Symptoms of severe depression

by Martin

in Depression Diagnosis

First, let’s get some terminology straight. ‘Severe depression’, ‘ major depression’ and ‘clinical depression’, are terms that tend to be used interchangeably to mean the same thing (see, for example, these descriptions at the Mayo Clinic or UC Berkeley).

What these terms refer to is the condition described technically by psychiatrists as ‘major depressive disorder’. Therefore as we discuss the symptoms of major depressive disorder in this article, bear in mind that we are looking at what may also be called:

  • Major depression symptoms
  • Clinical depressions symptoms, and
  • Symptoms of severe depression.

The symptoms of severe depression – the technical version

The technical manual that psychiatrists generally use to assess whether a person is suffering from depression is the revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV TR) published by the American Psychiatric Association.

According to DSM IV a person is suffering from major depressive disorder or (severe or clinical depression) if for most of the day, nearly every day for at least 2 weeks, they have had at least 5 of the following symptoms, including (1) and/or (2):

  1. a low/depressed mood; or
  2. significantly less interest in and pleasure from usual activities (this is called anhedonia);
  3. significant change in appetite or weight
  4. inability to sleep or sleeping more than usual
  5. fatigue, loss of energy
  6. feelings of guilt or worthlessness
  7. lethargy or hyperactivity
  8. difficulty concentrating or making decisions
  9. recurring thoughts of suicide or death.

Now, let’s break that down a bit.

Step 1

First, it is important to note that low mood and/or loss of pleasure or interest in usual activities (anhedonia) must be present.

In effect these are the threshold conditions. Doctors are sometimes recommended to screen for depression by asking questions to establish whether either of these two conditions are present (e.g. see the Macarthur Institute’s materials).

Step 2

If you are suffering from low mood and anhedonia, then the next consideration is whether 3 of the other listed symptoms are present.

If you are suffering from either low mood or anhedonia, then 4 of the other symptoms need to be present.

Step 3

The next step relates to the duration of symptoms. The relevant symptoms must have been present every day for at least two weeks and must have been felt for most of every day.

Of course you may in fact have been suffering for much longer than two weeks or have had more than one episode where the symptoms have been present for at least two weeks. This is really the norm, of course – we don’t usually go to our doctor two weeks and one day after starting to feel depressed.

Step 4

The final step that I didn’t refer to above, but which it is crucial to consider, is that your symptoms must be a change from your normal state and have a significant impact on your day to day functioning. The DSM IV states that the symptoms must :

“cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

If you think about it, this is what is at the heart of an individual’s experience of depression. It is the inability to function normally that takes us out of the ‘feeling down’ camp into a whole new arena.

Symptoms of severe depression – the real life version

Whilst it is useful for you to know the technical framework that doctors use to assess depression, the language of the DSM IV criteria may not necessarily reflect your own descriptions about the way you feel. We can all experience different symptoms or express them in different ways, both to ourselves and others.

What is more, as John Mcmanamy points out in his ultra perceptive analysis of the DSM IV criteria, Depression – what is it?:

“Diagnosis by counting is a totally absurd, and often very dangerous, proposition. When it works, we arrive at a very rough indicator of what may be wrong with us. Too often, the exercise is wholly misleading.”

For this reason, doctors assessing a patient for depression (assuming that are doing a thorough job) should ask lots of questions about the way the patient feels and look for examples of behavior that may or may not fit into the accepted criteria.

Some of the other ways that you might use to describe the way you feel, but which in substance may still fit within the technical criteria are as follows:

  • Feeling flat
  • Feeling very down
  • Feel like I don’t care about anything
  • Having to make a real effort to do anything
  • Can’t really feel anything any more
  • Don’t care about the things I used to
  • Feel very on edge
  • Feel very stressed
  • Very irritable
  • Can’t think straight
  • Can’t make up my mind about anything
  • Don’t feel like I can go on
  • Feel useless
  • Feel hopeless
  • Don’t see any future
  • Don’t see the point of anything
  • Can’t get out of bed
  • Don’t want to see anybody
  • Don’t want to talk to anybody
  • Can’t sleep
  • Can’t eat
  • Can’t stop eating
  • Don’t have any energy
  • Feel exhausted

Other diagnoses

If you feel that something is not quite right with your moods or the way that you feel, you need to be aware that there are various different types of depression and other behavioral or mood disorders. So, if you’re situation doesn’t reflect the symptoms of severe depression, then you or your doctor should consider whether any of the other possibilities might apply.

These include:

  • Dysthymia (milder, prolonged depression)
  • Bi-polar disorder (formerly manic depression)
  • Adjustment disorder with depressed mood (a depressive reaction to a particular event or stress)
  • Schizophrenia

Conclusions

The symptoms of severe depression will usually be very clear to you if you stop to think about how you feel.

But, one of the major difficulties with depression, of course, is that it takes away our inclination to take action to put things right – we can just feel ‘too depressed’ to do anything about it.

That’s why it is essential that you discuss how you feel with somebody close to you, as they may be able to help you get the attention you need.



Go from this Symptoms of Severe Depression page to Depression Help (the home page)
Go from this Symptoms of Severe Depression page to the main Depression Diagnosis category page

About the Author

Father, husband, writer and website publisher, discontented in his day-job, he writes here about depression - his own and in general. You can follow Too Depressed on Twitter. Please share the content on this site with all your friends, followers and contacts using the buttons above.

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Last revised on October 19, 2013

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