What is clinical depression
I said to a client that her scores on a depression test indicated that she suffered low mood and was probably depressed. She agreed and said her doctor had told her she had clinical depression. She wondered what the difference was between low mood, depression and clinical depression. She also wondered if clinical depression was somehow worse, maybe it was harder to treat or maybe it was only treatable by using antidepressants.
Mental health professionals often use words interchangeable and this seems to be a case where the words mean similar things but the perception of the meaning is very different.
Low mood is often used to describe depression that is of mild to moderate severity although it is also a common term for low mood that for sub clinical threshold but that nevertheless is recognisable as being a significant decrease in well being. Low mood is also used as a term to describe depression but without using the word depression.
Are you depressed?
Depression as we commonly talk of it is really clinical depression or Major Depressive Disorder to give it its full diagnostic criteria name.
Major depressive disorder
Is characterised by a loss of interest or pleasure in daily activities for more than two weeks
A subjective change in mood from a ‘normal’ baseline
Impaired functioning in social, occupational and/or educational domains
Do you suffer from at least 5 of the list below, the symptom is recognisably troubling and is present on nearly every day:
1. Depressed mood or irritable 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).
2. Decreased interest or pleasure in most activities, most of each day
3. Significant weight change (5%) or change in appetite
4. Change in sleep: Insomnia or hypersomnia
5. Change in activity: Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt
8. Concentration: diminished ability to think or concentrate, or more indecisiveness
9. Suicidality: Thoughts of death or suicide, or has suicide plan
Depressive episode as opposed to Depressive disorder
Depression can be reactive in that it is a reaction to a normal life event such as bereavement. Many first episodes of depression seem to have reactive elements to them. However, if the depression is long standing then it more properly falls into the category of a major depressive disorder. In terms of the name you give the disorder it doesn’t make much difference. However if you believe you have a reactive depressive disorder then I recommend you seem help as soon as possible. As a general principle the sooner you take action to counter the depression the better chance you have of defeating it and feeling well again. I have found that both reactive and Major depressive disorders respond well to self help strategies, such as Blues Begone or Mood Control.
Depressive Episode Criteria (may be part of Major Depressive Disorder OR an isolated episode)
|List ADepressed MoodLoss of interest and enjoyment in usual activities
Reduced energy and decreased activity
|List BReduced self esteem and confidenceIdeas of guilt and unworthiness
Ideas of self harm
Severity of Depressive Episode
Mild: more than 1 symptom from column A plus 1-2 symptoms from column B. Or 5-6 symptoms that are of mild severity and functional impairment.
Moderate: More than 1 symptom from column A plus 2-3 from column B. Or 7 – 8 symptoms of moderate functional impairment.
Severe: All 3 from column A plus more than 3 from column B. Or fewer symptoms but any of these show severe functional impairment, also with possible psychotic symptoms a recent suicide attempt, or a specific suicide plan or clear intent.
|Functional Domain||Moderately Impaired||Severely Impaired|
|FamilyRelationships||Quiet, negative and oppositional,||Withdrawn, won’t talk, brusque, angry, aggressive|
|School& Academics/ Work||Grades/work performance deteriorating, missing/cutting class or work,decreased effort, moderate academic or work stress||Failing performance, missing school or work doesn’t care about work, oppositional, argumentative, high academic or work stress|
|Peer Relationships||Decreased socializing or extracurricular activities, more time on computer Isolated,||discontinued extracurricular activities, excessive computer time|
|Stress Level Anxiety||Minimizes or denies issues, projects onto others or blames others||Withholds feelings, won’t talk|
|Suicidal Ideation||Vague/occasional||Frequently considered, has a plan, or prior attempt|
|Other Self Harm||Occasional thoughts but no attempts||Cutting, other self injury|
How to treat clinical depression
I have seen hundreds of people in my clinic who have suffered from clinical depression. Depression is such a pervasive problem that it usually accompanies every other psychological problem including the common ones of anxiety, OCD, GAD, health anxiety and PTSD. It has been my experience that all depression responds well to an active treatment strategy. It has also been my experience that doing nothing, taking no control over the depression and simply accepting you are depressed if definitely unhelpful.
Depression is not inevitable
All depression is treatable to some extent and most of it to a great extent. But you have to take the first treatment step, this is most fruitfully done with self help and in particular Active Self Help in the form of Blues Begone or Mood Control.
If you went on a journey and you found yourself going the wrong way you would turn around and go the correct way. One way to think about depression is a detour on life’s journey. Turn around and go the way you want to go. Once you get on the right path there is lots of help here for you. But only you can make the first turn!
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