How do you know if you’re actually depressed? Often, healthy people have many of the symptoms of depression, on a daily basis, but are not depressed. Other times, a person is so depressed that they might even be suicidal, and then it is clearly quite obvious. What I have found, however, is that many people are depressed and don’t realize it. They’ve ignored or not recognized some of the symptoms for so long, that it has simply become their normal, and I’d like to clarify this a bit. When you’re chronically depressed and either not aware or not doing anything about it, it can take a toll on your functioning, your relationships, and your overall happiness.
Let’s take a look at the diagnostic criteria for major depressive disorder (DSM-5TM Diagnostic Criteria):
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 attributable to another medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) 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.)
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 gain.)
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.
Sometimes, I gain weight without trying. I’m busy and eating poorly and not exercising as I should be. This might lead to some trouble sleeping and exhaustion. That might make it difficult for me to concentrate and make decisions. But it does not mean I am depressed. Other times, I might be so stressed that I lose weight without trying and lose interest in my usual activities because when I’m not busy, I just want to chill out or sleep. Again, this doesn’t mean I am depressed. So how does a person know the difference?
One of the most obvious ways to know if your symptoms are really depression is to ask if they cause impairment in any of the areas of your life. Is your fatigue making you unable to go to work or perform your job? Are you unable to get out of bed in the morning and go about your day? Do you feel sad or hopeless about the future? Have you thought about killing yourself? Have you experienced at least five of the symptoms above for at least a two week period? If so, it is very likely that you are depressed, and you should seek professional help from a therapist and/or a doctor.
There is another diagnosis that I see even more frequently than major depression, and that is dysthymia, or persistent depressive disorder. This is perhaps a less serious, less debilitating but potentially more common and longer lasting disorder. Both can have negative impacts on your life. Let’s take a look at the diagnostic criteria for persistent depressive disorder (DSM-5TM Diagnostic Criteria):
Depressed mood for most of the day, for more days than not, as indicated by either 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.
B. Presence, while depressed, of two (or more) of the following:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.
As you can see, this diagnosis does not include suicidal ideation, feelings of worthlessness, or agitation. But, one of the common threads is indecisiveness; difficulty making decisions. This is the single symptom that I see more than any of the others in my practice. With what I see, it’s not just the inability to decide what to wear of where to eat, it is an ambivalence or lack of really caring one way or the other. I often hear these people saying, “I don’t know” or “I don’t care” or “you decide” when asked questions. While it is certainly not alarming to say these things sometimes, it is concerning when that become your typical answer to most questions. If you don’t care what you do, where you go, what you eat or how you look, there is a good chance you are dealing with depression or dysthymia. You relationships may be silently suffering, and you haven’t even noticed!
If you think you might be suffering from depression or dysthymia, start by talking to those you love or those closest to you. Sometimes it is hard to be objective, but getting feedback from others can be helpful. Talk to a therapist who can help diagnose you and treat your depression. Depending on the severity of your depression, you might even need to talk your doctor about finding a medication that can also help you.
The benefits to acknowledging and treating your depression are many. Most importantly, you will fell better, happier and more productive. But also, you personal relationships and work productivity may also improve, so it’s really a win-win. If you are happier, a better partner, better employee, and a better parent, then everyone really benefits from your treatment.