<p>"Depression" is a symptom or state of being, one that everyone can experience.</p>

<p>"Major Depressive Disorder," however, is a diagnosable medical disorder for many reasons. The following list is by no means exhaustive:</p>

<ul>
<li>Major Depressive Disorder runs in families, and a <a href="http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.157.10.1552" rel="nofollow noreferrer">genetic component is well established</a> by family and twin studies.</li>
<li>Anyone who experiences a major depressive episode is at increased risk compared to the general population.</li>
<li>Major Depressive Disorder costs the US <a href="https://www.ncbi.nlm.nih.gov/pubmed/25742202" rel="nofollow noreferrer">$200 billion per year</a> in medical treatment and workplace costs.</li>
<li>There are many specific ways in which functioning in the brain is altered in depressed patients. Decreased functioning in the prefrontal cortex (executive functioning) is a good example.</li>
<li>Contrary to belief common in the 80s and 90s, clinical depression is much more complicated than "a deficiency in serotonin" - the neurology is multifactorial and still poorly understood. However, clinically depressed patients (usually) respond to SSRIs in a manner different from healthy individuals. Prozac is not a "happy pill" if you are not depressed.</li>
</ul>

<p>"A problem of thought" is one <em>aspect</em> of depression. Most individuals have some combination of cognitive, behavioral, neurochemical, and genetic elements.</p>

<p>I agree with you that telling people "you have a disease" is not always helpful and can be counter-productive in many instances. I too am a fan of positive psychiatry, and I think most individuals could benefit from caring for their mental wellbeing in the same way that healthy people benefit from exercise. On the other side of the coin, it is a <em>serious issue</em> that many patients do not take seriously enough, and non-compliance to medication and therapy is common and can have very serious adverse consequences.</p>

<p>Your question is a good one, and a common one. Thank you for asking. Be aware, though, that it may come off as insensitive and offensive to some who have it bad. </p>

<p>To use rationalist terms: depression and suicide has been a large problem for many people throughout human history. From that, you can assume that 1) many people care very deeply about it, and 2) it is a <em>difficult problem</em>. Given those facts, any statement along the lines of "All it requires is ____", someone will likely take offense.</p>

CC BY-SA 3.0
2017-04-25T19:31:27.057Z
Welcome to CogSci and thanks for the answer. Could you add sources or references to your answer? That way others can background read on your material.
AliceD
CC BY-SA 3.0
2017-04-25T20:42:51.823Z
The fact that MDD costs the US $200 billion per year etc. is not the reason MDD is diagnosable.  It is just the effect of MDD on medical treatment and workplace costs.  The fact that it is more than just sadness etc. in the rest of your answer is the reason it is diagnosable.
Chris Rogers
CC BY-SA 3.0
2017-04-26T13:49:11.257Z
AliceD, I do not have specific studies that I would like to recommend, but I have taken efforts to ensure that the bullet points I listed have been confirmed by multiple studies and are considered "common knowledge" in medicine (i.e. taught to medical students). I prefer not to cite specific articles without reading them thoroughly, and I did not think this topic particularly controversial to merit such. However, I found a decent meta-analysis on the heritability of depression which I edited to include.
ancientcampus
CC BY-SA 3.0
2017-04-26T14:02:02.217Z
Chris, one mandatory element of the diagnostic criteria for clinical depression (and indeed, nearly all psychiatric diagnoses) is that it causes "clinically significant distress or impairment in social, occupational, or other important areas of functioning." I included that source to show strong empiric evidence that, yes, it indeed impacts occupational functioning, to the tune of 100 billion dollars annually.
ancientcampus
CC BY-SA 3.0
2017-04-25T19:03:52.730Z
2017-04-26T13:50:17.037Z
2017-04-26T13:50:17.037Z
ancientcampus
<p>As @user30133 pointed out,</p>

<blockquote>
  <p>Not everyone who feels depressed some time [is] diagnosed with depression. Depression is not simply feeling sad. It has specific diagnosis criteria which you can find in [the] DSM</p>
</blockquote>

<p>The DSM is the <a href="https://www.psychiatry.org/psychiatrists/practice/dsm" rel="noreferrer">Diagnostic and Statistical Manual of Mental Disorders</a>, of which the most recent edition is the 5th edition (DSM-5) which also links to <a href="http://apps.who.int/classifications/icd10/browse/2016/en" rel="noreferrer">ICD-10</a> (International Statistical Classification of Diseases and Related Health Problems 10th Revision).</p>

<p>NICE (The UK's National Institute for Health and Care Excellence) <a href="https://www.nice.org.uk/guidance/cg90/resources/depression-in-adults-recognition-and-management-pdf-975742636741" rel="noreferrer">states in this 64 page document outlining recognition and management of depression</a></p>

<blockquote>
  <p>Depression is a broad and heterogeneous diagnosis. Central to it is depressed mood and/or loss of pleasure in most activities. Severity of the disorder is determined by both the number and severity of symptoms, as well as the degree of functional impairment. A formal diagnosis using the ICD-10 classification system requires at least four out of ten depressive symptoms, whereas the DSM-IV system requires at least five out of nine for a diagnosis of major depression (referred to in this guideline as 'depression'). Symptoms should be present for at least 2 weeks and each symptom should be present at sufficient severity for most of every day. Both diagnostic systems require at least one (DSM-IV) or two (ICD‑10) key symptoms (low mood,<sup>[1]</sup> loss of interest and pleasure<sup>[1]</sup> or loss of energy<sup>[2]</sup>) to be present.</p>
  
  <p>Increasingly, it is recognised that depressive symptoms below the DSM‑IV and ICD‑10 threshold criteria can be distressing and disabling if persistent. Therefore this updated guideline covers 'subthreshold depressive symptoms', which fall below the criteria for major depression, and are defined as at least one key symptom of depression but with insufficient other symptoms and/or functional impairment to meet the criteria for full diagnosis. Symptoms are considered persistent if they continue despite active monitoring and/or low-intensity intervention, or have been present for a considerable time, typically several months. (For a diagnosis of dysthymia, symptoms should be present for at least 2 years<sup>[3]</sup>.)</p>
  
  <p>It should be noted that classificatory systems are agreed conventions that seek to define different severities of depression in order to guide diagnosis and treatment, and their value is determined by how useful they are in practice. After careful review of the diagnostic criteria and the evidence, the Guideline Development Group decided to adopt DSM-IV criteria for this update rather than ICD-10, which was used in the previous guideline (NICE clinical guideline 23). This is because DSM-IV is used in nearly all the evidence reviewed and it provides definitions for atypical symptoms and seasonal depression. Its definition of severity also makes it less likely that a diagnosis of depression will be based solely on symptom counting. In practical terms, clinicians are not expected to switch to DSM-IV but should be aware that the threshold for mild depression is higher than ICD-10 (five symptoms instead of four) and that degree of functional impairment should be routinely assessed before making a diagnosis. Using DSM-IV enables the guideline to target better the use of specific interventions, such as antidepressants, for more severe degrees of depression.</p>
  
  <p>[1] In both ICD-10 and DSM-IV.</p>
  
  <p>[2] In ICD-10 only.</p>
  
  <p>[3] Both DSM-IV and ICD-10 have the category of dysthymia, which consists of depressive symptoms that are subthreshold for major depression but that persist (by definition for more than 2 years). There appears to be no empirical evidence that dysthymia is distinct from subthreshold depressive symptoms apart from duration of symptoms, and the term 'persistent subthreshold depressive symptoms' is preferred in this guideline.</p>
</blockquote>

CC BY-SA 3.0
2017-04-19T19:46:45.623Z
2017-04-19T19:46:45.623Z
Chris Rogers
<p><strong>Short answer</strong><br>
The current understanding is that depression is related to a neurochemical imbalance in the depressed brain. Pharmacological treatment to shift and correct that imbalance may therefore be an effective approach. </p>

<p><strong>Background</strong><br>
Basically you are saying depression is a state of mind and should be treated with counselling rather than  tagging a person as mentally ill and medicalizing the care.</p>

<p>As pointed out in the other answers, diagnosis of clinical depression happens through <a href="http://www.psnpaloalto.com/wp/wp-content/uploads/2010/12/Depression-Diagnostic-Criteria-and-Severity-Rating.pdf" rel="nofollow noreferrer">rational guidelines</a> using <a href="http://m.blog.naver.com/mistyeyed73/220427762670" rel="nofollow noreferrer">questionnaires and inventories</a>. Basically, the goal is to extract the clinical, chronic depression from the other group that only shows some, but not all the symptoms of clinical depression. Normal life events can trigger a depression, but that doesn't mean that person needs medical treatment.</p>

<p>In contrast, clinical depression, while being a mental disorder, has correlates in the neurochemical balance in the brain. From a neuroscience perspective, the depressed brain is physically different from a non-depressed brain.</p>

<p>Early medical treatments, and more recent accepted classes of anti-depressants show important correlates to dysfunctional <strong><a href="http://www.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-modpsy-toc~drugtreat-pubs-modpsy-2~drugtreat-pubs-modpsy-2-3~drugtreat-pubs-modpsy-2-3-intr" rel="nofollow noreferrer">mono-aminergic neurotransmission</a></strong>. A rough timeline of the various <a href="http://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273" rel="nofollow noreferrer">anti-depressants</a> shows the neurotransmitter systems that are targeted by these drugs <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181155/" rel="nofollow noreferrer">(Ferguson 2001)</a>:</p>

<ul>
<li>1950s: <a href="http://www.mayoclinic.org/diseases-conditions/depression/in-depth/maois/art-20043992" rel="nofollow noreferrer">MAO inhibitors</a>: elevate monoaminergic (MA) neurotransnmitters levels by blocking their breakdown (serotonin (5HT), noradrenaline (NE) and dopamine (DA) ;</li>
<li>'50s and '60s: <a href="http://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983" rel="nofollow noreferrer">tricyclic anti-depressants</a>: elevate 5HT, NE and DA by inhibiting reuptake; </li>
<li>'70s: <a href="http://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825" rel="nofollow noreferrer">selective serotonin reuptake inhibitors</a> (SSRIs): inhibit specifically reuptake of 5-HT, enhancing those levels of neurotransmitter and not others;</li>
<li>'70s: <a href="http://mentalhealthdaily.com/2014/12/24/norepinephrine-dopamine-reuptake-inhibitors-ndris-list/" rel="nofollow noreferrer">NE &amp; DA reuptake inhibitors</a> (NDRIs) </li>
<li>'80s: <a href="http://www.mayoclinic.org/diseases-conditions/depression/in-depth/atypical-antidepressants/art-20048208" rel="nofollow noreferrer">atypical antidepressants</a> (a hererogeneous class targeting multiple systems, including 5HT, DA and NE)</li>
<li>'90's: <a href="http://cdn.intechopen.com/pdfs/37606.pdf" rel="nofollow noreferrer">5HT &amp; NE reuptake inhibitors</a> (SNRIs)</li>
</ul>

<p>Without going into their specific mechanisms of action, the point I wish to make is that decades of research in anti-depressants has strongly indicated that a monoamine (MA) neurotransmitter imbalance (most notably 5HT), and specifically a <strong>reduced</strong> MA neurotransmission is one of the leading factors to a depression <a href="https://www.ncbi.nlm.nih.gov/pubmed/19442174" rel="nofollow noreferrer">(Muñoz &amp; Alamo, 2009)</a>. While counseling may help, the underlying disorder may perhaps be treated effectively through treatment with antidepressants.</p>

<p>Regarding your statement that a diagnosis may enforce depressive thoughts -
I disagree. <strong>Acknowledgement</strong> of the depressed state as a serious and debilitating illness is a necessary first step to recovery. Instead of the "<em>oh it's just all between your ears - here are some positive words for you</em>", depressed people are taken seriously and receive the appropriate medical care they deserve. This counts for pharmacological interventions and counseling alike. The first and likely the most crucial stage is acknowledging the problem - for the patient, the care providers, as well as for friends and family.    </p>

<p><sub><strong>References</strong><br>
<strong>-</strong> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181155/" rel="nofollow noreferrer">Ferguson, <em>Prim Care Companion J Clin Psychiatry</em> (2001); <strong>3</strong>(1): 22-7</a><br>
<strong>-</strong> <a href="https://www.ncbi.nlm.nih.gov/pubmed/19442174" rel="nofollow noreferrer">Muñoz &amp; Alamo, <em>Curr Pharm Des</em> (2009); <strong>15</strong>(14): 1563-86</a></sub>  </p>

CC BY-SA 3.0
2017-04-26T19:02:50.747Z
2017-04-27T05:45:11.300Z
2017-04-27T05:45:11.300Z
AliceD
<p>Not everyone who feels depressed some time diagnosed with depression. Depression is not simply feeling sad. It has specific diagnosis criteria which you can find in <strong><a href="https://www.psychiatry.org/psychiatrists/practice/dsm" rel="nofollow noreferrer">DSM-V</a></strong>. Diagnosis of a mental disorder is needed to help the patient, not to label them or to reenforce any idea. That's why in psychiatry, the term 'diases' is not used. Moreover, with the same way of thinking in your question, none of the psychiatric disorders could be defined. Because psychiatry is based on ways of feelings and thoughts.</p>

CC BY-SA 3.0
2017-04-15T13:17:54.260Z
2017-04-26T19:39:34.253Z
2017-04-26T19:39:34.253Z
user30133
<p>To me, it seems strange that something such as depression, which anyone can feel at any given time, is diagnosed and treated medically as if it is a mental disorder. I believe depression should be treated with constructive sessions, communication and through giving people a sense of meaning.</p>

<p><strong>Why is depression being treated as if it is a medical problem when it's a problem of thought?</strong></p>

<p>In my opinion, diagnosing a person as being depressed may re-enforce their negative ideas, while the more obvious approach would be to positively re-enforce this person?.</p>

CC BY-SA 3.0
2017-04-12T18:39:58.480Z
Hi Charlie, Welcome at CogSci, and you certainly ask a very valid and interesting question. However, I would refrain from sharing an opinion, because opinionated or biased question tend to get closed on this website. Regarding the question, I am no expert but I heard that there is a fundamental difference between sadness (which everyone feels from time to time) and a depression (longer lasting or chronic feeling of sadness/emptiness).
Robin Kramer-ten Have
CC BY-SA 3.0
2017-04-12T22:21:34.773Z
"which anyone can feel at any given time"  This part isn't correct.  You may be confusing episodes of sadness with episodes of depression.
mrt
CC BY-SA 3.0
2017-04-12T22:44:50.897Z
Hi guys, thanks for your comments. As to the differentiation between sadness and depression, this is rather profoundly understood but myself as an experience of both and indeed all sorts inbetween.
Charlie
CC BY-SA 3.0
2017-04-12T22:47:06.850Z
I would, however, stand by my comment that anyone can become depressed at any given time for a wide variety of reasons, and my belief is that assigning a label to depression gives it justification to exist and become part of a person's mindset. I would change the word "feel" to "experience", as I would affirm that depression is much more accurately described as an absence of feeling.
Charlie
CC BY-SA 3.0
2017-04-12T22:51:48.737Z
I will also take a look at the book you suggested, but I'll refrain from reading it at length for the time being as I've quite enough to read!
Charlie
CC BY-SA 3.0
2017-04-13T00:01:34.783Z
Depression isn't really an absence of feeling.  It's defined by noisy interoceptive signals from the body and altered interoceptive predictions in the brain, which are associated with negative affect, inflammation, reduced motivation, fatigue, etc.   However, it isn't a unitary disease, presenting heterogeneously in different populations and overlapping with other putative psychological disorders.   How exactly we label this disorder  and talk to patients about it is mostly a separate issue.
mrt
CC BY-SA 3.0
2017-04-13T17:10:42.253Z
That's an interesting proposition.
Charlie
CC BY-SA 3.0
2017-04-14T14:02:46.093Z
depression in different forms can be either a temporary hormonal dysfunction, a chemical imbalance in the brain or denial of a stressor
preston
CC BY-SA 3.0
2017-04-25T19:37:11.120Z
To be perfectly honest, this question really upset me as I am diagnosed with Depression and struggle with it every day. Depression is usually caused by an underlying biological issue in the brain, and while people can feel depressed for a while there are specific criteria that you have to meet in order to be diagnosed. Both my husband and I struggle with suicidal thoughts regularly. It has not "reinforced that we are helpless" it has given us the option to seek medication that gives us the ability to be happy and live fulfilling lives.
SolarLunix
CC BY-SA 3.0
2017-04-26T11:15:39.427Z
@SolarLunix Consider this question an opportunity for the community to clarify these commonly held misconceptions. I can understand you might be hurt by this (and similar questions), but _not_ talking about this topic would only lead to more people misunderstanding the true nature of depression.
Steven Jeuris
CC BY-SA 3.0
2017-04-26T16:10:05.923Z
@StevenJeuris That's why I commented rather than just simply reporting the question. I just don't have sources besides my own experience and so I did not want to leave it as an answer. I regularly try to advocate that depression is a *disease* and not a state of mind.
SolarLunix
CC BY-SA 3.0
2017-04-26T19:47:02.300Z
@SolarLunix - I handled your flag and marked it as helpful, but I didn't undertake action. I second Steven's comments that this seems a valid question. Because the question was self-help you felt offended. I have attempted to generalize the question as I *do* understand your concerns. But again, you should not take this personal. So many people, so many opinions. *You* are the expert here. Remember that.
AliceD
CC BY-SA 3.0
2017-04-26T19:49:16.493Z
@Charlie - I have generalized the question and removed any personal references. The convention on this site is to make the question interesting for the community at large. +1 for a nice question though :)
AliceD
<neuroscience><depression><psychopharmacology><positive-psychology>
Why is depression a diagnosable issue?
Charlie
# Why is depression a diagnosable issue?

(Asked by: username_0 on 2017-04-12)

To me, it seems strange that something such as depression, which anyone can feel at any given time, is diagnosed and treated medically as if it is a mental disorder. I believe depression should be treated with constructive sessions, communication and through giving people a sense of meaning.

**Why is depression being treated as if it is a medical problem when it's a problem of thought?**

In my opinion, diagnosing a person as being depressed may re-enforce their negative ideas, while the more obvious approach would be to positively re-enforce this person?.

**Tags:** neuroscience, depression, psychopharmacology, positive-psychology

> **Comments:**
> **username_1**: Hi username_0, Welcome at CogSci, and you certainly ask a very valid and interesting question. However, I would refrain from sharing an opinion, because opinionated or biased question tend to get closed on this website. Regarding the question, I am no expert but I heard that there is a fundamental difference between sadness (which everyone feels from time to time) and a depression (longer lasting or chronic feeling of sadness/emptiness).  
> **username_2**: "which anyone can feel at any given time"  This part isn't correct.  You may be confusing episodes of sadness with episodes of depression.  
> **username_0**: Hi guys, thanks for your comments. As to the differentiation between sadness and depression, this is rather profoundly understood but myself as an experience of both and indeed all sorts inbetween.  
> **username_0**: I would, however, stand by my comment that anyone can become depressed at any given time for a wide variety of reasons, and my belief is that assigning a label to depression gives it justification to exist and become part of a person's mindset. I would change the word "feel" to "experience", as I would affirm that depression is much more accurately described as an absence of feeling.  
> **username_0**: I will also take a look at the book you suggested, but I'll refrain from reading it at length for the time being as I've quite enough to read!  
> **username_2**: Depression isn't really an absence of feeling.  It's defined by noisy interoceptive signals from the body and altered interoceptive predictions in the brain, which are associated with negative affect, inflammation, reduced motivation, fatigue, etc.   However, it isn't a unitary disease, presenting heterogeneously in different populations and overlapping with other putative psychological disorders.   How exactly we label this disorder  and talk to patients about it is mostly a separate issue.  
> **username_0**: That's an interesting proposition.  
> **username_3**: depression in different forms can be either a temporary hormonal dysfunction, a chemical imbalance in the brain or denial of a stressor  
> **username_4**: To be perfectly honest, this question really upset me as I am diagnosed with Depression and struggle with it every day. Depression is usually caused by an underlying biological issue in the brain, and while people can feel depressed for a while there are specific criteria that you have to meet in order to be diagnosed. Both my husband and I struggle with suicidal thoughts regularly. It has not "reinforced that we are helpless" it has given us the option to seek medication that gives us the ability to be happy and live fulfilling lives.  
> **username_5**: @username_4 Consider this question an opportunity for the community to clarify these commonly held misconceptions. I can understand you might be hurt by this (and similar questions), but _not_ talking about this topic would only lead to more people misunderstanding the true nature of depression.  
> **username_4**: @StevenJeuris That's why I commented rather than just simply reporting the question. I just don't have sources besides my own experience and so I did not want to leave it as an answer. I regularly try to advocate that depression is a *disease* and not a state of mind.  
> **username_6**: @username_4 - I handled your flag and marked it as helpful, but I didn't undertake action. I second Steven's comments that this seems a valid question. Because the question was self-help you felt offended. I have attempted to generalize the question as I *do* understand your concerns. But again, you should not take this personal. So many people, so many opinions. *You* are the expert here. Remember that.  
> **username_6**: @username_0 - I have generalized the question and removed any personal references. The convention on this site is to make the question interesting for the community at large. +1 for a nice question though :)  

---

## 4 answers

### Answer by username_7 on 2017-04-25. Score: 7

"Depression" is a symptom or state of being, one that everyone can experience.

"Major Depressive Disorder," however, is a diagnosable medical disorder for many reasons. The following list is by no means exhaustive:

* Major Depressive Disorder runs in families, and a [genetic component is well established](http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.157.10.1552) by family and twin studies.
* Anyone who experiences a major depressive episode is at increased risk compared to the general population.
* Major Depressive Disorder costs the US [$200 billion per year](https://www.ncbi.nlm.nih.gov/pubmed/25742202) in medical treatment and workplace costs.
* There are many specific ways in which functioning in the brain is altered in depressed patients. Decreased functioning in the prefrontal cortex (executive functioning) is a good example.
* Contrary to belief common in the 80s and 90s, clinical depression is much more complicated than "a deficiency in serotonin" - the neurology is multifactorial and still poorly understood. However, clinically depressed patients (usually) respond to SSRIs in a manner different from healthy individuals. Prozac is not a "happy pill" if you are not depressed.

"A problem of thought" is one *aspect* of depression. Most individuals have some combination of cognitive, behavioral, neurochemical, and genetic elements.

I agree with you that telling people "you have a disease" is not always helpful and can be counter-productive in many instances. I too am a fan of positive psychiatry, and I think most individuals could benefit from caring for their mental wellbeing in the same way that healthy people benefit from exercise. On the other side of the coin, it is a *serious issue* that many patients do not take seriously enough, and non-compliance to medication and therapy is common and can have very serious adverse consequences.

Your question is a good one, and a common one. Thank you for asking. Be aware, though, that it may come off as insensitive and offensive to some who have it bad.

To use rationalist terms: depression and suicide has been a large problem for many people throughout human history. From that, you can assume that 1) many people care very deeply about it, and 2) it is a *difficult problem*. Given those facts, any statement along the lines of "All it requires is \_\_\_\_", someone will likely take offense.

> **Comments:**
> **username_6**: Welcome to CogSci and thanks for the answer. Could you add sources or references to your answer? That way others can background read on your material.  
> **username_8**: The fact that MDD costs the US $200 billion per year etc. is not the reason MDD is diagnosable.  It is just the effect of MDD on medical treatment and workplace costs.  The fact that it is more than just sadness etc. in the rest of your answer is the reason it is diagnosable.  
> **username_7**: username_6, I do not have specific studies that I would like to recommend, but I have taken efforts to ensure that the bullet points I listed have been confirmed by multiple studies and are considered "common knowledge" in medicine (i.e. taught to medical students). I prefer not to cite specific articles without reading them thoroughly, and I did not think this topic particularly controversial to merit such. However, I found a decent meta-analysis on the heritability of depression which I edited to include.  
> **username_7**: Chris, one mandatory element of the diagnostic criteria for clinical depression (and indeed, nearly all psychiatric diagnoses) is that it causes "clinically significant distress or impairment in social, occupational, or other important areas of functioning." I included that source to show strong empiric evidence that, yes, it indeed impacts occupational functioning, to the tune of 100 billion dollars annually.  

---

### Answer by username_8 on 2017-04-19. Score: 5

As @username_9 pointed out,

> Not everyone who feels depressed some time [is] diagnosed with depression. Depression is not simply feeling sad. It has specific diagnosis criteria which you can find in [the] DSM

The DSM is the [Diagnostic and Statistical Manual of Mental Disorders](https://www.psychiatry.org/psychiatrists/practice/dsm), of which the most recent edition is the 5th edition (DSM-5) which also links to [ICD-10](http://apps.who.int/classifications/icd10/browse/2016/en) (International Statistical Classification of Diseases and Related Health Problems 10th Revision).

NICE (The UK's National Institute for Health and Care Excellence) [states in this 64 page document outlining recognition and management of depression](https://www.nice.org.uk/guidance/cg90/resources/depression-in-adults-recognition-and-management-pdf-975742636741)

> Depression is a broad and heterogeneous diagnosis. Central to it is depressed mood and/or loss of pleasure in most activities. Severity of the disorder is determined by both the number and severity of symptoms, as well as the degree of functional impairment. A formal diagnosis using the ICD-10 classification system requires at least four out of ten depressive symptoms, whereas the DSM-IV system requires at least five out of nine for a diagnosis of major depression (referred to in this guideline as 'depression'). Symptoms should be present for at least 2 weeks and each symptom should be present at sufficient severity for most of every day. Both diagnostic systems require at least one (DSM-IV) or two (ICD‑10) key symptoms (low mood,[1] loss of interest and pleasure[1] or loss of energy[2]) to be present.
>
> Increasingly, it is recognised that depressive symptoms below the DSM‑IV and ICD‑10 threshold criteria can be distressing and disabling if persistent. Therefore this updated guideline covers 'subthreshold depressive symptoms', which fall below the criteria for major depression, and are defined as at least one key symptom of depression but with insufficient other symptoms and/or functional impairment to meet the criteria for full diagnosis. Symptoms are considered persistent if they continue despite active monitoring and/or low-intensity intervention, or have been present for a considerable time, typically several months. (For a diagnosis of dysthymia, symptoms should be present for at least 2 years[3].)
>
> It should be noted that classificatory systems are agreed conventions that seek to define different severities of depression in order to guide diagnosis and treatment, and their value is determined by how useful they are in practice. After careful review of the diagnostic criteria and the evidence, the Guideline Development Group decided to adopt DSM-IV criteria for this update rather than ICD-10, which was used in the previous guideline (NICE clinical guideline 23). This is because DSM-IV is used in nearly all the evidence reviewed and it provides definitions for atypical symptoms and seasonal depression. Its definition of severity also makes it less likely that a diagnosis of depression will be based solely on symptom counting. In practical terms, clinicians are not expected to switch to DSM-IV but should be aware that the threshold for mild depression is higher than ICD-10 (five symptoms instead of four) and that degree of functional impairment should be routinely assessed before making a diagnosis. Using DSM-IV enables the guideline to target better the use of specific interventions, such as antidepressants, for more severe degrees of depression.
>
> [1] In both ICD-10 and DSM-IV.
>
> [2] In ICD-10 only.
>
> [3] Both DSM-IV and ICD-10 have the category of dysthymia, which consists of depressive symptoms that are subthreshold for major depression but that persist (by definition for more than 2 years). There appears to be no empirical evidence that dysthymia is distinct from subthreshold depressive symptoms apart from duration of symptoms, and the term 'persistent subthreshold depressive symptoms' is preferred in this guideline.


---

### Answer by username_6 on 2017-04-26. Score: 4

**Short answer**  
The current understanding is that depression is related to a neurochemical imbalance in the depressed brain. Pharmacological treatment to shift and correct that imbalance may therefore be an effective approach.

**Background**  
Basically you are saying depression is a state of mind and should be treated with counselling rather than tagging a person as mentally ill and medicalizing the care.

As pointed out in the other answers, diagnosis of clinical depression happens through [rational guidelines](http://www.psnpaloalto.com/wp/wp-content/uploads/2010/12/Depression-Diagnostic-Criteria-and-Severity-Rating.pdf) using [questionnaires and inventories](http://m.blog.naver.com/mistyeyed73/220427762670). Basically, the goal is to extract the clinical, chronic depression from the other group that only shows some, but not all the symptoms of clinical depression. Normal life events can trigger a depression, but that doesn't mean that person needs medical treatment.

In contrast, clinical depression, while being a mental disorder, has correlates in the neurochemical balance in the brain. From a neuroscience perspective, the depressed brain is physically different from a non-depressed brain.

Early medical treatments, and more recent accepted classes of anti-depressants show important correlates to dysfunctional **[mono-aminergic neurotransmission](http://www.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-modpsy-toc~drugtreat-pubs-modpsy-2~drugtreat-pubs-modpsy-2-3~drugtreat-pubs-modpsy-2-3-intr)**. A rough timeline of the various [anti-depressants](http://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273) shows the neurotransmitter systems that are targeted by these drugs [(Ferguson 2001)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181155/):

* 1950s: [MAO inhibitors](http://www.mayoclinic.org/diseases-conditions/depression/in-depth/maois/art-20043992): elevate monoaminergic (MA) neurotransnmitters levels by blocking their breakdown (serotonin (5HT), noradrenaline (NE) and dopamine (DA) ;
* '50s and '60s: [tricyclic anti-depressants](http://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983): elevate 5HT, NE and DA by inhibiting reuptake;
* '70s: [selective serotonin reuptake inhibitors](http://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825) (SSRIs): inhibit specifically reuptake of 5-HT, enhancing those levels of neurotransmitter and not others;
* '70s: [NE & DA reuptake inhibitors](http://mentalhealthdaily.com/2014/12/24/norepinephrine-dopamine-reuptake-inhibitors-ndris-list/) (NDRIs)
* '80s: [atypical antidepressants](http://www.mayoclinic.org/diseases-conditions/depression/in-depth/atypical-antidepressants/art-20048208) (a hererogeneous class targeting multiple systems, including 5HT, DA and NE)
* '90's: [5HT & NE reuptake inhibitors](http://cdn.intechopen.com/pdfs/37606.pdf) (SNRIs)

Without going into their specific mechanisms of action, the point I wish to make is that decades of research in anti-depressants has strongly indicated that a monoamine (MA) neurotransmitter imbalance (most notably 5HT), and specifically a **reduced** MA neurotransmission is one of the leading factors to a depression [(Muñoz & Alamo, 2009)](https://www.ncbi.nlm.nih.gov/pubmed/19442174). While counseling may help, the underlying disorder may perhaps be treated effectively through treatment with antidepressants.

Regarding your statement that a diagnosis may enforce depressive thoughts -
I disagree. **Acknowledgement** of the depressed state as a serious and debilitating illness is a necessary first step to recovery. Instead of the "*oh it's just all between your ears - here are some positive words for you*", depressed people are taken seriously and receive the appropriate medical care they deserve. This counts for pharmacological interventions and counseling alike. The first and likely the most crucial stage is acknowledging the problem - for the patient, the care providers, as well as for friends and family.

**References**  
**-** [Ferguson, *Prim Care Companion J Clin Psychiatry* (2001); **3**(1): 22-7](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181155/)  
**-** [Muñoz & Alamo, *Curr Pharm Des* (2009); **15**(14): 1563-86](https://www.ncbi.nlm.nih.gov/pubmed/19442174)


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### Answer by username_9 on 2017-04-15. Score: 3

Not everyone who feels depressed some time diagnosed with depression. Depression is not simply feeling sad. It has specific diagnosis criteria which you can find in **[DSM-V](https://www.psychiatry.org/psychiatrists/practice/dsm)**. Diagnosis of a mental disorder is needed to help the patient, not to label them or to reenforce any idea. That's why in psychiatry, the term 'diases' is not used. Moreover, with the same way of thinking in your question, none of the psychiatric disorders could be defined. Because psychiatry is based on ways of feelings and thoughts.


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