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Are you interested in receiving our newsletter on matters relating to depression? You often hear people saying things like "I feel depressed today" or "after his best friend died he was depressed for several weeks." Depression is a word in our language that most people use quite freely. However in psychiatry, and specifically in studies about the effect of medications in the treatment or course of depression, "depression" has a very specific meaning. The way psychiatry goes about diagnosing the various conditions that have depressive-like symptoms is found in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). What follows here first of all is an effort to make this information easily understandable to a lay reader with little or no experience in the fields of psychiatry or psychology. It is not a substitute for the precision of the DSM-IV, rather it is meant to give you the gist of the idea in simple terms. Below we provide the criteria used to diagnose a major depression. But be aware of this important disclaimer: The diagnosis of major depression requires a mental health professional experienced in the field of mental illness to conduct a clinical interview. This information and any tests you may take when you visit our Links page are only there for your education, they are not meant to provide for self-diagnosis. Major Depression: The mechanism of this illness is probably a faulty regulation of certain chemical processes in specific parts of the brain. Most mental health professionals think a mixture of different factors causes it. Certainly, genetics play a major role. For decades we have known that depression runs in families. Some people become depressed without any known stress. We call such depressions "endogenous," meaning they were generated from within their own brain. These depressions are almost certainly genetic. Some people become depressed after significant and prolonged distress. Such people may have only a slight tendency to depression, but the stress amplifies that tendency into a full-blown depression. People may be depressed only once in their lives and others may become depressed many times. Depression can occur throughout the life span from childhood to old age. It is most frequent in the middle years of life. We think we know some of the underlying chemistry that is the mechanism of the depression. Many different brain chemicals appear to be involved and many more may yet be discovered that also play a role in the manifesting of depression. While many treatments exist, the consensus now is that some sort of pharmacological (antidepressant medication) intervention is required as an essential part of the treatment. Psychotherapy certainly has a valuable place especially in depression resulting from stressful life circumstances. For more serious depressions that fail to respond to several trials with medication and psychotherapy, electro-convulsive (ECT) therapy still has a role. In some severe cases of depression, it is the only treatment that clears the depression. Currently in the research stage, there is hope that strong, carefully applied magnetic fields may duplicate some of the benefits received from ECT, so called Trans-Cranial Magnetic Stimulation or TMS. Have you been consistently depressed or down, most of the day, nearly every day, for the past two weeks? In the past two weeks, have you been less interested in most things or less able to enjoy the things you used to enjoy most of the time? If both answers are NO, you are probably not experiencing a Major Depression at this time. If either answer is YES, then go on to the following questions: Over the past two weeks: 1. Was your appetite decreased or increased nearly every day? Did your weight increase or decrease without trying intentionally (+ or - 5% of body weight over the past month)? 2. Did you have trouble sleeping nearly every night (difficulty falling asleep, waking up in the middle of the night, early morning awakening or sleeping excessively)? 3. Did you talk or move more slowly than normal or were you fidgety, restless, or having trouble sitting still almost every day? 4. Did you feel tired or without energy almost every day? 5. Did you feel guilty or worthless almost every day? 6. Did you have difficulty concentrating or making decisions almost every day? 7. Did you repeatedly consider hurting yourself, feel suicidal, or wish you were dead? If five or more of the above questions were answered YES, this is very indicative of a Major Depression. If three or four were answered YES, there is still a considerable possibility that Major Depression is present. As we emphasized above, this is a screening questionnaire. Only a trained mental health professional can make the actual diagnosis of Major Depression. Bipolar Disease: This is what has been called manic-depressive disease. Major depression is usually, but not invariably a part of the picture. In bipolar disease, there are also periods of time when a person feels high and elated - too high and too elated. Bipolar disease comes in two forms, Bipolar I and Bipolar II. Bipolar I is the classic severe manic depressive disease where a person may become psychotic and frequently requires hospitalization. Bipolar II is a milder form. Perhaps there is more depression and the highs are not so very high. Frequently they do not require hospitalization. Have you ever had (or are you currently) a period when you were feeling ‘up’ or ‘high’ or so full of energy or full of yourself that you got into trouble, or that other people thought you were not your usual self? Have you ever been (or are you currently) persistently irritable, for several days, so that you had arguments or verbal or physical fights, or shouted at people outside your family? Have you or others noticed that you have been more irritable or over-reacted, compared to other people, even in situations that you felt you were justified? If you answered both of the questions "NO" you are not likely to suffer from Bipolar Disease. If you answered either of the questions above "YES" answer the following questions. During the times mentioned above when you felt high, full of energy, or irritable did you: 1. Feel that you could do things other couldn’t do, or that you were an especially important person? 2. Need less sleep (for example, feel rested after only a few hours sleep)? 3. Talk too much without stopping, or so fast that people had difficulty understanding? 4. Have racing thoughts? 5. Become easily distracted so that any little interruption could distract you? 6. Become so active or physically restless that others were worried about you? 7. Want to engage in pleasurable activities so much that you ignored the risks or consequences (for example, spending sprees, reckless driving or sexual indiscretions)? Were three or more of the above questions answered "YES"? If so, you may have bipolar disease. Once again, as we emphasized above, this is a screening questionnaire. Only a trained mental health professional can make the actual diagnosis of Bipolar Disease. The Blahs: Everybody has up and down days. Some variation in mood is normal for almost everybody. So long as it is brief (a couple days) and doesn’t have the symptoms of Major Depression, it is a temporary state of mind that most people take in stride. The Blues (type I): Something bad happens to you such as unemployment, ill health of a family member or friend, having your house flood or such things; and you feel down and sad for awhile. You have the blues. Any normal person would feel down or sad in response to these events. You are not depressed; you have what the DSM-IV calls an Adjustment Reaction with Depressed Mood. The Blues (type II): You are a generally sad and down person most of the time over a period of a couple years or more. You are like that character in the L’il Abner cartoon many years ago who walked around with a cloud over his head all the time. We call this Dysthymia. The term actually means "ill humored." This is more of a chronic, low-grade state in which a person may feel a depressed mood. If dysthymia is a thunderstorm, major depression is a hurricane. Grief or Bereavement: This occurs when someone close to you dies. It is a terribly sad period of time when you experience the loss of a loved one. The condition feels very much like depression, but it differs in that it (normally) gradually heals itself and usually you don’t feel you are a bad person. Think of it like an amputation. You lose your leg and it takes a long time to heal and it really hurts, but it is a necessary part of the healing process. The Baby Blues: Following the birth of a child, many women go through a brief period of sad mood. Usually it clears in a few weeks and they are back to normal. This is a self-limited condition that does not require treatment. However, in some cases the birth of a baby marks the entrance into a very serious major depression and professional help is absolutely essential. The Winter Blues: A significant number of people get down during the winter when the sunlight is diminished. This Seasonal Affective Depressive Disorder (SADD) usually this is not serious enough to interfere with functioning, but in other cases it can take on the dimensions of a major depression. On our LINKS page, we have listed a number of websites you can visit that can give you more information about depression. Some have self-testing pages which may provide you a clearer picture if you or someone you know might be suffering from major depression. For those who want to understand the wide variety factors which conspire to cause Major Depression, there is a recent article from The American Journal of Psychiatry that uses a study of women twin pairs to explore all of the various issues, both genetic and environmental, that work together to bring this disease about. This article demonstrates the complexity of psychiatric research in the causation of mental disorders. While the article speaks of female twin pairs, the information may reasonably be generalized to men and non-twins as well. |