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Medical Disability Advisor  >  Depression Major  >  Failure To Recover

Depression, Major

Related Terms

  • Clinical Depression
  • Depressive Psychosis
  • Endogenous Depression
  • Major Depressive Disorder
  • Psychotic Depression
  • Unipolar Depression

Specialists

  • Clinical Psychologist
  • Psychiatrist

Comorbid Conditions

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Factors Influencing Duration

Length of disability may be influenced by the severity of the illness, the presence of complicating factors such as substance abuse or suicide attempts, response to therapy, and job requirements. Only in the most severe and unusual cases should major depression result in permanent disability.

Substance abuse will complicate treatment and may significantly delay returning to work. Suicide attempts that lead to hospitalization will also be associated with longer periods of disability.

Duration Trends from Reference Data

DURATION TRENDS
 ICD-9-CM: 296.2  
CasesMeanMinMaxNo Lost TimeOver 6 Months
117775902661.5%3.6%
 
  
 
Percentile:5th25thMedian75th95th
Days:6214381172
 
  
 

DURATION TRENDS
 ICD-9-CM: 296.3, 296.32, 296.33  
CasesMeanMinMaxNo Lost TimeOver 6 Months
90217403600.2%5.9%
 
  
 
Percentile:5th25thMedian75th95th
Days:13325998183
 
  
 

DURATION TRENDS
 ICD-9-CM: 311  
CasesMeanMinMaxNo Lost TimeOver 6 Months
229406503150.3%4.8%
 
  
 
Percentile:5th25thMedian75th95th
Days:11274888179
 
  
 

Differences may exist between the duration tables and the reference graphs. Duration tables provide expected recovery periods based on the type of work performed by the individual. The reference graphs reflect the actual experience of many individuals across the spectrum of physical conditions, in a variety of industries, and with varying levels of case management. Selected graphs combine multiple codes based on similar means and medians.

Medical Codes

ICD-9-CM:
296.2 - Major Depressive Disorder, Single Episode
296.20 - Major Depressive Disorder, Single Episode; Unspecified
296.21 - Major Depressive Disorder, Single Episode; Mild
296.22 - Major Depressive Disorder, Single Episode; Moderate
296.23 - Major Depressive Disorder, Single Episode; Severe, without Mention of Psychotic Behavior
296.24 - Major Depressive Disorder, Single Episode; Severe, Specified as with Psychotic Behavior
296.25 - Major Depressive Disorder, Single Episode; in Partial or Unspecified Remission
296.26 - Major Depressive Disorder, Single Episode; in Full Remission
296.3 - Major Depressive Disorder, Recurrent Episode
296.30 - Major Depressive Disorder, Recurrent Episode; Unspecified
296.31 - Major Depressive Disorder, Recurrent Episode; Mild
296.32 - Major Depressive Disorder, Recurrent Episode; Moderate
296.33 - Major Depressive Disorder, Recurrent Episode; Severe, without Mention of Psychotic Behavior
296.34 - Major Depressive Disorder, Recurrent Episode; Severe, Specified as with Psychotic Behavior
296.35 - Major Depressive Disorder, Recurrent Episode; in Partial or Unspecified Remission
296.36 - Major Depressive Disorder, Recurrent Episode; in Full Remission
311 - Depressive Disorder, Not Elsewhere Classified

Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Was a thorough history obtained? Does individual have a history of prior depressive episodes? Does family have history of depression or of suicides?
  • Was substance abuse identified or ruled out?
  • Does individual have a history of psychological problems? Does individual have any physical conditions such as neurologic disorders (stroke, Parkinson's, epilepsy), endocrine disorders (diabetes mellitus, hypothyroidism, or hyperparathyroidism), or other disorders (cancer, coronary artery disease)?
  • Were endocrine tests done?
  • Were neurological tests done?
  • Were specific psychological tests, including symptom validity tests, carried out? What did they show?
  • Were brain scans performed to rule out brain tumor or prior silent stroke?
  • Is the physician an expert in diagnosis and psychopharmacology?
  • Was diagnosis confirmed?
  • Is it possible that individual was misdiagnosed?
  • Would individual benefit from a second opinion?

Regarding treatment:

  • Since major depression can be the result of biochemical imbalances in the brain, is the physician adequately trained in psychopharmacology?
  • Do drug dosages need to be adjusted to achieve therapeutic benefit?
  • Is individual responding favorably to current medication(s)? Is a change of medication warranted at this time?
  • If individual is experiencing side effects from current medication, is individual comfortable with and diligent in reporting side effects to doctor? If not, does individual trust family member or caregiver to share this information with physician?
  • Is psychotherapy being used as part of individual's treatment regimen?
  • Is individual learning to recognize and change behavior, thoughts, or relationships that cause or maintain depression? Is therapy helping individual to develop more healthful and rewarding habits?
  • Are underlying medical conditions that may complicate treatment or influence recovery being effectively addressed or treated?
  • If individual's depression is incapacitating, severe, and life-threatening, or if he or she cannot take or does not respond to antidepressant medications, is electroconvulsive therapy (ECT) being considered at this time?
  • Is individual seriously contemplating suicide? Has individual previously attempted it? Does the threat of self-harm or personal neglect put individual at risk?
  • Is individual frail because of weight loss or at risk for heart problems because of severe agitation?
  • Would individual benefit from hospitalization, partial hospitalization, or intensive outpatient care until self-care is possible?

Regarding prognosis:

  • Assuming diagnosis and treatment are accurate, can individual comprehend and follow medication treatment regimen, including proper dosage, time to take medication, and how to increase dosage when ordered? If individual is not capable, is another responsible individual available to oversee treatment? If not, would individual benefit from hospitalization until self-care is possible?
  • Was individual made aware of possible medication side effects and what to do if a side effect is experienced?
  • Does individual have a good working rapport with his or her physician?
  • Does individual know how often to see physician, and is transportation available? Is individual diligent about keeping appointments?
  • Has physician informed individual about how to improve response to treatment and which activities to avoid to increase the likelihood of improvement? Is individual engaged in psychotherapy?
  • What other support is available to individual? Family? Friends? Church? Support group?
  • Is there any evidence to suggest that the condition is prolonged for the purpose of some sort of financial or other gain?

Source: Medical Disability Advisor


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