What Is Depression? Further reading

Episode 2 - https://apple.co/2NbRwGl

Depression isn’t just sadness

The condition is best thought of in terms of a changing capacity to experience pleasure – anehonia (an = lack of, hedonie = pleasure), lack of energy and drive, and negative distortions in the way we think about ourselves, and our past, present and future. 

In addition to looking sad, depressed people are usually more slowed up physically and mentally. They move, think and speak more slowly and their concentration is impaired.

Depression and anxiety are common bedfellows, and the bodily manifestations of anxiety differ across different cultures.

It’s not a vacillating condition like the pangs of grief - it is stubbornly persistent and pervasive, affecting the sufferer on most days. It must last for at least a couple of weeks to reach a diagnosis but usually lasts for months, especially if it is not managed properly.  

We mention a few questionnaires that are useful for diagnosing depression, including the Beck Depression Inventory. We also talk about the diagnostic ‘triangle’ – how depression fits in to a hierarchy of other conditions. This will be explored again in a future episode on the causes of depression.

Depression varies in severity

At the milder level people are still functioning at work and at leisure but with greatly increased effort, and feel tired most of the time. Sleep is less refreshing. At the more severe end work is impossible, self-care deteriorates, sleep is very disturbed, you lack motivation to eat and suicidal thoughts might become very intense. 

Rarely, severe depression is associated with psychotic symptoms like hallucinations and delusions, mostly of a depressive nature (like hearing unfamiliar people telling you that you are worthless).

These are the DSM-V criteria for diagnosing a “Major Depressive Episode”:

To qualify for a diagnosis of major depressive episode, the patient must meet criteria A through E:

A. Five or more of the following symptoms have been present and documented during the same two-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 attributable to another medical condition.

1) Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful)

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)

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

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.

C. The episode is not attributable to the physiological effects of a substance or to another medical condition.

Note: Criteria A-C represent a major depressive episode.

Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include feelings of intense sadness, rumination about the loss, insomnia, poor appetite and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history of and the cultural norms for the expression of distress in the context of loss.

D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.

E. There has never been a manic episode or a hypomanic episode.

Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition.

Severity is based on the number of criterion, the severity of those symptoms and the degree of functional disability. 

The ICD-10 criteria are very similar:

Diagnostic criteria for depression ICD-10 uses an agreed list of ten depressive symptoms. Two out of three of these core symptoms must be present on most days, for most of the day, for at least 2 weeks to make a diagnosis:

  1. Persistent sadness or low mood;and/or

  2. Loss of interests or pleasure

  3. Fatigue or low energy

Additional symptoms:

  1. Disturbed sleep

  2. Poor concentration or indecisiveness

  3. Low self-confidence

  4. Poor or increased appetite

  5. Suicidal thoughts or acts

  6. Agitation or slowing of movements

  7. Guilt or self-blame

Useful links and references:

You can find the Beck depression inventory here:


You find the Hamilton Depression Rating Scale here: