We all have times when we might say we feel depressed, but does that mean you have "clinical depression?" What are the symptoms of clinical depression?
Clinical depression is a disabling mental disorder that can interfere with your sleep, appetite, and sexual drive. It can contribute to pain, headaches, and gastrointestinal problems. It takes away your interest in activities you once enjoyed, saps your energy, and can leave you feeling worthless or guilt-ridden. Depression can destroy your marriage, wreak havoc on your career, and drive your friends away. It leaves you feeling as though you're on an island, alone in a sea of seemingly happy people. It can also result in suicidal thoughts and behaviors. Depression, if left untreated, can be a downward spiral, with its symptoms driving away needed supports when the sufferer needs them the most.
Feeling sad because a friend moved away, a loved one passed on, or you didn’t get an expected promotion is certainly normal. Feeling temporary sadness for no identifiable reason is still considered to be within the range of normal. In both cases, even though you may not have a diagnosed mental disorder, a depression counselor can help. In therapy, you can talk about your feelings, work through any life problems that are bothering you, and learn techniques to help you reduce your symptoms.
When your symptoms persist or worsen, you may be clinically depressed. First, “clinical depression” isn’t really an official term; it is used informally and loosely to describe a group of conditions more officially known as depressive disorders. To determine whether your sadness or gloomy mood is in the range of normal, it’s helpful to know when it’s not normal. As you read on, please keep in mind that having some of these symptoms does not necessarily mean that you have a disorder. There’s no way to know for sure if you have clinical depression without a diagnosis from a doctor or mental health professional.
Did you know that you don’t have to feel sad or cry all the time to have clinical depression? Some people have other symptoms that, together, represent a depressive disorder.
Types of Depression
There are different types of depression, but all types share some of the same symptoms. Mental health counselors and psychologists don’t call it a depressive disorder unless you have a certain number of symptoms, the symptoms are of a certain severity, and you’ve had the symptoms for a certain amount of time.
For all depressive disorders (actually most mental disorders), the symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. What does that mean? Clinically significant distress means that your symptoms are severe enough that they are really bothering you. Clinically significant impairment means that some aspects of your daily life are affected. For example, you’re having a hard time getting your work done, you’re distancing yourself from family and friends, or your pantry is bare because you can’t muster up the motivation to go grocery shopping.
The Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5) identifies several specific depressive disorders:
Major Depressive Disorder
Persistent Depressive Disorder (Dysthymia)
Disruptive Mood Dysregulation Disorder
Premenstrual Dysphoric Disorder
Substance/Medication-Induced Depressive Disorder
Depressive Disorder Due to Another Medical Condition
Other Specified Depressive Disorder
You may have heard of Seasonal Affective Disorder (SAD), which is a type of Major Depressive Disorder that tends to occur only during the winter or more gloomy months of the year. You may be surprised to learn that some people with SAD only experience symptoms during spring and summer.
It is important to note that there is another class of disorders that include depression symptoms. Bipolar Disorder is a class of disorders that is separated in the DSM-5 from depressive disorders.
The depressive disorders most commonly seen in our practice are Major Depressive Disorder and Persistent Depressive Disorder (Dysthymia).
Major Depressive Disorder (MDD)
MDD sufferers have at least five of these symptoms all present during the same 2-week period. Most symptoms must be significant and be present most of the day, nearly every day.
Feeling depressed. You may feel sad, empty, and/or hopeless.
Lowered interest in activities or decreased pleasure in activities you used to enjoy.
Increase or decrease in appetite, possibly with weight loss or weight gain.
An increase or decrease in sleep.
Restless behaviors such as pacing, hand wringing, and difficulty being still. Alternately, you may experience a slowing of movement and reactions, such as slower speech, moving and completing tasks slowly, and having difficulty doing routine things such as getting ready for work.
Fatigue or loss of energy.
Feelings of worthlessness or guilt.
Difficulty thinking, concentrating, or making decisions.
Recurrent thoughts of death, suicidal thoughts, or suicide attempt.
At least one of the symptoms must be depressed mood or loss of interest or pleasure.
It’s important to note that you may have other symptoms not listed above as part of MDD. For example, anxiety often co-occurs with depression. Depression counseling can help with your other symptoms as well.
You may appear to meet the diagnostic criteria if you have recently endured a significant loss, such as death of a loved one, financial ruin, or being diagnosed with a serious medical condition. If that is the case, MDD is not typically diagnosed. This is because depressive symptoms are an expected reaction to one of these devastating events.
Persistent Depressive Disorder (Dysthymia)
Persistent Depressive Disorder used to be known as dysthymia or dysthymic disorder. For the purpose of brevity, I will refer to it as PDD. PDD is different from MDD in that fewer symptoms are required for the diagnosis, but the symptoms have been ongoing for a much longer period of time – at least two years.
A person with PDD experiences a depressed mood for most of the day, for more days than not, for at least two years. Additionally, two or more of these symptoms are present for much of the time:
Increase or decrease in appetite.
Difficulty sleeping or sleeping too much.
Low energy or fatigue.
Poor concentration or difficulty making decisions.
As you can see, you do not have to be holed up in a dark room and crying uncontrollably for weeks at a time to meet the diagnostic criteria for a depressive disorder. Many sufferers of clinical depression get up on time, go to work, and play with their children every day despite their symptoms and inner turmoil. On the other hand, some sufferers have significant difficulty getting out of bed and going through the basic motions of life. The range of symptoms and severity is large.
It is important, however, that you get an accurate diagnosis. You may know you are depressed, but getting evaluated for depression ensures that you determine what kind of depression you have, rule out other possible causes of your symptoms, and get the right treatment for your specific symptoms.
You may have recognized some of the symptoms in yourself and perhaps do not feel that you have the minimum number of symptoms or do not meet some other diagnostic criteria. If that is the case, and you are distressed or struggling, there may be something else going on. You may have a different type of disorder (like bipolar disorder or perhaps PTSD), you may be grieving a loss of some kind, or you may be experiencing the effects of general stress or a specific psychosocial stressor. A mental health professional can help you figure this out.
What Causes Clinical Depression?
Most professionals believe, based on years and years of studies, that depression is caused by a combination of biological, psychological, and social factors. Biological factors may be rooted in the genes you inherited from your parents, a medical disease or condition you have, a drug (prescription or otherwise) that you’re taking, hormonal levels, and possibly even gut bacteria.
Psychological factors can include your thinking patterns, beliefs, self-esteem, personality characteristics, and coping skills. Social factors include the quality of your relationships and support system, difficult events in your life, and even the way you were parented as a child.
Since there are so many potential contributing factors, there is no way to tell for sure all of the exact causes of any given individual’s depression. A good evaluation by a mental health professional can pinpoint likely causes, and this is enough to create a treatment plan tailored to your specific needs.
What are the Treatments for Depression?
I like to categorize treatment options into three categories: self-help, psychological help, and medical help. Self-help options include activities such as reading books and reputable online articles about depression, writing down your thoughts and feelings in a journal, exercising regularly, making an effort to get together with family and friends, getting a little direct sunlight when you can, and keeping a regular sleep schedule. Psychological help involves working with a psychologist, therapist, or mental health counselor. Therapy for depression can help you explore the roots of your symptoms, identify any thinking patterns that may be contributing to your distress, and help you change some behaviors that will get you on your way to feeling like yourself again. Medical help starts with a physical examination to look for possible physical causes of some of your symptoms. A medical doctor, such as a primary care physician or a psychiatrist, may also prescribe an antidepressant medication.
Most people have had fleeting thoughts of wanting to die at some point in their lives. When you are having repeated suicidal thoughts, your thoughts are becoming more and more specific (e.g., you start considering methods of killing yourself), or you begin taking steps toward suicide (e.g., obtaining a method, writing a note, arranging your affairs), you need immediate professional help.
Many individuals are concerned that if they seek counseling for suicidal thoughts, they will be committed to a psychiatric hospital. This is not necessarily the case. It is perfectly fine to discuss your suicidal thoughts with your counselor. In fact, therapy is sometimes the only place you can feel safe talking about those dark thoughts and feelings. It is only when your counselor believes that you are at an immediate and serious risk of harming yourself or someone else that they are required to take steps to protect your life or someone else’s life.
If you or someone you love are having suicidal thoughts and feel that you need immediate assistance, please click on our “Crisis Resources” link at the bottom right of this web page.
A Final Note
Whether or not you have “clinical depression,” you deserve to feel better. You do not have to have a mental illness to seek and benefit from counseling for depression. We offer depression therapy for children, teens, and adults.