Everyone has likely experienced some of the symptoms associated with depression. When looking at the diagnostic criteria for depressive disorders, there are many traits that a vast majority of people all experience at some point.
The term “Depressive Disorders” refers to a category of disorders that essentially revolve around being sad, vacant, empty, unmotivated, or void. Generally, these symptoms will have an impact in your life either through somatic symptoms (such as sleep issues, eating problems, fatigue, and pain). The disorder will usually cause your life functioning to be off in one way or another, occupational, social, physical, relational, emotional, motivational, spiritual, or other.
Many people people meet the diagnostic criteria for depressive disorders, but will go undiagnosed for years or never receive a diagnosis. Each of the six depressive disorders is unique and has it’s own diagnostic criteria, according to the Diagnostic and Statistical Manuel of Mental Health, Fifth Edition (DSM-5) (American Psychiatric Association, 2013).
What makes a diagnosis different than normal, expected sadness we all experience?
Virtually all people can relate to experiencing one (if not multiple) of the common symptoms (see below) of depressive disorders, at least at some time in their life. It is essential to remember that just because you have some of the symptoms that you do not necessarily have a depressive disorder. Since most people have experienced these symptoms at some point, here are four factors that take these from normal human emotions, like sadness, into a more severe and diagnosed mental health disorder. Please remember, formal diagnosis should be done by a licensed professional.
When evaluating the severity of the disorder (mild, moderate, or severe) each of these categories can used to identified severity. Whenever assessing for a depressive disorder you need to factor each of these in and understand that one extremely high area can be very serious and potentially dangerous, as can mild issues in multiple areas.
- Intensity: While feeling sad or bummed out is normal, people who have a depressive disorder will feel the symptoms much more intensely than someone who does not have a diagnosis and is just really sad.
- Example: Feelings of worthlessness, helplessness, or hopelessness may be accompanied by very plausible suicidal ideation, self-harm, or binge-eating with the person who is diagnosed, whereas the undiagnosed may just feel sad and have a loss in self-confidence, motivation, and activity.
- Frequency: How often people experience the symptoms of a depressive disorder will often be an indicator of a potential diagnosis and can impact severity. Those without a diagnosis may experience symptoms occasionally (a few times a month, or less). Those with a diagnosis can display symptoms constantly without any relief, weekly, or daily.
- Example: You may get bummed out when you have to go to work on Monday, display many of the symptoms of a depressive disorder, that doesn’t mean you have one. After that Monday is over you get back into your routine and seem in pretty good mental health. A person with a depressive disorder would constantly, or at least much more frequently feel depressed.
- Duration: The amount of time people spend demonstrating symptoms will also vary greatly. People with depressive disorders will experience the symptoms over much more extended periods of time, like months and years. Whereas people who are just down and out but do not have a diagnosis will likely experience those symptoms for days and weeks.
- Example: Frequently people will feel unmotivated and be lazy, lay on the couch, be mopey, and not accomplish anything. There is nothing wrong with this for a day or two, and can be really beneficial. People with depressive disorders however will do this weeks, months, and in extreme cases years and decades.
- Quantity of Symptoms: Remember, depressive disorders are a category of disorders that include multiple disorders, each with a specific set of symptoms. Each disorder usually requires a person to demonstrate a certain amount of criteria, like 5 out of 9 symptoms. Those who are just experiencing sadness may demonstrate only a few traits, whereas a person with a diagnosis may have 7, 8, or all the symptoms.
- Example: A person with a Major Depressive Disorder diagnosis, would need 5 of 9 symptoms to meet the criteria, someone with more severe Major Depressive Disorder is likely to show 7+ symptoms. Someone who is just experiencing a down time may have 3 or 4 and not need a diagnosis.
Common Symptoms of Depressive Disorders (American Psychiatric Association, 2013)
There is variation between each of the depressive disorders, but much of the behavior is similar, here are some of the symptoms of depressive disorders:
- Fatigue or lack of energy Being lazy, not having energy to go to work, always tired
- Sleep issues Insomnia (not enough sleep, staying up all night, restless sleep) or Hypersomnia (oversleeping, frequent napping)
- Lack of motivation Buried in the couch, don’t go see friends, neglecting exercise, often talking about what you should do but not doing anything.
- Disinterest in once pleasurable activities Reducing the amount you ski/bike/run/sing/paint/write/etc., no longer engaging in your hobbies, doing “nothing” more often, once pleasurable activities are no longer enjoyable
- Hopelessness Feeling like there is no chance that things can get better, negative outlook on the future, out of control of life, no hope in the future being an improvement
- Worthlessness Feeling not worth anything, no good, may say, “No one would miss me if I was gone,” negative/inaccurate view of self’s worth to the world or people.
- Helplessness Not having any control in life, “no matter what I do it doesn’t matter, I am still miserable,” “The world is just against me!”
- Weight gain/loss Some people will put on weight and eat unhealthy, eating their emotions, others will lose their appetite and subsequently lose weight, some people will yo-yo up and down.
- Trouble Concentrating Seems to be glazed over, frequent day dreaming, inability to focus.
- Feeling Gloomy/Depressed Not feeling happy, being sad, melancholy, or depressed
- Suicidal Thoughts “The world would be better off without me”, has a plan for suicide, talks about death, begins to give a way their possessions. THIS IS SERIOUS, IF THIS IS YOU OR SOMEONE YOU KNOW PLEASE VISIT THE CRISIS CHAT or CALL 1-800-273-8255 FOR SUPPORT, THERE IS HELP.
The Depressive Disorders
The DSM-5 identifies six depressive disorders, all with the central features of depression:
- Major Depressive Disorder
- Disruptive Mood Regulation Disorder
- Persistent Depressive Disorder (Formerly Dysthymia)
- Premenstrual Dysphoric Disorder
- Substance/Medication-Induced Depression
- Depressive Disorder Due to Another Medical Condition
Causes of Depressive Disorders
Most people today believe that there are multiple factors that all play a role in the development of a depressive disorder. The amount each factor impacts an individual’s mental health will vary greatly.
- Genetic Predisposition/DNA/Family History A genetic predisposition is basically the likelihood you develop a trait, this is based off the DNA that your biological parents passed on to you. If your biological family members all have Major Depressive Disorder, you have a high genetic predisposition for also developing it or another mental health disorder. If no one in your family has a depressive disorder, you have a lower genetic predisposition. All people, regardless of DNA, can develop depressive disorders, but DNA is a major indicator.
- Chemical Imbalances Having low levels of certain chemicals can help to explain the development of depressive disorders. Low levels of dopamine, serotonin, dopamine, and norepinephrine all have shown to impact depressive disorders. This can also be impacted by brain injuries and family history.
- Trauma Experiencing a traumatic event can have a drastic impact on mental health. The issues can manifest in a variety of ways, including through depressive disorders. Trauma is essentially experiencing an event where a person is physically, mentally, or emotionally harmed or threatened, or witnesses something distressing or disturbing. All people are impacted differently and will have subsequently unique reactions.
- Learned Behaviors People do learn negative behaviors that can become patterns. Things like drinking, fighting with people, drugs, poor communication, laziness, apathy, and other negative traits can strengthen depressive thoughts. Turning negative patterns into positive choices should be the goal.
- Physical Health Finding out a person has a serious illness, injuries, obesity, heart disease, and other forms of illness can all impact depressive symptoms.
Treatments for Depressive Disorders
There are a wide array of mental health disorder, largely based off the varied etiologies of mental health disorders. While each treatment may claim to be the most effective, it is paramount to understand that all people are different and the efficacy of each will vary.
Generally, depressive disorders are multi-faceted, meaning there are many causes. These can include but are not limited to biological/chemical imbalances, learned behaviors, negative relationships, communication issues, motivation problems, laziness, and many more. The percentage of each varies from person to person. Everyone is different and responses to treatment can fluctuate. Our individual mental health has a unique make up, as does the treatment of it.
- Talk Therapy Also called counseling, this is usually done with a Licensed Professional Counselor or Psychologist. The aim is to talk through problems to hopefully help empower a client to make emotional and behavioral changes that lead to a happier life and minimizing of depressive symptoms. Types of talk therapy differ greatly.
- Behavioral Modification Often done in conjunction with talk therapy, a person changes their behaviors to change the way they feel. This can include being more active, social, or things like drinking less. The thought is that changes in behavior need to occur for changes in happiness to occur. Making better decisions will usually lead to better feelings. This could include spending more time with friends, pursuing hobbies, writing, hiking, etc.
- Yoga/Meditation For thousands of years yoga has been used these two practices to help with both physical and mental health. There is a great amount of support for yoga being helpful for fighting depressive disorders and issues.
- Exercise Being physically active offers a variety of health benefits, both physical and mental. Some of these are physical, the production of endorphins, serotonin, and dopamine all make us feel better, think runner’s high. Also, exercise can build confidence in self, form positive relationships, minimize negative decisions.
- Diet The food that we ingest is what fuels our body and mind. If we constantly feed our brains processed junk, sugars, and bad fats how can it possibly run well? Improving your diet to include more whole foods and healthier options can help mental health functioning.
- Natural Herbs/Supplements/Vitamins A variety of different options exist for those who would like to try to naturally treat a depressive disorder. Many of these options have been around for thousands of years and a much safer and healthier way to treat depressive disorders without all the incredible risks of psycho-pharmacological options. Check out this website for more information on the specific details. A great, safe, natural way to give your body the chemical boost it may need to help with the symptoms of a depressive disorder.
- Writing/Journaling/Art Expressing yourself can be a fun and affordable way to help with depressive symptoms. Finding whatever your passion is can help improve your mental health. Trying out different artistic ventures can show immediate and prolonged improvement.
- Spending time with Friends/Family/Dogs/Nature Changing the people you spend your time with can have a huge impact. Who are you happiest around, makes you feel good about being you? Spend more time with those people. Who is negative, brings you down, and is high maintenance? Minimize time with them.
- Be Productive and Active Sometimes the hardest part of making changes is getting off the couch. Get things done, they don’t have to be big things, but clean your house, chop wood, do yard work, organize your closet, just do things. And chopping wood helps relieve stress and anger as well!
- Medications The use of psychopharmacological options should be a last option, only after all other options have been explored. Also, medication alone will not solve all your problems. A person with a depressive disorder will still likely need improve diet, make behavioral changes, exercise, talk to someone in order for medication to have the best effects. This needs to be done under the care of a licensed psychiatrist or medical doctor. If you are on meds, you should not stop taking them without your doctor. Generally, Selective Serotonin Reuptake Inhibitors (SSRIs) like Zolofot, Prozac, Paxil, and Lexapro are used to make serotonin more usable and improve feelings of depression.
If you are being treated for a depressive disorder, generally a combination of behaviors need to change. Medication should be a last resort and used in conjunction with other changes like diet, exercise, behavioral modification, and counseling.
If you are depressed, there is help out there, don’t give up. Keep trying! Everyday people with depression who are working hard on their mental health live happy, healthy, and productive lives. Just because you have depression does not mean your life is over, just that you may have to work a little harder, take better care of yourself, and improve your self awareness. YOU CAN DO IT!