One out of five people will have at least one episode of depression over their lifetime., Major depression is the leading cause of disease burden in North America. It is projected that by the year 2030, depression will be the second leading cause of disease burden worldwide after HIV.
Answer the following 10 yes or no questions. Most questions have more than one part, because everyone feels their depression differently. You need to answer yes to only one part per question in order for that question to count.
1) Depressed mood. Do you feel sad, down, or depressed most of the time? Do you feel that all the color has been drained out of your life? Do you cry more easily? Do you have crying spells for no apparent reason?
2) Loss of interest. Have you lost interest in things that used to give you enjoyment? Have you lost interest or enjoyment in the activities of daily life? Are you more socially withdrawn or isolated?
3) Low energy. Is your energy lower? Do you feel more fatigued or sluggish? Is it hard to get going in the morning? Is your libido suddenly reduced or do you have less interest in sex?
4) Anxiety or irritability. Are you more anxious, worried, fearful, irritable, or intolerant?
5) Lower self-confidence. Is your self-confidence or self-esteem lower? Do you feel more hopeless or pessimistic? Do you feel more guilty or worthless?
6) Poor concentration. Is it hard for you to think, concentrate, or make decisions? Do you find it hard to concentrate outside of work? Do you find it harder to read articles or to take in what you read?
7) Sleep changes. Do you have difficulty falling asleep or staying asleep? On the weekends do you feel like you could sleep all day and don't want to get out of bed? Do you feel that you're not refreshed when you wake up in the morning?
8) Appetite or weight change. Is your appetite either significantly lower or higher than a year ago? Have you unintentionally lost or gained weight? Do you eat only because you have to eat, but don't get any pleasure from food?
9) Slow moving or restless. Are you more slow moving lately? Is your speech slower lately? Do you feel like you're shuffling when you walk? Are you restless or fidgety? Do you wring your hands more?
10) Thoughts of death. Do you have recurrent thoughts of death or suicide (not just a fear of dying)? Do you think it would be easier if you just didn't wake up in the morning? Do you think it would be easier if you developed a serious illness? Do you wonder if anyone will miss you when you're gone? Do you think you would be better off dead, or that your family would be better off if you were gone? Do you imagine ways of hurting yourself?
If you answered yes to at least 5 of these questions, then you meet the medical criteria for depression.
These are the combined criteria of the American Psychiatric Association (DSM-IV) and the World Health Organization (ICD-10). The DSM requires that you have at least 5 of the above symptoms for at least two weeks before you meet the criteria for depression. The ICD requires that you have at least 3 symptoms to meet the criteria of mild depression but does not set a time limit. Some doctors feel that two weeks is too brief, and that many people feel sad for two weeks without being depressed.
There is no simple blood test for depression. The diagnosis of depression is based on history. Depression is caused by changes in neurotransmitters inside the brain, and there is no blood test that can check what's going on inside the brain. Laboratory tests are helpful to see if there are any other medical causes for depression.
For your convenience, I've included a printable version of the depression test.
You don't have to feel sad to be depressed. This is what's confusing about depression. People often think they're not depressed, because they're not sad. But sadness is not a necessary symptom of depression. People often manifest their depression in other ways. Depression affects your entire body. Everything slows down. You have low energy, lack of enjoyment, and high anxiety.
The best one line description of depression is lack of vitality.
Anxiety is not one of the standard criteria for depression. But it is a common symptom. Approximately 90 percent of people who are depressed also feel anxious. Anxiety is usually not a separate condition, but part of depression. It is so common that some doctors feel if a patient suffers from anxiety, the first explanation that should be considered is depression. There are other causes of anxiety besides depression. But if you are depressed, you will usually feel anxious.
It’s been my experience that patients who suffer from depression and anxiety also feel irritable and intolerant. In fact, when patients begin to pull out of depression, they almost universally say that they begin to feel more tolerant, and that family and friends don’t irritate them as much.
It’s only people who haven’t suffered from depression who think it isn’t real. They are usually full of well-meaning advice that’s not very helpful. They will tell you things such as, you just have to pull up your socks, or go out more. But if you’ve suffered from depression, you know it’s not that simple.
Thoughts of hurting yourself are frightening but a common part of depression. Suicidal thoughts are the most troubling and frightening aspect of depression. Therefore it's important to discuss them openly. Most people who are depressed will have at least some thoughts of dying or hurting themselves.
It's important to understand that there is a big difference between having such thoughts and acting on them. If you have thoughts of hurting yourself, you should immediately discuss them with your health professional.
There is a difference between active and passive thoughts of hurting yourself. In passive thoughts, you think that it would be easier if you weren't alive. You think it might be easier if you went to sleep and didn't wake up. But you don't want to hurt yourself. In active thoughts of death, you think about hurting yourself. Both are serious, but active thoughts of self-harm are obviously more serious.
Passive thoughts of hurting yourself are usually fleeting. It's easy to chase them away by remembering that you want to get better, that suicide is permanent, and that it would hurt the people left behind.
If your thoughts of death or hurting yourself change in character, if they occur more often, if it's harder to chase them away, or if you start to make plans of how to hurt yourself, then you should immediately seek help. Contact your health professional, call a crisis hotline, or go to emergency.
There are different levels of depression. Most people automatically assume the worst when they hear depression. They think that they'll become bedridden or suicidal. But that's the most severe level of depression. It's more common to have mild depression, where you can still go to work and function – it's just that your energy and sense of enjoyment are low.
Depression usually doesn't get worse. If you have mild depression, it is unlikely that it will get worse and turn into severe depression. Not that that's much consolation, since even mild depression is painful. But it should give you a little comfort to know that your symptoms probably won't get worse.
After one episode of depression, the risk of another episode is 50 percent.
After two episodes of depression, the risk of another episode is 70 percent.
After three episodes of depression, the risk of another episode is 90 percent.
Approximately 15 percent of people who have depression, have chronic depression. These people don't have episodes of depression, instead their mood is constantly low with slight variations up and down.
The bad news is that depression is recurrent. The good news is that depression is treatable.
Two important coping skills for overcoming depression are the ability to relax and manage stress, and the ability to change negative thinking. For more information, follow these links:
1) RC Kessler, KA McGonagle, S Zhao, CB Nelson, M Hughes, S Eshleman, HU Wittchen, KS Kendler, "Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey" Arch Gen Psychiatry. 1994 Jan;51(1):8-19.
2) RC Kessler, P Berglund, O Demler, R Jin, D Koretz, KR Merikangas, AJ Rush, EE Walters, PS Wang, "The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R)," JAMA. 2003 Jun 18;289(23):3095-105.
3) C.D. Mathers and D. Loncar. "Projections of global mortality and burden of disease from 2002 to 2030," PLoS Med 2006 November; 3 (11): e442.
4) B.J. Sadock, V.A. Sadock, Kaplan& Sadock's Synopsis of Psychiatry 9th ed. (Philadelphia: Lippincott Williams & Wilkins 2003), p. 552.
5) J Angst. The course of affective disorders. Psychopathology. 1986;19:47-52.
6) Eaton WW, Shao H, Nestadt G, Lee HB, Bienvenu OJ, Zandi P. Population-based study of first onset and chronicity in major depressive disorder. Arch Gen Psychiatry. 2008 May;65(5):513-20