Depression is a complex mental disorder that can cause a wide variety of symptoms. These symptoms can vary from person to person and can range in severity from mild to severe.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are several different types of depression, each with its own distinct set of symptoms.
There are a lot of myths out there about what depression is and also what it isn’t. It’s important to separate fact from fiction when it comes to this mental disorder so that you can better understand it and seek out the help you may need.
Here are some facts about depression, according to the DSM-5:
- Depression is a serious mental illness. It’s not just feeling “down” or “sad” for a few days. Depression is a persistent feeling of sadness, hopelessness, and/or fatigue that lasts for weeks or even months.
- Depression can affect anyone at any age. It is not discriminate.
- There are different types of depression, each with its own set of symptoms. The most common types of depression are major depressive disorder, persistent depressive disorder (also known as dysthymia), premenstrual dysphoric depressive disorder, and substance/medication-induced depression.
- Depression is caused by a mix of genetic, biological, psychological, and environmental factors.
- Depression is treatable. There are a variety of ways of treating depression, including medication, psychotherapy, and/or lifestyle changes.
In this article, we’ll take a closer look at each of these facts about depression and what they mean for those who are dealing with this mental disorder.
What is the DSM-5?
First of all, what is the DSM-5? The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the standard classification of mental health conditions used by mental health professionals in the United States. It is used to diagnose and classify mental diagnoses. The DSM-5 was published in 2013 by the American Psychiatric Association (APA).
This publication is important because it provides a common language and standard criteria for the diagnosis of mental conditions. This manual is used by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, and policymakers.
How is the DSM 5 Used?
The DSM-5 is used to diagnose a mental disorder. It provides a set of depressive symptoms and criteria that must be met in order for a diagnosis to be made. The DSM-5 is also used to guide effective treatment.
For example, if a person is experiencing symptoms of a severe form of depression, the DSM-5 can be used by providers to help determine whether or not they meet the criteria for a diagnosis of depression. If they do meet the criteria, the DSM-5 can then be used to guide treatment. This might include medication, psychotherapy, or lifestyle changes.
What is severe depression, according to the DSM-5?
Depression, in its simplest definition, is a mental and mood disorder characterized by a persistent feeling of sadness, hopelessness, and/or fatigue. However, according to the DSM-5, there are different types of depression, each with its own set of symptoms.
What are the symptoms of depression?
Major depression can trigger symptoms that vary from person to person and can range in severity from mild symptoms to severe symptoms. Some common symptoms of depression include:
- Persistent feelings of sadness, hopelessness, or emptiness
- Loss of interest or pleasure in activities that were once enjoyable
- Changes in appetite or weight
- Sleep disturbances (insomnia, hypersomnia)
- Decreased energy or fatigue
- Feelings of worthlessness or guilt
- Difficulty concentrating or making decisions
- Thoughts of death or suicide
If you are experiencing any of these symptoms, it’s important to see a mental health professional for an evaluation. Only a trained professional can give you a diagnosis. However, self-awareness is an important first step.
What are the different types of depression?
There are different types of depressive disorders, and the DSM-5 lists them as follows:
Major Depressive Disorder
This is the most common type is called major depressive disorder. People with Major Depressive Disorder experience symptoms such as depressed mood, loss of interest or pleasure in activities, fatigue, changes in appetite, sleep disturbances, problems concentrating, feelings of worthlessness or guilt, and thoughts of death or suicide.
Perinatal depression is a modifier used to describe those experiencing depression with peripartum onset (symptoms starting before or after giving birth).
This differs from postpartum depression, which is used to describe depression symptoms appearing after giving birth.
Persistent Depressive Disorder (Dysthymia)
This type of depression is characterized by a depressed mood that lasts for at least two years. People with Persistent Depressive Disorder may also experience some of the other symptoms listed above. However, the symptoms are usually not as severe as those experienced by people with depression, Major Depressive Disorder.
Seasonal Affective Disorder (SAD)
This type of depression is characterized by episodes of depression that occur at the same time each year, usually in the winter. People with SAD may experience symptoms such as depressed mood, fatigue, changes in appetite, and sleep disturbances.
Premenstrual Dysphoric Disorder (PMDD)
This type of depression is characterized by symptoms of depression, irritability, and mood swings that occur in the week or two before a woman’s period.
Situational Depression (Adjustment Disorder with Depressed Mood)
This type of depression is characterized by symptoms of depression that occur in response to a stressful life event, such as the death of a loved one, divorce, or job loss.
How is depression diagnosed?
When it comes to diagnosing clinical depression, the DSM-5 is the gold standard. The DSM-5 is a handbook that clinicians use to diagnose mental disorders. To be diagnosed with depression, a person must meet the criteria listed in the DSM-5.
If your clinician believes you suffer from one of the above forms of depression, they will conduct a variety of assessments to rule out other possible causes of your symptoms. These assessments may include a physical exam, lab tests, and/or a psychological evaluation.
Once other potential causes have been ruled out, your clinician will make a diagnosis based on the criteria listed in the DSM-5. There are many conditions that can co-occur with depression, including anxiety disorder, chronic illness, emotional and physical problems, chronic pain, recreational drugs, drug use, and other medical conditions or medical illnesses.
What is depression? Depression does not discriminate. Depression affects all walks of life. There are many risk factors which include brain chemistry, life events, and family history.
Some of the criteria to be diagnosed with clinical depression include:
A. Five (or more) of the subsequent symptoms have been present during the same 2-week span and represent a change in habits and previous behaviors; and at least one of these symptoms is a persistent feeling of depression or a general or overarching loss of interest or pleasure in most or all activities.
The following symptoms can be observed by both the individual in question and reported by those close to the individual (colleagues, family members, roommates, or friends).
- Sad, down, or discouraged mood for most of the day, every day or almost every day
- Loss of interest in most activities that once brought pleasure, or are necessary to survival
- A significant change in appetite that may result in significant weight loss or weight gain.
- Insomnia or hypersomnia almost every day
- Physical psychomotor agitation or loss of function nearly every day. This one must be espoused by others and not just the individual being evaluated.
- Chronic exhaustion or lack of energy.
- Excessive feelings of worthlessness, inappropriate or disproportionate (and sometimes delusional) guilt most of the time.
- Reduced ability to think or focus on a daily basis. This can cause severe indecisiveness.
- Recurrent invasive thoughts about death that go beyond the fear of dying. This can include recurrent suicidal ideation without a specific plan, a suicide attempt, or a thought-out plan for committing suicide
B. These symptoms cause clinically serious impairment or anxiety in social spheres, at the office, at school, or in other important areas of day-to-day life.
C. These symptoms are not due to direct physiological effects of a drug or medication or of a common medical condition.
D. The symptoms cannot be explained by bereavement.
E. The symptoms endure for a period of 2 months or longer.
F. These symptoms are characterized by significant functional impairment, morbid fixation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
Once a diagnosis of depression has been made, there are a few things that need to be taken into account in order to make a more specific diagnosis. These include the severity of the depression, how long the symptoms have been present, whether there is a seasonal pattern, and whether or not the person has had any previous episodes of depression.
What is depression severity? The severity of depression can be mild, moderate, or severe. It is important to note that even mild cases of depression can be debilitating and cause a significant amount of distress.
Acute cases of depression are those that last for less than 3 months. If the symptoms persist for longer than 3 months, it is considered to be a chronic form of depression.
What is depression recurrence? If a person has had more than one episode of depression, it is considered to be recurrent. The interval between episodes can vary but must be at least 2 months in order for it to be considered recurrent.
What are the treatments for depression?
Once a diagnosis of depression has been made, the next step is to begin treatment. It is possible to improve depression symptoms and enter complete remission. Depression treatment typically includes some combination of medication and therapy.
The treatment for severe to mild depression will vary depending on the type of depression that is being treated. However, some common treatments for depression include:
This is a type of therapy that involves talking to a therapist about your thoughts, feelings, and behaviors which can be beneficial to a variety of mental disorder. Psychotherapy helps with both understanding and managing symptoms.
Cognitive-behavioral therapy (CBT)
This is a type of therapy that focuses on helping you identify and change negative thought patterns and behaviors that are associated with your depression.
Transcranial Magnetic Stimulation (TMS)
There are several brain stimulation therapies that have been proven to relieve symptoms of depression. TMS is a non-drug, FDA-approved treatment for major depression that is covered by most insurance. Research suggests TMS is twice as effective as oral antidepressants, particularly for those who have not responded adequately to talk therapy and medication.
TMS is also indicated for those with treatment-resistant depression and TMS works quickly, typically 2 weeks, compared to the typical 6-8 week onset time of oral medications. Unlike electroconvulsive therapy (ECT), TMS has little to no side effects.
There are a variety of medications that can be used to treat depression. The type of medication that is best for you will depend on your individual situation. Some common depression medicines include:
Selective serotonin reuptake inhibitors (SSRIs)
This type of medication is typically used as a first-line treatment for depression. It works by increasing the level of serotonin in the brain.
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
This type of medication is similar to SSRIs, but it also works on norepinephrine. It is typically used as a second-line treatment for depression.
Tricyclic antidepressants (TCAs)
This type of medication is an older type of antidepressant that is not as commonly used due to the fact that it has more side effects than newer medications. It works by increasing the level of serotonin and norepinephrine in the brain.
Monoamine oxidase inhibitors (MAOIs)
This type of medication is typically used as a last-line treatment for depression due to the fact that it can have serious side effects. It works by preventing the breakdown of serotonin and norepinephrine in the brain.
Resources for people living with depression
Depression is a serious condition that can have a devastating impact on a person’s life. If you think you may be suffering from depression or bipolar depression, it is important to seek professional help. A qualified mental health professional can make a diagnosis and develop a treatment plan that is specific to your needs.
There are also many resources available for people who are living with depression. Some of these resources include:
- Depression and Bipolar Support Alliance
- National Alliance on Mental Illness
- Mental Health America
- National Institute of Mental Health
- National Crisis / Suicide Prevention Line
If you or someone you know is in need of help, please call the National Suicide Prevention Lifeline at 988.
Depression is a real, treatable mental health condition. There are many resources and treatments that can help and early intervention makes a huge difference.