Are you depressed? A look at the diagnostic criteria
If you were to see your doctor about the way you have been feeling, they'd most likely use the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5 for short, to assess whether you meet the diagnostic criteria for major depressive disorder. There are nine in all, and:
- You need to recognize five of them in yourself
- They have to have applied to you for at least two weeks (on and off, on most days or most of the day)
- You need to fit the bill for either of the first two to "qualify" for a diagnosis of depression.
1. A depressed mood
More concretely, a depressed mood means things like feeling sad and tearful, but also empty, low, pessimistic, hopeless, like everything is bad or meaningless (or at least most things are), and nothing can ever get better. Depressed people tend to feel this way most days, or most of the day, and when you go in for diagnosis, it's OK not to be completely aware of how you are feeling — other people can also have told you that you seem depressed. In some people, especially adolescents and children, depression can also manifest as a very irritable mood.
2. Loss of interest in activities that used to mean something
People who are "just sad" tend to at least temporarily perk up when they're about to do something that means something to them, whether that means working on writing that novel, spending time with friends, going to work, exercising, or whatever else. Depressed people, on the other hand, usually lose that motivation. When just doing nothing seems more appealing, or less unappealing, than engaging in the things that used to really excite you, that's a major warning sign.
3. Weight and appetite changes
Many depressed people either suddenly don't feel like eating much, resulting in weight loss, or overeat, causing them to gain weight. If you've noticed appetite changes and resulting weight fluctuations, that is, again, one of the signs that you may be depressed.
4. Changes in the way you sleep
Two options are, again, on the table here. Some depressed people find it hard to get to sleep or stay asleep, often thinking about all the bad things that are, could be, or they think will come to be. Others sleep too much, finding it hard to even get out of bed in the morning. Both ends of the spectrum can be an integral part of depression for some people.
5. Psychomotor agitation or retardation
These medical terms essentially denote a condition of either:
- Slowed physical movement
- Or restlessness, expressed physically
To meet this diagnostic criteria, the way in which you move actually needs to have changed, rather than just having subjective feelings of slowness or restlessness.
6. Fatigue or loss of energy
This one pretty much speaks for itself — you feel like your batteries are all out and you're not able to do much, nearly every day.
7. Worthlessness or guilt
I've personally always wondered why this one doesn't go under the "depressed mood" heading, but there you go — it's separate. People suffering from clinical depression tend to feel worthless and guilty, more than they really have reason to. That may include feeling guilt and worthless for stuff that objectively couldn't have been your fault.
8. Trouble concentrating
Difficulty concentrating or making decisions is another frequent symptom of depression. Even if you try, nothing is easy.
The last diagnostic criterion is also the most drastic, and it's returning thoughts about death that go beyond a fear of dying, thoughts about suicide, plans to commit suicide, and attempts to commit suicide. If you are feeling suicidal, that alone, without any of the other criteria, is enough reason to seek help immediately.
Beyond the DSM-5: What depression can do to you physically
Depression is thought of as a mental illness, something that's literally "all in the head", but it can and does have physical symptoms as well. Besides slowness of movement or increased physical agitation, appetite and weight changes, and changes in sleep — which are part of the diagnostic criteria and also, really, physical in nature — depression can also lead to:
- Physical aches and pains (including back pain, tense shoulders, and joint pain)
- In women, changes in your menstrual cycle
- Lowered libido or loss of interest in sex
- Migraine headaches
In fact, many depressed people initially see their doctor not to ask whether they're clinically depressed, but for physical symptoms — something for which many people find it easier to seek medical attention.