Understanding Depression: What is clinical depression?

Disclaimer: The information provided here is for information purposes only. It is not intended to substitute for professional evaluation, advice or help. If you feel you or someone you know is depressed, please talk to someone you trust, and contact a healthcare provider for further management.

This year, the theme for World Health Day is ‘Depression: Let’s talk’.

There are several myths surrounding what is and isn’t depression. In this post, I will provide the definition of clinical depression (major depressive disorder).

Background information:

The  Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) is one of the major resources for diagnosis of mental disorders.

It contains clear descriptions of, and diagnostic criteria for mental disorders.

The World Health Organization (WHO) describes depression as:

Depression is an illness characterized by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks.

In addition, people with depression normally have several of the following symptoms:

  • a loss of energy;
  • a change in appetite;
  • sleeping more or less;
  • anxiety;
  • reduced concentration;
  • indecisiveness;
  • restlessness;
  • feelings of worthlessness, guilt, or hopelessness; and
  • thoughts of self-harm or suicide.

Key Messages:

Depression is a common mental disorder that affects people of all ages, from all walks of life, in all countries.

The risk of becoming depressed is increased by poverty, unemployment, life events such as the death of a loved one or a relationship break-up, physical illness and problems caused by alcohol and drug use.

Depression causes mental anguish and can impact on people’s ability to carry out even the simplest everyday tasks, with sometimes devastating consequences for relationships with family and friends.

Untreated depression can prevent people from working and participating in family and community life.

At worst, depression can lead to suicide.

Depression can be effectively prevented and treated. Treatment usually involves either a talking therapy or antidepressant medication or a combination of these.

Overcoming the stigma often associated with depression will lead to more people getting help.

Talking with people you trust can be a first step towards recovery from depression.

In all instances, other causes for the symptoms should be explored and excluded. These include:

  • other medical conditions
  • effects of drugs (prescription and recreational)
  • responses to major events (like bereavement, natural disaster, financial ruin, etc.)
  • physiological conditions (mood alteration during adolescence, for instance)

Major Depressive Disorder (DSM-5)

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly attributable to another medical condition.

  1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
  2. 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.)
  3. 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.)
  4. Insomnia or hypersomnia nearly every day.
  5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
  6. Fatigue or loss of energy nearly every day.
  7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
  8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
  9. 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.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The episode is not attributable to the physiological effects of a substance or to another medical condition.

Note: Criteria A-C represent a major depressive episode

Useful Links:

Link to World Health Day 2017 campaign page:

http://who.int/campaigns/world-health-day/2017/campaign-essentials/en/

Link to document providing details of DSM-5 criteria for major depressive disorder:

http://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_MajorDepressiveDisorder.pdf

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