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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
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?
Posted by Mal on September 30, 2002, at 11:18:03
In reply to Depression symptoms, posted by Eddie Sylvano on September 30, 2002, at 10:47:03
Eddie, we can always count on you to bring up interesting, relevant topics!
As you may know, I have never been to a PDoc, nor psychiatrist, so I have never had meds. But I have been through periods of depression (I have read about it and diagnosed myself). I have maintained very high function, but that is not to say I wasn't miserable on the inside for several weeks to a couple of months at a time. When I am affected, I experience #1, 2, 5, 7 & 8, but not usually # 3, 4 or 9.
#5 is exhibited as restlessness (I need to do something with my time on this earth, but what? Whatever it is I need to do it now) and #8 as severe indecision- to go, not to go, don't feel like it, but I need to do it- to the point of tears.
I have rarely had trouble sleeping. I think I sleep a little more (~10 hrs) than usual (~8 or 9 hrs) when in a funk.
I do think about death a lot when I am down, but I wouldn't call it excessive. I certainly do not consider trying suicide. I think stuff like, "I am worthless. What if I just wreck the car and die?" But I know even at that moment I don't want to die.
Sometimes I lie around feeling drained and isolated. My husband sees I'm not myself and asks what is wrong. All I can do is cry and say I don't know. Because I know the kind of answer he is looking for is a tangible event or upsetting circumstance. I have talked to him about it enough to know he isn't really going to understand anything else. He is caring and tries to make me happy, but I don't think he has ever experienced anything like this, so he doesn't get it.
So there are my answers to the questions that relate to me. Hope this gets more replies. I would be interested in others' experiences, too.
Mal
Posted by BrittPark on September 30, 2002, at 12:05:06
In reply to Depression symptoms, posted by Eddie Sylvano on September 30, 2002, at 10:47:03
The DSM inventory for depression is useful but doesn't go far enough. There are subtypes of depression (melancholic, and atypical I think are the only ones that have names). Mine by the way have usually been melancholic. I think it would be very interesting to do a study of different peoples responses to something like the HAM-D scale and look for clustering. Hmmm... maybe I'll set up a web page.
BTW, I'm a scientist by profession (post doc in Structural Biology currently) in case you hadn't guessed.
Britt
Posted by amy_oz on September 30, 2002, at 18:45:37
In reply to Re: Depression symptoms, posted by BrittPark on September 30, 2002, at 12:05:06
Brilliant plan. With all of the arguments about biological vs psychological, its v. easy to jump on a bandwagon, especially when you find something that helps you. We'll all have variations of different causes and helpful/unhelpful treatments.
Maybe when we all work together on trying to find the connections between our causes, symptoms and treatments we'll be able to spot some trends that the researchers haven't been able to pick up yet.
I am getting very much into the holistic and interconnectedness approach to all of this after many years studying biochemistry reductionist style. There is no one magic cure, but hopefully we can find the best combinations of treatments for each person.
Posted by madison88 on September 30, 2002, at 21:01:08
In reply to Re: Depression symptoms » Eddie Sylvano, posted by Mal on September 30, 2002, at 11:18:03
i have had all of them. i think meds help with eating and sleep, and a little bit with thoughts of suicide. that is about it. the other symptoms go away more gradually. dysthymia is considered a less severe form of major depression, and lasts much longer. you prob aready know that. i have found that meds help more with major depression than with dysthymia. perhaps it is b/c dysthymia becomes a lifestyle, a way of living, that is much harder to treat by tweaking neurotrans levels. i find the subject of free will facinating. i wonder if treatment resistent people, at some level, refuse to do what others who are helped "do." what exactly that is, i have little clue. thanks for the brain rush.
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