On Depression

Today was a somewhat OK day.  It’s been that way for a few days now.

Whether somebody has depression seems to be something that is mostly driven by the pharmaceutical industry.  They have a pill for what ails you.  Often, whether a person is suffering from depression, or any mental illness, is based upon whether they meet the criteria in the DSM, so that way you can be sold a pill.  But I thought it might be good to take a look at what constitutes depression.

Couple of things first, though.  I don’t have the DSM-V.  I don’t even have the DSM-IVR.  I’ve got an old copy of the DSM-IV.  I don’t know if the criteria has changed, but I don’t think it has for depression.  Also, you’re not supposed to diagnose yourself, for good reason.  Growing up, my parents had a copy of the AMA Death Book.  I don’t know exactly what it was called, but they had flowcharts at the front and it all boiled down to this:  1.  Are you alive?  If yes, you have cancer.  If no, Are you sure?  You probably have cancer anyway.  I’m not using this to diagnose myself, but simply to reflect upon what it is that I suffer from.

The DSM-IV lists the diagnostic criteria for Major Depressive Episode as the following:

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. 

Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations

(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), recurrentsuicidal 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 (see p. 335). 

C. 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.

That’s quite a mouthful.  But let’s go through them.  I have a depressed mood a good chunk of the day, although not necessarily most of it.  I get feeling down at discreet periods of time.  I find that if I’m not working, and nobody else is around, I just sit and watch TV and not really do anything.  I’m not sure if this falls under number 2, but it certainly seems to be appropriate.  Things I generally enjoy doing, I really avoid during those times.  I’m not having a weight loss or weight gain, which I have had in the past,  I find that when I’m not feeling good, I either don’t eat, or eat less, or I just eat crap.  Either way it isn’t good.  I don’t have insomnia.  I sleep fine.  Nor any sort of psychomotor agitation or retardation.  I can’t really say I have loss of energy, although as I mentioned a couple sentences ago, I don’t do much if people aren’t around.  I often have feelings of worthlessness, and definitely guilt.  I think and concentrate just fine.  Recently in particular, I have had suicidal ideation, but no plan. It’s not a mixed episode because I don’t have manic episodes.  I find that if I’m at a social even, I will want to stop being there and really I don’t like speaking with people there.  (I would say I am an introvert which contributes to a depression diagnosis, but this goes further than just simply being an introvert.)  And the symptoms can’t be explained through any other diagnosis.

So do I have depression?  Yeah, I’m pretty sure that I can fit into that diagnosis.  Could I be diagnosed with something else?  Sure.  Like Major Depressive Disorder Recurrent.  The definition for Major Depressive Episode permits a diagnosis of a disorder, such as Major Depressive Disorder Recurrent.  Dysthmic Disorder is a possibility, but only if I haven’t had an episode.

So that’s it.  I’m prettu sure I suffer from it, at least it appears to meet the criteria.

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