Depression

Most of us feel sad, lonely, blue, or “down in the dumps” at times, and it’s normal to feel depressed when experiencing loss or great stress. But when these feelings become overwhelming and/or last for long periods of time, they can interfere with leading a productive, active and fulfilling life.

If you are feeling depressed, you are not alone. Depression is a fairly common mental health condition with about one in six adults experiencing an episode of major depression each year. Depression in general is even more pervasive than that, however, as clinicians distinguish between three main types of depression: bipolar, unipolar (major depressive disorder) and dysthymia.

To be diagnosed with major depressive disorder, a person must either have a depressed mood or a loss of interest or pleasure in daily activities consistently for a period of at least two weeks. With dysthymia, the essential symptom involves feeling depressed most of the day, for more days than not, for at least 2 years. Major depression is considered more intense and debilitating, though with dysthymia, the chronic experience of feeling depressed can be quite distressing as well.

Many people experience symptoms of depression without recognizing that they are suffering from depression, and therefore, do not seek treatment. If left untreated, symptoms of major depression can cause untold suffering and possibly lead to suicide. Recognizing the symptoms of depression is often the biggest hurdle to getting the proper help.

If you are experiencing any of the following symptoms, it is a good idea to see your physician first to rule out any physical causes, and then to seek psychological help if your doctor does not determine a physical cause.

Symptoms of depression can include:

• Agitation, restlessness, and irritability
• Dramatic change in appetite, often with unintended weight gain or loss
• Difficulty concentrating
• Fatigue and/or lack of energy
• Sadness, hopelessness, helplessness, tearfulness or frequent crying
• Feelings of worthlessness, self-hate, and guilt
• Becoming withdrawn or isolated
• Thoughts of death or suicide
• Trouble sleeping or excessive sleeping
• Irritability, anger, hostility, or acting out
• Problems at work or school
• Loss of interest or enjoyment in activities.
• Lack of enthusiasm and motivation
• Extreme sensitivity to criticism

With teens and children specifically, depression often appears as irritability and anger.

Fortunately, depression is treatable! Causes of depression vary, including genetics and/or stressful life situations, but with counseling and sometimes medical help, the prognosis for most people with depression is very hopeful as the symptoms of depression can usually be greatly reduced.

At APPLE FamilyWorks, we rely on valid and reliable measurement tools to help determine if an individual meets the criteria for a diagnosis of depression. We have trained licensed and pre-licensed professionals who know how to apply empirically-based treatment methods to help treat depression and we work collaboratively with psychiatrists when medication is a part of the treatment. Please don’t hesitate to call us if you have concerns that you or a loved one may be suffering from depression.

For your general information, below are the professional diagnostic criteria for depression. It is always best, however, to have a mental health professional determine whether or not the diagnosis of a psychiatric disorder is warranted. We recommend you seek the expertise of a professional who can apply reliable assessment tools to make that determination.

DSM-IV Criteria for an Episode of Major Depression

1. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note:  Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
   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.
   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).
   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.
   4. insomnia or hypersomnia nearly every day.
   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 day.
   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).
   8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
   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.
2. The symptoms do not meet criteria for a Mixed Episode.
3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
4. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
5. The symptoms are not 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.

DSM-IV Criteria for Major Depressive Disorder

Single Episode

1. Presence of a single Major Depressive Episode.
2. The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
3. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced, or are due to the direct physiological effects of a general medical condition.

Recurrent

1. Presence of two or more Major Depressive Episodes. Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode.
2. The Major Depressive Episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
3. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced, or are due to the direct physiological effects or a general medical condition.

DSM-IV Criteria for Dysthymic Disorder

1. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
   1. Presence, while depressed, of two (or more) of the following:
   2. poor appetite or overeating
   3. insomnia or hypersomnia
   4. low energy or fatigue
   5. low self-esteem
   6. poor concentration or difficulty making decisions
   7. feelings of hopelessness
2. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time.
3. No Major Depressive Episode has been present during the first 2 years of the disturbance (1 year for children and adolescents); i.e., the disturbance is not better accounted for by chronic Major Depressive Disorder, or Major Depressive Disorder, In Partial Remission.
4. Note: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder. In addition, after the initial 2 years (1 year in children or adolescents) of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode.
5. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.
6. The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder.
7. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
8. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

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