Reclaim Your Life A Guide Beyond Depression

Part 1:

Understanding the Storm

​​Chapter 1: Recognizing the Shadows: What is Depression?

Understanding Depression: A Detailed Exploration of its Definition

In the established domains of medical and psychological science, depression is largely classified in relation to the mood disorder category. The acceptance of depression as a mental health disorder acknowledges it to be a legitimate health issue worthy of consideration, empirical research, and intervention. The fact that there is agreement within the medical and psychological domains about the mood disorder classification is indicative of a shared and considerable knowledge of depression based on obvious biological, behavioral, and cognitive explanations of its onset, course, and presentation. To ensure a recognized and shared perspective of depression and its treatment is important because there now exists a common agreement on standard diagnostic criteria for depression and standard treatment protocol that work to ensure both consistency and effectiveness in care directed to those experiencing it. The classification of depression as a mood disorder elevates it beyond merely an emotional episode and acknowledges it as a valid health concern to be examined through research investments, informed health care policy, and reducing the stigma placed by society.

At its essence, depression can be described as an ongoing experience of negative emotions, primarily in the form of sadness, as an inner sense of emptiness, or as a feeling of hopelessness. This sadness is not a momentary disturbance but rather a deeply entrenched experience with significant being in a person's day to day. The feelings can often be extremely intense; descriptors such as profound and overwhelming suggest debilitating feelings. While these three primary emotions are a part of the experience of depression, the phrase primarily manifesting indicates that other negative affective states, such as anxiety and irritability, and feelings of guilt and worthlessness, will likely also be present during the experience of depression. These complex emotional experiences are often difficult to disentangle, which is why being aware of the more core emotional components of an experience is critical for effective diagnosis. Additionally, these core emotional components can help individuals understand their internal experience better and in turn can allow individuals to better express their experience so that they can get help sooner if they wish to take part in some form of support process.

A defining aspect of these negative affect states in depression involves their duration, which is normative; they do not last a few minutes or hours and then fade away. Rather, they can last for many weeks, even many months or years. One of the main reasons that clinical depression is distinguishable from the mere emotional responses to life circumstances is due to the duration of the symptoms. The fact that depressive states can last from weeks to years, it is recognizes that depression is not a static condition, and the degree of persistence and severity can vary among individuals. This has implications for the standards of care. The tenacity of these symptoms conveys that there is some underlying biological or psychological mechanism that cannot be easily dealt with via normal coping and time.

It's important to recognize and differentiate between clinical depression and normal sadness, which everyone experiences. Sadness is a natural, transient, human emotion that typically occurs in reaction to an event or events in someone’s life. Sadness is not pleasant, but it is usually a fleeting feeling, allowing a person to sooner or later proceed with life and get back to happy activities. Clinical depression is, however, a significant departure from this normal emotion of sadness. The ability to have some positive experiences and to carry on with daily activities are two elements that differentiate the feeling of sadness from the all-encompassing anhedonia and inability to function that is often seen in people with depression. Understanding this basic difference is an essential step toward reducing the stigma associated with mental health challenges, and to encourage people who are feeling clinically depressed to seek professional help, rather than to trivialize their deep suffering as simply feeling a little down.

Depression's nature is such that, in contrast to a specific feeling of sadness, depression becomes an overwhelmingly persistent illness that can interfere significantly with a person's ability to function in their life. Depression makes life hard and can create obstacles to being able to function in many domains of one's life. These domains can include functioning and engagement in the workplace/school, fostering and maintaining healthy and meaningful relationships with others, or, even just engaging in the very basic self-care acts we all take for granted, like hygiene, nutrition, and sleep. Depression can impact many aspects of life or function, and this reflects the systemic nature of depression; depression is not something that only impacts one's internal experience but instead, reflects a breakdown of one's functioning and social lives. Neglecting self-care can create additional obstacles; because this might make someone feel less worthy in their social contexts and hopeless about their situation, the neglect creates additional problems that can, at the same time, maintain or worsen the depressive state.

To further emphasize the distinction, consider the reactions we might have after a romantic breakup. A person who experiences normal sadness may feel heartbroken and upset for a period of time; which is perfectly normal. Over time, the individual will likely begin to gradually engage in activities again, see friends again, and gradually acclimate to the situation; and as they do so, their sadness eases. In contrast, a person with depression may have a much more severe and prolonged response to a similar event. They may find they lose interest in nearly all the activities which provided them pleasure before their depressive episode, and could even socially withdraw for months. Even the very basic effort of merely getting out of bed in the morning could result in immense emotional struggle or mental barrier; plainly showing just how depression can hinder, or interfere with our daily activities. Thus this example demonstrates the difference in the intensity and duration of emotional distress and functional impairment that is endured with normal sadness and clinical depression.

The next possible key discriminator of depression is the sustainability of negative feelings. Because moods are dynamic, daily life includes both positive and negative emotions. Emotions rise and fall based on the day's situations. However, depression brings feelings of sadness, emptiness, or hopelessness that overshadow everything and do not lift for long periods of time. The consistent negative influence of depressive feelings is an immense impairment when it comes to experiencing any joy, motivation, or sense of meaning. Furthermore, the pervasive nature of these feelings, so different from temporary moods, appears disappointing and indicates some sort of system dysregulation in the brain's systems for emotional regulation. A key component of depression is the disruption of a person's ability to feel positive emotions, the psychological disorder called anhedonia, which underlines the sense of distress and disconnection from life.

Depression is more than just an emotional experience. It can impact thinking, causing issues with concentration, decision-making, and memory. There can also be physical symptoms associated with the disorder. For example, you might feel tired all of the time, have a significant change in your appetite or sleep (such as sleeping much more or sleeping less), and have unexplained aches and pains. These physical symptoms highlight how depression can affect people mentally and physically too. At its core, depression is not just feeling down or fine - depression can be serious. It is important for people affected by depression to receive understanding, compassion, and professional support through therapy, medication or both. One of the most important first steps in seeking help is to recognize the differences between sad and the persistent, overwhelming experience of depression.

Core Symptoms of Depression: A Comprehensive Analysis

Introduction: Understanding the Multifaceted Nature of Depression

Depression, clinically known as major depressive disorder (MDD), represents a serious issue of global health concern affecting people of every age, socioeconomic status, and culture. Depression is projected to be the leading contributor of disease burden globally by 2030 by the World Health Organization, furthering the need to have a more complete understanding of the different dimensions of this disorder. Depression is typically more than feelings of temporary sadness and follows a number of symptoms which can exacerbate individuals emotional state, physical health, thinking, and behaviors. Accurate diagnosis and a clear understanding of depression's core symptoms—emotional, physical, cognitive, and behavioral—are critical for successfully managing and treating this highly prevalent disorder. This report will go through these core symptoms in detail with the latest diagnostic criteria, recent research, new understandings of the underlying mechanisms, and clarify with examples.

2. Diagnostic Framework: DSM-5-TR Criteria for Major Depressive Disorder

Major Depressive Disorder is clearly defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR); this is the standard classification system used by mental health professionals. A diagnosis of MDD requires the presence of five or more specific symptoms during the same two-week period, which must involve a marked alteration in the individuals previous level of functioning. The above symptoms must occur for most of the day, nearly every day, must include (1) depressed mood or (2) markedly diminished interest or pleasure in all or almost all activities (anhedonia). The nine symptoms discussed in the DSM-5-TR range from:

Depressed mood: Symptoms of sad, empty, or hopeless mood; an individual could describe themselves this way or an observer may describe the individual this way. In children and adolescents, this should be diagnosed as irritability.

Loss of interest or pleasure (Anhedonia): A depressed mood accompanied by a loss of interest or pleasure in all, or almost all activities for most of the day, nearly every day. This can be reported by the individual or observed by others. 

Significant weight loss or gain: A change in weight, or noticeable weight loss (greater than 5% in a months time); or a decrease or increase in appetite nearly every day. In children this may be evidenced by a failure to gain weight as expected. 

Insomnia or hypersomnia: Lack of sleep (insomnia) or too much sleep (hypersomnia) nearly every day. 

Psychomotor agitation or retardation: This must be observed by another, this might mean an increase in purposeless physical activity (agitation) or a slowing down of thought and physical movement (retardation). This is not merely the observation of the individual feeling either restless or slowed down.

Fatigue or loss of energy: Fatigue or loss of energy occurs nearly every day.

Feelings of worthlessness or excessive or inappropriate guilt: An individual experiences feelings of low self-worth or guilt that are out of proportion to the situation or may even become delusional. This is not just self-reproach or guilt for being sick. 

Diminished ability to think or concentrate, or indecisiveness: An individual has difficulty focusing, concentrating or making decisions almost every day. This may be solely subjective reports from the depressed individual or it can be observed by others. 

Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, suicidal attempt or a specific plan for committing suicide: Have thoughts about death that are not a fear of dying, although, thinking about suicide or making an attempt.

Apart from these symptom criteria, the DSM-5-TR enumerates exclusion criteria. First, the symptoms cannot be due to the physiological effects of a substance (e.g., drug abuse, medication), or another medical condition. Additionally, an episode cannot be better explained by (a) schizoaffective disorder, (b) schizophrenia, (c) schizophreniform disorder, (d) delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders. Further to this, there cannot be a history of any manic or hypomanic episode, but this exclusion does not apply if all manic-like or hypomanic-like episodes are substance induced, or if they are due to the physiological effects of another medical condition. Lastly, the symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The requirement for at least one of the first two symptoms (depressed mood or anhedonia), emphasizes that these are central to the symptomatology of MDD.

The DSM-5-TR (published in 2022) included revisions to answer that goal of diagnostic clarity. Criterion D was updated to be more in alignment with DSM-IV language regarding a mood episode vs a psychotic disorder.  The new wording clearly states, that at least one major depressive episode is not better explained by schizoaffective disorder and is not superimposed on schizophrenia. This is an improvement from the DSM-5 wording, especially with regard to individuals that may experience both mood symptoms and psychotic symptoms. Additionally, a revised introduction to prolonged grief disorder as a new diagnostic category was included and is listed in the differential diagnosis for major depressive disorder (MDD). The introduction establishes that while symptoms of intense sadness, excessive rumination, marked insomnia and significant alterations to appetite can occur following a substantial loss, prolonged grief disorder is characterized by a persistent yearning or preoccupation with the deceased person lasting at least 12 months, and presence of other grief-related symptoms that the do not share the broad category of depressed mood in MDD. The DSM-5-TR also indicated a sensitivity to language and terminology, as an example, committing suicide was replaced with "a specific plan for suicide