Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Major Depressive Disorder


Related Terms

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

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Psychiatrist

Comorbid Conditions

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.

Medical Codes

ICD-9-CM:
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
296.30 - 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

Treatment

Treatment choice depends on the outcome of the evaluation (history, physical exam, and tests). Treatment usually consists of some form of psychotherapy, antidepressant medications, or a combination of the two. One or more antidepressant medications may be prescribed, such as selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), or monoamine oxidase inhibitors (MAOIs). These medications work by correcting imbalances in the levels of brain chemicals (the monoamine neurotransmitters serotonin, dopamine, and norepinephrine). About two-thirds of individuals treated will respond to one or more medications. Generally, these medications take full effect 3 to 6 weeks after treatment has begun. Psychiatrists usually recommend that individuals continue to take the medication for five or more months after symptoms have improved.

Psychotherapy, especially cognitive behavioral therapy, may be used alone for treatment of mild depression. Antidepressant medications in combination with psychotherapy are preferred treatments in the more severe forms of major depressive disorder. In addition to cognitive behavioral therapy, the different types of psychotherapy include psychodynamic psychotherapy, interpersonal therapy, and supportive psychotherapy. Research suggests that using a combination of antidepressants and talk therapy is more effective than either treatment alone for most individuals.

Treatment of depression consists of three phases. Acute treatment, lasting 6 to 12 weeks, is aimed at remission of symptoms. Continuation treatment, lasting 4 to 9 months, is aimed at preventing relapse; during this phase, medication is continued at full dosage, and psychotherapy may be initiated. Maintenance treatment is aimed at preventing new episodes (recurrence) in individuals with prior episodes. Both maintenance medication and maintenance psychotherapy can prevent relapse or delay the next episode.

Electroconvulsive therapy (ECT) is another treatment option that has been shown to be safe and effective in treating individuals of all ages who have not responded sufficiently to antidepressant medications and psychotherapy or whose depression is severe and prolonged. Although the precise mechanism of action of ECT is not understood, it is believed to work by increasing neurotransmitter levels in the brain, improving neurotransmission and elevating mood (Moore). Recently other forms of interventions such as transcranial magnetic stimulation have become available. Experimental treatments include the use of agents such as ketamine intravenously.

For individuals whose depressive episodes can be attributed to use of specific medications, changes in medication or changes in dosage may be required.

Psychiatric hospitalization is warranted when the individual neglects self-care or is at high risk of self-harm. Other forms of more intensive treatment, such as partial hospitalization and intensive outpatient care, may be considered for individuals who fail to recover in a reasonable period of time with more standard treatments.

Before treatment, individuals and their families should be educated about the diagnosis, likely outcome, treatment options, cost of treatment, and potential side effects and complications.

Source: Medical Disability Advisor






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