Description of Depression

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The diagnostic reference mental health professionals use is called the Diagnostic and Statistical Manual of Mental Disorders(DSM). This provides us with the standard language and description for depression.

Major Depressive Episode
This is used in the baseline definition and includes many of the symptoms the public associates with depression. “Episodes” will then be used to characterize the different types of depression. Either they occur with another set of symptoms, occur multiple times over a certain span.

The be considered diagnostic, at least three of the following six symptoms have happened in a two week period and those symptoms happened along with a daily depressed mood, with a loss of interest and the ability to take pleasure in almost all activities. These symptoms cannot be the result of an underlying physical condition (like withdrawal from drugs) that would otherwise explain them.

1) Weight loss and decrease in appetite – food is no longer pleasurable or worthwhile. Eating is robotic and may seem like a chore, not worth the effort.

2) Daily insomnia or hypersomnia. Hypersomnia is sleeping too much – using sleep as an escape from life or to “turn off.”

3) Observed restlessness or lassitude. This is called psychomotor agitation or retardation.

4) Patient reports fatigue or loss of energy nearly every day. This is different than number 3, which is an observed, instead of a self-reported symptom.

5) Diminished capacity for decision making, opinion forming, or agency – the patient may be unable to direct their own life affairs.

6) Suicidal thinking, with or without an attempt. A toxic focus on death as opposed to a fear of dying.

Most of the above symptoms would have to happen almost daily over two or more weeks to meet the criteria of a major depressive episode.

Dysthymic Disorder
This standard is also considered depression by the public, but doesn’t meet the higher standard for major depression. It is, however a treatable illness and would likely use many of the same methods as major depression.

• Depressed mood for more days than not for the last two years.
• While depressed, two or more of the following are present: appetite changes (over or under eating), sleep disturbances (insomnia or hypersomnia), fatigue, poor concentration or inability to make decisions, feelings of hopelessness,
• During the previous two years, the patient has never been symptom free more than two continuous months.
• The symptoms cause social or employment impairment.
• The patient doesn’t meet the criteria for major depression and does not have any other diagnosed mental health issue (bipolar, psychosis, schizophrenia).

Other
Depression is just one of several mood disorders, and there is often an overlap or mixing of symptoms. Humans are complex and it is very difficult to place them into even the most carefully described categories. In general, all of the depressive disorders will have components of a major depressive episode to some degree over an extended period.

For example, about a third of people with chronic illnesses end up showing signs of depression. It is up to a professional to judge whether this is the normal consequence of the reality of the condition and or whether it rises to the level of a depressive episode.

 
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