Depression Overview

Symptoms of a Major Depressive Episode, DSM IV
List distilled, see below for full DSM IV description

1. Feeling sad or empty, appearing tearful
   Note: can be irritable mood in children and adolescents.
   
2. Anhedonia: loss of pleasure or interest in pleasurable activities
3. significant weight loss when not dieting or weight gain or daily decrease or increase in appetite.
4. daily insomnia or hypersomnia
5. energy increase: restlessness, agitation OR energy decrease: physical retardation
6. daily fatigue or loss of energy
7. daily feelings of worthlessness or excessive or inappropriate guilt
8. daily diminished ability to think or concentrate, or indecisiveness
9. recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

In Western culture women are allowed to express emotions and vulnerability, thus they are more accepting of their emotions and emotionally open; they recognize and feel their sadness. Society considers it a sign of weakness in men to be emotional and has thus trained them to repress their emotions, leading to internalization; in such circumstances emotions, like sadness, turn inward and are expressed in more violent manners such as through anger and aggression. Where women will express their depression openly as sadness and seek help and comfort in relationships, men express their feelings indirectly as being tired and burned out and seek to isolate themselves. They cut themselves off emotionally and are unable to recognize the root emotions. Their insistence on feeling fine leads them to work harder to prove they are fine and become more burned out, since the feeling is real, they assume it is the only explanation.

Midlife Depression

Depression in midlife is not an external problem. It is about issues within one's Self. Replay is Covert Depression, a running away from the self manifested through anger and external blame, as well as a variety of self-medications; affair, drugs, alcohol, risky behaviour, spending, new friends and activities, often an interest in exercise and an obsession with youth and aging. It is a monster that feeds itself. I don't want to feel despair and hopeless or face my demons (Overt Depression) so I'm going to drink, party and have an affair. I'm bad, I have tremendous guilt. I've cheated on my wife...this just can't be fixed. He adds another demon to the Overt Depression he's avoiding and run further away at an even faster pace. Covert Depression is a self-medication taken in an attempt to avoid Overt Depression.

When there is quiet, he can think, and thinking brings on Overt Depression, so he keeps running, being active; it is an avoidance stemming from a fear of what is inside. It is his own internal demons that he has been running away from, and they will eventually catch up. He fights, but they drag him down to the bowels of the great chasm. The only cure for it is Overt--Liminal Depression. Some cling desperately to the ledge, no longer self-medicating but still not facing the Shadow Self. Overt Depression is despair, hopelessness and feels eternal; it is the place where they are forced to face all those things they have repressed from childhood--the issues at the root of the MLC.

DSM IV
Major Depressive Episode

more) of the following symptoms have been present during the same 2-week period and r
1. 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 depressed mood or loss of interest or pleasure.
   Note: Do note 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. 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 (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.
2. insomnia or hypersomnia nearly every day
3. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
4. fatigue or loss of energy nearly every day
5. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
6. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
7. 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
2. The symptoms do not meet criteria for a Mixed Episode. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
3. 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).
4. 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.

Major Depressive Disorder

1. Presence of a single Major Depressive Episode
2. The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
3. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.
   Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.

1. Presence of two or more Major Depressive Episodes.
   Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode.
2. The Major Depressive Episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
3. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.
   Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects or a general medical condition.