Clinical depression – or Major Depression (as it is more properly referred to) is a biological disorder with clearly defined neurotransmitter abnormalities that can result in anywhere from moderate to extreme and disabling mental and emotional pain. Patients have told me that it’s like a “dark night of the soul” or being “in the pit,” or being disabled with hopelessness and helplessness, and where it seems (incorrectly) that suicide is the only option to put themselves out of this misery.
It is not a condition of “not trying hard enough,” or not reading enough motivational books or listening to enough motivational audio programs, or chanting, meditating, doing yoga, going to the gym or whatever – no matter what your unsympathetic partner, spouse, SO, religious congregant, or family member might say.
This is a serious medical condition that needs serious medical treatment – and that usually means antidepressants, which, these days, are really remarkably good and pretty much devoid of side effects. If the case is severe enough that it is not medication responsive, TMS (Transcranial Magnetic Stimulation, a procedure that we do here at CWI and that is done at many other centers across the country), can be life-transforming.
- Basically, there are nine agreed upon symptoms of Major Depression. You MUST have one of the first two, and then four more symptoms to meet the quantity of five required for diagnosis. Note that these symptoms cannot be accounted for by any other medical or psychiatric condition. In many cases, medical conditions (obstructive sleep apnea, hypothyroidism, low testosterone in aging males, chronic pain, cardiac or pulmonary insufficiency) must be ruled out before an independent, exclusively psychiatric diagnosis of depression can be made.
- One cautionary exclusion. You can’t have had a manic episode or a “hypomanic” (“junior grade”) episode of elevated mood, irritability, excessive spending, or sleeplessness and be diagnosed with “major depression.” In that case, the diagnosis would be “bipolar depression.” This is not just a diagnostic nicety: applying an antidepressant to a patient that has bipolar depression, and who is not on a mood stabilizer, can make them psychotic.
- Here are the nine symptoms of depression:
- Sadness, depression, lack of pleasure
- Lack of, or loss of interest in things.
- Sleep disruption
- Inappropriate (undeserved) or overwhelming feelings of guilt and worthlessness
- Loss of energy and “get up and go”
- Poor or decreased concentration
- Appetite changes (up or down, with either weight loss or weight gain)
- Feelings of being slowed down or sped up
- Thoughts of suicide, passive thoughts of “I would be better off dead,” a desire to “never wake up,” etc., even if you wouldn’t actually act on them.
- FIVE of these symptoms is enough to get you the diagnosis, officially. However, if it gets to the point that the patient is actually thinking about suicide, I don’t wait for them to “reach the magic number of 5” before calling it.
This is not a condition to be trifled with, and, statistically, 1 out of 7 patients with recurrent depression that just keeps coming back will suicide.
If you are reading this and are having thoughts of suicide right now, please pick up the phone, talk to someone, and get help immediately. It has often been said, and it is so tragically true, that suicide is a permanent solution to a temporary problem. Depression CAN be treated, and you CAN be helped.
- Footnotes – the “fine print”:
- If you are considering the possibility of depression in a child, the “rule book” goes out the window. You no longer have to have five symptoms. Irritability, mild depression, loss of interest in things, and particularly voiced or contemplated suicidal thinking are all clinical triggers to make one think about the possibility of depression. If a child says anything about suicide, the child should be seen.
- In the elderly, depression may be seen not as a “fully diagnosable clinical depression,” consistent with the five minimum criteria, but simply a loss of desire to live, loss of appetite, sleeplessness, or social withdrawal.