Depression

Diagnosis | Explanation | Next steps | Treatment | Other links

Formal Diagnostic Criteria (from DSM-IV-TR)

What does this really mean?

Mood Symptoms:

• Abnormal depressed mood:
  
  
  1. Sadness is usually a normal reaction to loss. However, in Major Depressive Disorder, sadness is abnormal because it:
  
  
  • Persists continuously for at least 2 weeks.
  • Causes marked functional impairment.
  • Causes disabling physical symptoms (e.g., disturbances in sleep, appetite, weight, energy, and psychomotor activity).
  • Causes disabling psychological symptoms (e.g., apathy, morbid preoccupation with worthlessness, suicidal ideation, or psychotic symptoms).
  
  
  2. The sadness in this disorder is often described as a depressed, hopeless, discouraged, "down in the dumps," "blah," or empty. This sadness may be denied at first. Many complain of bodily aches and pains, rather than admitting to their true feelings of sadness.


• Abnormal loss of interest and pleasure mood:
  
  
  1. The loss of interest and pleasure in this disorder is a reduced capacity to experience pleasure which in its most extreme form is called anhedonia.
  
  
  2. The resulting lack of motivation can be quite crippling.
  
  
• Abnormal irritable mood:
  
  
  1. This disorder may present primarily with irritable, rather than depressed or apathetic mood. This is not officially recognized yet for adults, but it is recognized for children and adolescents.
  
  
  2. Unfortunately, irritable depressed individuals often alienate their loved ones with their cranky mood and constant criticisms.
   

Physical Symptoms:

• Abnormal appetite:
  
  
  • Most depressed patients experience loss of appetite and weight loss. The opposite, excessive eating and weight gain, occurs in a minority of depressed patients. Changes in weight can be significant.


• Abnormal sleep:
  
  
  • Most depressed patients experience difficulty falling asleep, frequent awakenings during the night or very early morning awakening. The opposite, excessive sleeping, occurs in a minority of depressed patients.


• Fatigue or loss of energy:
  
  
  • Profound fatigue and lack of energy usually is very prominent and disabling.


• Agitation or slowing:
  
  
  • Psychomotor retardation (an actual physical slowing of speech, movement and thinking) or psychomotor agitation (observable pacing and physical restlessness) often are present in severe Major Depressive Disorder.
   

Cognitive Symptoms:

• Abnormal self-reproach or inappropriate guilt:
  
  
  1. This disorder usually causes a marked lowering of self-esteem and self-confidence with increased thoughts of pessimism, hopelessness, and helplessness. In the extreme, the person may feel excessively and unreasonably guilty.
  
  
  2. The "negative thinking" caused by depression can become extremely dangerous as it can eventually lead to extremely self-defeating or suicidal behavior.
  
  
• Abnormal poor concentration or indecisiveness:
  
  
  1. Poor concentration is often an early symptom of this disorder. The depressed person quickly becomes mentally fatigued when asked to read, study, or solve complicated problems.
  
  
  2. Marked forgetfulness often accompanies this disorder. As it worsens, this memory loss can be easily mistaken for early senility (dementia).
  
  
• Abnormal morbid thoughts of death (not just fear of dying) or suicide:
  
  
  1. The symptom most highly correlated with suicidal behavior in depression is hopelessness.

I think I or my loved one may have Depression.
What do we do next?

One of the best sites I found which guides people through the process of getting diagnosed and managing depression is www.allaboutdepression.com. See the links page for other useful websites and local resources.

Summary of Treatment Options

(The links below will lead to a list of online resources for the relevant category.)

1. Medication
2. Psychotherapy
3. Support Groups
• Peer Run
• Therapist Run - These may be general groups for women, men, or mixed. They may be specific to your diagnosis or primary issues. Or they may focus on a specific type of therapy such as the following:
• Cognitive
• DBT
• Coping Skills
4. Hospitals - Call the local chapter of NAMI or a similar organization for help picking hospital programs if your insurance provides multiple options. They may be able to help you sort out which are the best programs in your area for meeting your needs.
• Inpatient - Inpatient treatment is important when someone's life is at risk (one's own or someone else's). They are most effective at keeping people safe and helping to stabilize medications.
• Day Treatment
• Intensive Outpatient
5. Other Ongoing Support
• Clubhouses

For further information on these and a variety of other topics, visit the Links page.