What you should know about depression and how to manage it

How does clinical depression differ from normal sadness?

There are three important questions about depression which I often get asked in my clinical practice:

• How does clinical depression differ from normal sadness?
• What causes depression?
• What cures depression?

 
In today’s post I will answer the first question concerning how depression is defined. In following posts I will answer the other two.

We all experience te occasional few hours or even a few days in which we feel sad, or have the “blues”.  But how is this different from what a mental health professional would diagnose as clinical depression?   The answer is not simple; clinical experience suggests that three factors must be considered: the severity, duration, and context of the mood of sadness.

Intensity

Many professionals believe that depressed mood occurs on a continuum of severity from normal sadness to severe clinical depression. According to the Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition (DSM IV)) published by the American Psychiatric Society to obtain a diagnosis of Major Depressive Disorder the intensity of sadness must be such as to result in a significant number of symptoms including reduced pleasure in activities that used to be pleasurable, weight and sleep disturbance,  changes in level of physical activity, fatigue, feelings of worthlessness, reduced ability to concentrate and to make decisions, or continuing preoccupation with death or thoughts of suicide.  The DSM IV also provides the diagnosis of Dysthymic Disorder in which these symptoms of depression are of lower intensity.

In addition to the DSM IV which provides criteria for qualitatively determining if one should assign the diagnosis of depression, I have found the Beck Depression Inventory (BDI) to be extremely useful for measuring quantitatively the intensity of depression which can exist along a continuum.  This enables one to detect subclinical levels of depression which may still benefit from treatment. The BDI is also useful to track continuously the client’s recovery from clinical depression.

Duration

Another question that arises regards the duration of depressive symptoms.  To obtain the diagnosis of Major Depressive Disorder the DSM IV requires that the above symptoms must be present most of the day over a period of two weeks.  To obtain the diagnosis of the less severe form of depression, Dysthymic Disorder, the duration must be at least two years.

Context

Another important factor is the context in which the sadness takes place e.g. is the sadness due to death of one’s mate?  The DSM IV states that the diagnosis of clinical depression should not be applied if the person’s mate has died and the grieving does not continue past two months or if the grieving does not include extreme features such as suicidal thoughts or attempts.

The first thing is to distinguish between a transitory few hours of feeling the blues and a prolonged period of severe sadness and or loss of interest/pleasure. Secondly check of the presence of several or more of the common symptoms of depression:

• unusual amount of sadness despair
• weight and sleep disturbance
• changes in level of physical activity
• fatigue
• feelings of worthlessness
• reduced ability to concentrate and to make decisions
• continuing preoccupation with death or thoughts of suicide.

The purpose of this post was to introduce you to how the diagnosis of depression is made. Although there is currently no completely objective scientific test for clinical depression e.g. no blood test, the criteria specified by the DSM IV and the scores on the BDI are extremely useful.  If you think you might be suffering from depression I urge you go to a mental health professional such as a psychologist or psychiatrist for assessment, diagnosis, and treatment.  Research over the past decade or two has provided an abundance of therapeutic strategies for alleviating depression. There is lots of hope!  In a future post I will be discussing the treatment of depression in some detail.

Comments

[Daniel Tan]

Dear Brian,

This is a great article, I am looking forward to part II and III.

Thank you very much for the information!!

Daniel Tan
Malaysia