Diagnoses of Depression

What is Depression?

There are far, far better things ahead than any we leave behind. Mental pain is less dramatic than physical pain, but is more common and is more hard to bear.  The frequent attempt to conceal mental pain increases the burden: It is easier to say “My tooth is aching” than to say “My heart is broken.” ~ C.S. Lewis

DISCLAIMER NUMBER #1: If you think you have depression, please see your doctor. There are medical reasons for depression including thyroid problems, vitamin deficiencies, anemias, heart disorders, and other problems. These MUST be ruled out before a diagnosis of major depressive disorder is made.

What is depression? Is it just sadness and feeling down? Approximately 20% of people will suffer a Major Depressive episode during their life. Depression is a serious illness because according to the Centers for Disease Control (CDC), 47,511 people died from suicide. It is in the top 10 causes of death in the United States. Depression costs over $210 billion per year including health care costs (inpatient, outpatient, emergency room visits, and prescriptions), workplace losses in productivity, suicide costs, and other causes. Women experience depression more frequently than men.

There are a number of symptoms which people with depression present with.  When I diagnose people with depression, I use the criteria found in the DSM 5. If you don’t remember what the DSM 5 is, it’s basically the manual mental health diagnosticians use, and it contains specific criteria that must be met in order for a person to receive that diagnosis.  When talking about criteria for diagnosis, let’s talk about it in terms of a physical illness. For example when diagnosing diabetes, one of the criteria used is to draw blood to find the hemoglobin A1C.  If it is 5.7% to 6.4%, a person receives a diagnosis of prediabetes. If the hemoglobin A1C is 6.5% or more, a person is considered diabetic.

Just like physical illnesses, mental illnesses have criteria. In order to be diagnosed with depression a person has at least one of the following symptoms for two weeks or greater. These symptoms are generally felt all day and nearly everyday.

1. Feeling down, depressed, or hopeless– Self explanatory, but one thing to note is that kids can also be depressed and sometimes they manifest feeling down, depressed, or hopeless as irritability.
2. Anhedonia– What is anhedonia? Anhedonia is the inability to feel pleasure or a lack of interest. Maybe you have a specific hobby you normally love to do, but you just can’t get yourself to do those things anymore and they aren’t enjoyable even if you do try to do them.

Beside the symptoms of feeling down, depressed, or hopeless and/or anhedonia, a person must have at least four other symptoms as listed below.

1. Weight loss or weight gain. Many people do not eat when they are depressed and other people eat a lot of comfort food.  Most people gain weight and eat too much.  The criteria indicates that if a person loses or gains 5% of their body weight, this is significant for depression. If you weigh 100 pounds and you go up to 105 pounds or down to 95 pounds this is 5% of your body weight.
2. Insomnia or hypersomnia. Insomnia is when you have a difficult time getting to sleep, staying asleep, or waking up early.  Hypersomnia means a person excessively sleeps or has significant daytime sleepiness
3. Psychomotor agitation and retardation. This means that you are so restless, you can’t be still or you are moving so slowly that others notice.
4. Fatigue. A person with depression has general fatigue, or loss of energy all day.
5. Feeling worthless or excessive guilt.  This type of guilt is unfounded. It’s not necessarily because you bounced a check or forgot to add sugar to the pie you were baking (I have no experience with this). This type of guilt is daily and a person feels that they have constantly let themselves or their family members/friends completely down.
6. Decreased concentration. This may look like you’re completely unorganized when you previously weren’t. This can be noticed by you and by others. An example I frequently hear is when people are reading a book and can’t remember anything they just read. We all do that at times, but if it’s a significant change, pay attention.
7. Thoughts of death or suicide. This is a very important thing to report. We will talk specifically about suicide and what to look for and how to intervene.

Topics we will discuss regarding depression will be the neurobiology, what depression feels like, faith and depression, suicide, and treatment for depression.

DISCLAIMER NUMBER #2: If you are having thoughts of death or wanting to harm yourself in anyway, click here to go the resource page with the suicide crisis numbers. You can also call 911 or go to the emergency room.

References:

Centers for Disease Control (2021). https://www.cdc.gov/nchs/fastats/depression.htm