term into the International version of SNOMED CT for the July 2020 release: 871840004 |Depressive episode (finding)|

    Many thanks.

  11. Piper Allyn Ranallo

    Terrific!

    Thanks Nicola!