Posted by Eddie Sylvano on September 30, 2002, at 10:47:03
With all of the discussions lately on the biological vs developmental origins of depression, I wonder what symptoms constitute depression for each person. I've known people on ADs who didn't strike me as being depressed in any way, and people who are obviously depressed, but would never consider medication.
Being a mental illness, the symptoms aren't as clear cut as kidney infection or herpes. The subjectiveness of it probably undermines a lot of reports and statistics the describe it. For that matter, it's hard to say that what you're experiencing is depression, per se, and not some other mental disorder or endocrine imbalance, cancer, etc. I was only ever diagnosed by my primary physician, who's an osteopath.
According to the DSM, evaluation is based on:(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
This seems pretty obvious, and is probably what most people think of when they think about depression. I imagine most people feel this. I did, anyway.
(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 made by others)
This one defines depression for me, and is how I know when things aren't right. I can experience other symptoms off and on, but this one is my gold standard.
(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 gains.
This symptom is really an extention of the previous one for me. I don't enjoy anything when depressed, food being one of them. Dropped 40 lbs. I wonder which route most people take?
(4) insomnia or hypersomnia nearly every day
I've heard a lot of people mention this one, but it's not something unusual for me. I can sleep 12 hours every day if I want, since I was a kid. I *do* notice that I will wake up at say 3 in the morning during a bad depression, though, and then again at 5, etc.
(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 dayThese two seem to be the same, and they're definately one of the more debilitating effects I feel. At its worst, I can't even take out the trash without stopping for a break. Still, I've seen many people who don't seem to be affected at all.
(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)
This used to be the case a lot more than now. It's one of the few symptoms that you can address in a constructive way via therapy. The most useful thing I got from therapy was the concept of ANTs (automatic negative thoughts). Still, when it's ahrd to think clearly (next symptom), it's not always easy to avoid.
(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
Oh my god, is this the worst. My brain feels like tapioca, which frustrates me, which makes me sad, etc. I avoid talking to people because it's such an effort. I can't get anything done. I feel totally deprived. Again, though, I've met people who are "depressed" but seem energetic and on the ball.
(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
This is sort of like symptom 7, in that you can recognize and redirect these thoughts. I feel like I have control over this, certainly now that I have experience with it. Knowing that these thoughts are the result of an abberation helps a lot.
So there they are. I think that they're a pretty useful diagnostic tool. I'd be hard pressed to improve on them. I still have to wonder about the disparity of symptoms between different people with depression. Do you need medication if you only have symptom 1 or 7? What symptoms do you guys think are the most definitive ones? Which are the most debilitating? Which respond the best to medication?
poster:Eddie Sylvano
thread:121643
URL: http://www.dr-bob.org/babble/20020930/msgs/121643.html