Rosh Psychiatry Board Practice Exam

What symptom is essential for diagnosing major depressive disorder?

1. Depressed mood in response to an identifiable stressor

2. Thoughts of worthlessness or excessive guilt nearly every day for at least one month

3. Loss of interest or pleasure in most activities, nearly every day for at least two consecutive weeks

4. Depressed mood most of the day, nearly every day for at least two consecutive months

The correct answer is: Loss of interest or pleasure in most activities, nearly every day for at least two consecutive weeks

The diagnosis of major depressive disorder requires the presence of specific symptoms, and loss of interest or pleasure in most activities, known as anhedonia, is one of the key features. To meet the diagnostic criteria, this symptom must be experienced nearly every day for at least two consecutive weeks. This duration is important, as it reflects a significant change from previous functioning. The concept of anhedonia is crucial because it underscores a fundamental aspect of depression; patients may continue to feel emotionally numb or indifferent, even toward activities they once enjoyed. This symptom is often a reliable marker for identifying the severity and impact of depression on a person’s life. In contrast, while symptoms such as feelings of worthlessness or excessive guilt can contribute to the overall picture of major depressive disorder, they do not constitute the defining characteristic necessary for diagnosis. Similarly, symptoms induced by identifiable stressors or those lasting for shorter periods do not align with the core diagnostic requirements. The focus on prolonged loss of interest emphasizes the chronic nature of the disorder, distinguishing it from other mood disturbances.