IN BRIEF: In this post we address the SYMPTOMS of depression. We belive that better knowledge about depression, prepares us to handle it wisely.
‘Depression’ has become a highly overused and misinterpreted term today. Access to internet paves path to read about depression and those ever so generalised and vague descriptions give the feeling, “OMG! I have this! I have Depression”. Read the next disorders, may be you have so many of them too. It is therefore necessary to know what depression is like in clinical terms and what are the signs and symptoms used by us clinicians to diagnose depression.
Before The Symptoms Are Discussed, Here Is An IMPORTANT NOTE about DIAGNOSIS
No diagnosis is made without taking into account the detailed case history from a person and then combining it with the symptoms present to reach a conclusion as to whether it really is clinical depression or some other issue, like a tough phase, or grief. Not to forget the differential diagnosis where all these other possibilities are ruled out carefully. Thus, there are nuances that a clinician is trained to understand and come to a proper diagnosis.
Refrain from Self-Diagnosing (Thinking and believing you have depression just because you are being sad or you have read something over some website).
Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) explains depression as a combination of mood disruption, a lot of changes in thought process, and numerous somatic (body related) changes too.
Here are the symptoms of Depression (technically, major depressive disorder) as per DSM-5:
- From the list presented below, there should be a presence of at least five (5) symptoms. These should be present in a continuous two (2) week duration. Out of this list ONE of these two symptoms is a must to suspect depression: (1) depressed mood or (2) loss of interest or pleasure. All the symptoms in the list are seen in comparison to how the person has been in general, before these two weeks.
- Depressed mood most of the day, nearly every day (Note: In children and adolescents, can be irritable mood.) Now this one, either you report it yourself that you feel sad, terrible, emptiness. Or others report about you (Example: she always looks sad, he is always tearful.)
- 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). NOTE: only those activities count that you used to enjoy earlier and now you just don’t feel like doing or you have to push yourself to do them.
- 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 appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
- Insomnia or Hypersomnia nearly every day. This means, you either have been sleeping a lot more than usual (feeling sleepy all day), or very little than your usual sleep. NOTE: Sleep disturbance can be due to million other reasons too.. so, do not consider yourself as having depression if you just realised you can relate to this symptom.
Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
See those words? ‘Observable’, not just ‘restlessness’ and feeling ‘slowed down’. It means, there is a significantly visible impairment (reduction) in muscular control and activities. Or too much of these activities. Agitation can be shown by the inability to sit still, or pulling or rubbing of the skin, clothing, or other objects, etc. On the other hand, retardation can be represented by slowed speech, thinking, and body movements, etc.
- Fatigue or loss of energy nearly every day. NOTE: This could be due to many other reasons as well. Something as simple as nutritional deficiency can also cause this feeling.
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). NOTE: ‘Excessive’ and ‘Inappropriate’, the words to look for. Excessive means, not in sync or proportionate to an incident (in simple terms, like overreaction of guilt). This may not even be rooted in something real and may be due to some strong false beliefs (like, someone thinking, “I am responsible for the earthquake.”)
- Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others). NOTE: Not being able to think clearly, evaluate and make decisions in matters you were able to make decisions before.
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. NOTE: There is difference between fear of death, and thoughts about death. And the word is ‘recurrent’ constantly on mind , occurring again and again.
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Either you are facing problems at work because of all the above mentioned symptoms, or in your social life (example, not feeling like meeting friends you used to meet a lot before) and other activities in your routine you usually do.
The episode is not attributable to the physiological effects of a substance or to another medical condition.
Here comes the important criterion! Having five of those nine symptoms MIGHT mean you have depression. Yes. The word ‘Might’ is indeed important. If only, it cannot be explained by other things, like, some actual recent disturbing incident which might produce symptoms like depression but may not necessarily be depression. Also, some medications you are prescribed or other diseases might lead to depression like phases but cannot be diagnosed as depression. Other than that, it can be result of substance abuse also, which is another category altogether.
We all get disturbed by stressful life incidents, some major loss, and many other such reasons, and it does not necessarily mean we have clinical depression. It means we are going through a tough phase and might bounce back in a while! Even nutritional deficiency can cause some of these symptoms. So, please do not diagnose yourself and feel vulnerable unless you have consulted a clinician and all the factors have been taken into account.
Here is a video on Depression
Reference:
Diagnostic and statistical manual of mental disorders (5th edition) (2013). Depressive disorders (pp.155-168). Washington, DC : American Psychiatric Association.