Although Depression is often thought of a being an extreme state of sadness, there is a vast difference between clinical Depression and sadness. Sadness is a part of being human, a natural reaction to painful circumstances. All of us will experience sadness at some point in our lives.
Depression, however, is a physical illness with many more symptoms than an unhappy mood. The person with clinical Depression finds that there is not always a logical reason for his dark feelings. Exhortations from well-meaning friends and family for him to “snap out of it” provide only frustration for he can no more “snap out of it” than the diabetic can will his pancreas to produce more insulin. Sadness is a transient feeling that passes as a person comes to term with his troubles.
Depression can linger for weeks, months or even years. The sad person feels bad, but continues to cope with living. A person with clinical Depression may feel overwhelmed and hopeless.
To clarify the differences between normal sadness and depression, the DSM-IV* defines specific criteria for the diagnosis of major depression. A person who suffers from a major depressive disorder must either have a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a two week period. This mood must represent a change from the person’s normal mood and impair his functioning in his daily life. A depressed mood caused by substances such as drugs, alcohol, or medications is not considered a major depressive disorder, nor is one which is caused by a general medical condition. Major depressive disorder cannot be diagnosed if a person has a history of bipolar disorder (ie. manic, hypomanic or mixed episodes) or if the depressed mood is better accounted for by schizoaffective disorder and is not superimposed on schizophrenia. Further, t he symptoms should not be better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
This disorder is characterized by the presence of 5 or more of the following symptoms:
- 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). Children and adolescents may exhibit irritability.
- Markedly diminished interest or pleasure in all, or most, daily activities most of the day, nearly every day.
- Significant weight changes (e.g. a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
- Insomnia or hypersomnia (sleeping too much) nearly every day.
- Psychomotor agitation or retardation nearly every day.
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
- Diminished ability to think or concentrate, or indecisiveness, nearly every day.
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
If you are still uncertain as to whether you may be suffering from depression, screening tests exist which can help you determine whether you should seek a professional evaluation. There is a test provided on this site which is simple to use and completely confidential.
Revision date: July 8, 2011
Last revised: by Andrew G. Epstein, M.D.