People are considered to have clinical depression when they experience low mood that accompanies:
- negative thinking about self, other people and the future;
- loss of motivation for important social activities, such as work and study;
- loss of hope and enjoyment in life.
Neurologically, when a person has clinical depression, the level of one or more types of neurotransmitters in the brain (eg serotonin, norepinephrine, dopamine) is low.
It is normal for everyone to become depressed at different points in life, because we all encounter stressful event and situations. But when does it become clinical depression?
What is Clinical Depression?
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a person is formally diagnosed as having Major Depressive Disorder (clinical depression), when they fulfil criteria A, B and C below:
Criteria 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.
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (eg feels sad or empty) or observation made by others (eg appears tearful).
- 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).
- Significant weight loss when not dieting or weight gain (eg a change of more than 5 percent 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.
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
- 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.
Criteria B: the symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.
Criteria C: the symptoms are not due to the direct physiological effects of a substance (eg a drug of abuse, a medication) or a general medical condition (eg hypothyroidism).
Why do People become Depressed?
Depression is often not the cause of problems, but the outcome of some problems in life. People experience depression for a number of different reasons, including:
- Unexpected, stressful life events and circumstances (eg loss of significant others, diagnosis of chronic illness, failures in life, divorce) and not being able to cope effectively with the stress.
- Physical illness—when our body is stressed, we can become psychologically stressed and experience depression.
- A lack of exercise, poor sleep, and poor diet, all of which cause more stress in our body and mind.
- Not absorbing enough sunlight every day—the level of serotonin in our brain diminishes when we do not absorb enough sunlight, especially in the morning.
In some cases, people can also become depressed even when everything in life is going well because the level of serotonin, norepinephrine and/or dopamine in brain has decreased.
Treatment for Clinical Depression
The causes of depression are unique for every individual.
Research studies show that treatment is most effective when it includes a combination of:
- Psychotherapy for finding better ways to cope with the causes of depression (eg stressful life events/situations, loss of significant others, diagnosis of chronic illness).
- Medication (eg anti-depressants to increase the level of serotonin, norepinephrine and/or dopamine). Some people may prefer Chinese medicine that brings similar effects to Western medicine without notable side-effects.
- Doing sufficient exercise and regulating sleep and diet.
- Making sure to receive sufficient sunlight, especially in the morning.
- Regular engagement in enjoyable activities (eg spending time with family members and friends, doing sports and hobbies).
- Treating the physical illness—physical stress in the body can cause psychological stress and that, in turn, can make people feel more stressed.
As soon as you find that you are struggling with low mood and depression, and it is affecting your daily life, it is a good idea to consult a health professional such as a GP, psychologist, counsellor or social worker, experienced in treating people with depression.
It can be also useful to build up some knowledge through books and online websites, and utilising some self-help strategies. However, treatment is more effective when health professionals thoroughly assess individual circumstances and implement interventions that are tailored to your unique circumstances.
Author: Yu Takizawa, B Sc (Hons), M Couns, M App Psych.
Yu Takizawa is a Brisbane psychologist, fluent in both English and Japanese. He is particularly interested in offering counselling and psychotherapy services to people who are facing cultural challenges, or problems with anxiety.
To make an appointment with Brisbane Psychologist Yu Takizawa, you can try Online Booking – Mt Gravatt or call Vision Psychology (Mt Gravatt) by freecalling 1800 877 924.