Is there a way to determine if someone has clinical depression besides examining their behavior? I mean, do we now have the ability to perform a test and find, say, too much of a certain chemical in the brain?
What I am getting at is there a clear cut line between clinical depression and your ordinary garden-variety depression?
I’m sorry for putting this here if it turns into a great debate.
PeeQueue
Clinical depression is identified by a set of symptoms (change in appetite, libido, sleep habits, etc.) which can be brought about by a number of causes. It may be a chemical imbalance in the brain, or it may be due to a recent death in the family. Traditional therapy has always been to treat the patient to make the symptoms disappear. Now that the chemical imbalances are becoming better understood, there may someday be a simple blood test, but it isn’t here yet.
I understand all the words, they just don’t make sense together like that.
Well, the DSM lists several criteria for determining whether or not someone has clinical depression (they call it major depressive disorder, which is a string of consistent major depressive episodes). They are as follows:
Criteria for Major Depressive Episode:
(A) Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
(4) insomnia or hypersomnia nearly every day
(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
(6) fatigue or loss of energy nearly every day
(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
(B) The symptoms do not meet criteria for a Mixed Episode.
© The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
(D) The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
(E) The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
Nothing in there involves chemical testing, which frankly would be too expensive to do on a case-by-case basis even if it were possible (a doctor would have to answer that one). So I guess the answer to your question is no, there’s no useful chemical test, and the difference between major depression and garden-variety depression is that major depression is prolonged, more severe, and more likely to not stem from an incident.
I got this information here.
So, my HMO has a clinic, but they’re not doing well in terms of profitability…in fact, they can’t make economic ends meet, they’re in the red. Would you describe their financial situation to be… um… clinically depressed?
Triglyceride and cholesterol levels have long been associated with clinical depression, but I do not think that the processes are fully understood. I don’t even know what a “triglyceride” does.
I can say this: a triglyceride test very well might have saved my life when I was suffering from severe, suicidal depression a long, long time ago. It was on the basis of that test that the doctors and psychologists decided that yes, I was in some serious brain-chemical trouble and no, I was not simply manipulating the situation so that I could continue to be a totally f***ed up person.
Little did they know that I was manipulating the situation so that I could continue to be a totally f***ed up person, a status which I still proudly hold today. It’s just that being manipulative and strange is very depressing work.
As far as I know, the concrete aspects of depression are still theoretical. That is, we still mostly diagnose depression based on its symptoms - examining people’s behaviour, like you said.
Ideas about the brain chemistry behind depression aren’t based so much on direct observation; rather, we observe the effects of chemicals (psychopharmaceuticals) on symptoms, and then we draw the tentative conclusion that the brain chemistry must be the source of the problem. E.g., devise a drug that will inhibit reuptake of serotonin, give it to a bunch of people who have trouble sleeping, frown a lot, describe themselves as sad, etc., and see what happens. They describe themselves as less sad, frown less, etc., so we decide that serotonin reuptake is too high in those individuals.
Brain chemistry tests for this kind of thing are mostly things of the future. I gather that direct measurements of neurotransmitters aren’t easy, and usually involve nahsssty things like spinal taps. Right now, it’s easier just to combine therapy and pharmacy and see what works for each individual.
One problem I see with past behaviour studies of depression is, too many of them have focussed on major depression to the exclusion of atypical depression. Ask an atypical depressive if they have lost their appetite, they’ll say no. Ask them if they have trouble sleeping - they’ll say, no (unless they have fallen asleep during the interview). Ask them when they started feeling this way - they’ll say they have no idea. All of these are taken as signs that they don’t have depression; really it applies only to major depression. Atypical depression is typically (yes, it’s an oxymoron, but it just shoes that "atypical depression is probably a misnomer) characterized by overeating, oversleeping, a very gradual and often undetectable onset, and lethargy rather than agitation.
We only have come to realize that atypical depression is a real condition because it responds as well or better to SSRIs when compared with major depression. Way too many professionals, in my non-professional opinion, have come to the conclusion that atypical depressives are just sad. By understanding how various depressive types respond to various drugs, we can figure out what is actually going wrong in the brain.
Another example of “the tail wagging the dog” in psychotherapy: Schizophrenia and bipolar disorder were originally teased apart because the some people responded so much better to a certain drug treatment (manic depressives on lithium, or schizophrenics on thorazine, can’t remember which came first).
Why do you wish to know?
CAREFUL! We don’t want to learn from this!(Calvin and Hobbs)
Basically, Clinical Depression is a form of depression which lasts, without treatment, for a long, long time. Regular depression might last a day or a week and then the person returns to normal.
Clinical depression requires medication and/or therapy to over come. Regular depression does not.
Clinical depression can often turn into several of the major depressive forms including bipolar, and often will carry the attendant disorders like an anxiety disorder or obsessive compulsive behavior. It may also carry the potential for suicidal thoughts, tendencies or impulses.
CAREFUL! We don’t want to learn from this!(Calvin and Hobbs)
I just want to add this in case somebody who is reading this because he/she thinks he/she might be depressed:
A “depressed mood” is one of the most common symptoms of clinical depression, but it is not required. Example: Me! I was perfectly cheerful, but suffering from pretty bad depression. I had many of the other symptoms, though. (40mgs of Paxil a day fixed me right up.)
So, you might be depressed even if you are not moping around. And you might not be clinically depressed even if you are moping around.
The list kindly provided by Drain Bead is a good starting point for self-evaluation. If the symptoms on that list sound like you, hie yourself to a shrink.
One of the real buggers about depression is that the depression itself can keep you from seeking help. But it can be an easy problem to “fix.” So, if you seriously think that you might be depressed, call your doctor and ask for a referral to a psychiatrist. DO IT NOW! There, now don’t you feel better?
Nothing serious, I was just discussing it with my fiancee because of a program we had watched. The discussion basically revolved around a few points:
If there is no test for it, how do we know it (clinical depression) is any different than someone who is depressed for a week? That is, in the sense that a mild case of the flu is the same thing as a severe fever of 104 degrees that just won’t go away and threatens your life.
If someone shows all the signs of clinical depression for 5 years, and finally manages to drag themselves out of it, do they not have clinical depression for the sole reason that they didn’t need therapy/drugs to escape it?
Is clinical depression considered a disease only because it is harmful? That is, one would think if an imbalance of chemicals in the brain can cause depression, another imbalance may cause happiness. Is it possible for someone to contract clinical happiness?
Lastly, does classifying this as a disease cause people to lose hope and/or not take responsibility for their actions? This last one is more of a Great Debate I guess.
Please see this for what it is - a request for information and enlightenment. I honestly don’t know much about the topic and am looking to understand where the psychiatrists are coming from.
PeeQueue
I think clinical depression can end on its own. It is not common; it is much more likely for depression to remit temporarily, and come back later. People have pulled through depression on their own, just as people can survive other diseases without treatment. It’s just not something you want to rely on, like hoping a bone is set correctly after a “minor” fracture. A history of pulling out of temporary major depressions is a good sign on the one hand, since it means you can pull through, but on the whole it’s more of an indicator that you (and your doctors) should be on the lookout should another case of depression creep up with a vengeance.
Clinical depression is caused by brain chemicals being out of balance (et al.), but we only consider it an imbalance because it’s so horrible to be depressed. I’m quite convinced (with no real evidence) that dozens of other conditions are caused by unusual chemical balances in the brain - we just don’t notice them if they are not pathos.
Your hypothetical “clinical happiness” probably does exist - people who bounce back from loss, chuckle when people put them down, get up at the crack of dawn feeling refreshed every day, knock 'em dead at every board meeting, and have a (non-fake) smile on their face evey time you see them. Now can you see why we try not to notice these people?
Seriously, though, these folks are probably blessed with high, consistent amounts of some chemical(s) (e.g. endorhpins, norepinephrine, serotonin?) that the rest of us would kill to have. Lucky bastards.
On responsibility: Diabetics have to take responsibility for their insulin; depressive have to take responsibility for therapy. Really, most disease throw a lot of responsibility onto the shoulders of the patient - hypertensives cut down on salt, epileptics can’t be airline pilots, blind folks have to take care of their dogs. So depression isn’t unique in that way either.
Good questions, by the way.
Would someone mind expanding on the possible clinical depression-cholesterol level link? Due to heredity, I have a minimal level of cholesterol (and lipids? I think that’s right). In fact, it’s so low that other doctors, nurses and P.A.s always come over and gawk at my chart every time I’ve come in for tests. I’ve also had several bouts with clinical depression since my mid-teens. Could there be a connection?
As with other psychiatric diagnostic categories, “clinical depression” flunks inter-rater reliability tests. That is, if you have the same patient (or pseudopatient) evaluated by multiple shrinks in a test where they do not know the findings of previous shrinks, the diagnostic overlap ratio is pretty miserable.
In other medical subcategories, a low inter-rater reliability ratio is sufficient to call the diagnostic cateogory into question, but in psychiatry if you did that you would soon be left with none at all.
To answer your question, there is no way to determine if clinical depression (as opposed to simply feeling melancholy or shitty) exists, either in one individual or in the population at large.
Disable Similes in this Post
Depression is one of the most, – if not THE most – commonly diagnosed illness and is curable.
Interestingly enough, for some cases of major depression, a life change cures it – like suddenly winning a million bucks or so.
Depression is easily enough to diagnose, but then it is usually separated into the various categories. Some forms of depression come close to appearing like schizophrenia and another form is called, for obvious reasons, ‘smiling depression’ because the person looks happy outwardly.
Then there is depression, bipolar depression, manic depression and various attendant disorders which accompany most severe depressions. The old periods of melancholy mentioned in classic books and historical texts years ago were depressive episodes.
One of the biggest problems with depression is that as it gets worse, the person becomes often reluctant to seek help because the depression often makes one feel that it is not worth doing so or that it takes too much actually energy to go to a doctor. By then, even getting up in the morning often requires a lot of effort.
Currently, around a dozen famous stars have depression and there are dozens of famous people, including Winston Churchill – who had severe depression – who have had it.
CAREFUL! We don’t want to learn from this!(Calvin and Hobbs)
If you have to ask, you are, but then I have never seen a clinic being depressed.
Yikes, I just typed a long response, but mistyped my password, so I lost the whole thing. Well, I’ll try again.
You guys have given me a lot of information. What I don’t get is why clinical depression is considered a disease. I had previously assumed that there was some physical abnormality that could be pointed at as the cause for certain adverse mental effects. Or at least some mental abnormality that could be consistently diagnosed by competent doctors. Has it been declared a disease simply to alleviate the stigma that society previously attached to depressives?
I don’t see the connection between this and a disease like cancer. I have no problem with doctors attempting to alleviate symptoms for people that are born with characteristics that are disadvantageous in society, just as I have no problem with doctors attempting to make short people taller or dumb people smarter, but I wouldn’t call a 5 foot person or a person with an 85 I.Q. diseased. (How’s that for a run-on sentence?)
(Not that there’s anything wrong with being short 
)
The following quotes are some of what led me to the question in my first paragraph:
The last quote really makes me wonder what the difference is between clinical depression and the times that I felt down because of a lack of money. Or when I didn’t have a girlfriend in college. Or when work gets really stressful. Or when a million other things happen that make me feel like crap for a while. Those times are what makes my experiences unique, as are the times when I was happy, and I wouldn’t want to think it was just because I was diseased that I had those feelings.
Of course, it is just a word, and if you’re telling me they called it that just because they couldn’t agree on a different one (hmm, condition? state? I don’t know…) I can accept that.
PeeQueue
‘disease’ = ‘dis’ - ‘ease’
Its a condition.
dis•ease \di-"zez\ noun [ME disese, fr. MF desaise, fr. des- dis- + aise ease] (14c)
1 obs : trouble
2 : a condition of the living animal or plant body or of one of its parts that impairs normal functioning : sickness, malady
3 : a harmful development (as in a social institution)
dis•eased -"zezd\ adjective
“‘How do you know I’m mad’ said Alice.
'You must be, ’ said the Cat, ‘or you wouldn’t have come here.’”
Speaking as both a former psychology major and one who has personal experience with depression: one of the best indicators I ever had that I was clinically depressed was when I felt horrible, like a black cloud constantly hung over my head, and could not figure out why. Our brains evolved to seek meaning and answers, and when one feels depressed, the natural reaction is to attempt to explain the problem. Most times the explanation the brain reaches is correct. Sometimes it is not, and fixes upon some external event or person, externalizing the depression or pain.
Clinical depression feels very different from sadness about something in particular, but it is hard to describe to one who has not experienced it.
Christ, what an imagination I’ve got…
Basically clinical depression is any form of depression which requires treatment.
Mild depression is the average, transient form.
Psychiatrists and Psychologists have various forms of signs and symptoms they look for to determine the level of depression, if any, a client has. Plus, the Minnesota Multiphasic Personality Test – a long, long deep psychiatric test – among other things, also determines if a person taking it is depressed and to what degree.
Many of a persons moods are caused by certain chemical levels in the brain. A certain chemical, Seratonin, governs one’s sense of well being verses depression. If this chemical is not produced enough, one gets depressed. Various factors can influence the production of this chemical. The most common are emotional. IF a person is faced with enough emotional problems or situations that causes the chemical to decrease for a long enough period of time, the brain has a tendency to get used to being depressed.
THAT’S where the problem comes in because once that happens, two things need to be done. (1) is the simplest, and that is to be given antidepressant medication which encourages the production and absorption of Seratonin. After a length of time, the person returns to normal and the medication can be stopped. (2) is to combine medication and therapy to solve any emotional/menttal conflicts and problems which can be working to prevent recovery. (3) is to use a couple of different forms of medication to not only encourage the uptake of Seratonin but to decrease the brains potential for secondary disorders, which can be triggered by the depression, which then work to prolong it. (Obsessive Compulsive Behavior, Social Anxiety Reactions, Agoraphobia, Major Loss of Self-esteem and so on.)
In the worst phases one can experience auditory and visual hallucinations, schiophrenic-like black outs where one does not recall what one did and while in the Black Out, one’s behavior is often somewhat bazaar. One may also go into a manic stage where one has super energy, needs little sleep, feels real damn good, has rapid thoughts, can feel very superior to most, can feel much smarter than most, and usually functions on a faster level i.e.: talking, thinking, working faster than normal.
THAT phase doesn’t last real long and the resulting down swing is almost devastating because one goes from an almost euphoric high to a Black, Deep Dark depression. The latter stage also doesn’t last long before one starts to swing up to a lesser stage of depression.
(There’s more, but I won’t go into it now. Check the archives for DEPRESSION.)
Depression can be caused by life factors ie: lost loves, dysfunctional home life, extreme working environment and pressures, illness, too high expectations, loss of status, personal image attacks (bosses and people who like to let you know you’re shit), loss of friends and so on.
Basically environmental depression can be spontaneously cleared up by a major life change – like winning the lottery. Other forms might improve, but still remain and require therapy. Others take therapy and medication to end.
Suicide is always a factor to watch for in serious depression because virtually all affected people have suicidal thoughts and might seriously consider it as a viable option. Sometimes suicidal ideation created by depression might not be consciously considered but one might start acting in a reckless enough way to encourage ‘accidental’ death. Like, drinking far too much far too often, the heavy use of illegal and harmful drugs, working recklessly in a dangerous job, taking far too many risks in potentially dangerous situations and so on.
Then there are the possibility of attention getting mechanisms being used.
Interestingly enough, it has been discovered that those ‘painfully shy kids’ from school later turned out to be affected by a genetic form of social anxiety disorder which later on in life turned into major depression because the ‘shyness’ prevented them from performing normally socially and affected their emotional, working and public lives.
CAREFUL! We don’t want to learn from this!(Calvin and Hobbs)
Thanks all, I think I got it now. From what you guys say, what seems like the substantial difference between someone with clinical depression and someone without is that the person with it may or may not be depressed for any good reason at all, and if a good reason does come along, then the person may be physically unable to get out of it without treatment.
It makes sense to me now, but I hope they continue the research and find something like a brain chemical test - it seems it would be real useful.
PeeQueue