In this video, I discuss the most common signs and symptoms of depression, offering advice for how to make sense of all the information available online, with suggestions about the different treatment options.
If you’ve been searching the Internet for information about how to recognize depression, either in yourself or in someone close to you, this post will introduce you to the 10 most common signs of depression that appear on many mental health websites, with little variation; I’ll also discuss how to understand and make use of them. These signs of depression derive from the Diagnostic and Statistical Manual IV issued by the American Psychological Association; the DSM-IV is the official manual of the mental health profession and is used by psychiatrists, psychologists, social workers, etc. who must provide a diagnosis to insurance companies before the insurer will issue reimbursement. Here are the 10 most commonly recognized signs of depression:
1. Depressed mood indicated by persistent sad, anxious, or “empty” mood
2. Feelings of hopelessness or pessimism
3. Feelings of guilt, worthlessness, or helplessness
4. Loss of interest or pleasure in hobbies and activities once enjoyed, including sex
5. Decreased energy, fatigue, or feeling “slowed down”
6. Difficulty concentrating, remembering, or making decisions
7. Insomnia, early-morning awakening, or oversleeping
8. Appetite and/or weight loss or overeating and weight gain
9. Thoughts of death or suicide or actual suicide attempts
10. Restlessness or irritability
This kind of symptom list is very common in the DSM-IV for a broad range of diagnoses; in order to earn the label, you have to meet X number of the “diagnostic criteria,” as they’re called. To receive a diagnosis of a Major Depressive Episode, for example, you have to exhibit at least five of those 10 signs of depression during a two-week period, and those five have to include either (1) or (4). If you exhibit only four symptoms, or if you have six symptoms for less than two weeks, then you don’t qualify.
Just about every mental professional who must chart and deal with insurance companies owns a copy of the DSM-IV. So why are there websites disseminating this information? Since it’s not for the psychotherapist who already knows the details or has them close at hand on the bookshelf, who is it for? Clearly, it’s for depressed people searching for help, or parents worried that their teenager is depressed, or possibly someone concerned that a
husband or father may be depressed. Believe it or not, “signs of depression in men” is a commonly searched term on Google.
All right, so you search for “signs of depression” and you hit upon one of these sites with its 10-point list. What have you learned? I guess there are people who aren’t sure if they truly are depressed, or if a loved one actually is depressed; this list may confirm a suspicion. Then what? Many of these sites recycle the familiar information about negative self-statements, affirmations and biochemical imbalances; a few might tell you something of value, but the vast majority are commercial sites designed to sell you something — online therapy, for example — or to get you to click on banner advertising so the website owner can earn revenue. The goal of so many of these sites isn’t to provide anything of actual value, but to lure troubled people in order to make money from their distress. A look at the advertising on these sites shows how Big Pharma uses them to shill for their worse-than-ineffective drugs, hyped with the baseless claim that depression results from an imbalance in brain chemistry.
Excuse me if I sound cynical. In all fairness, therapists have to earn a living just like any other professional; the only way you can do so is if you have clients, and advertising is an accepted method for drawing people into your practice. I don’t have a problem with the advertising; what I find troubling is that these sites offer so little of value. Their primary purpose is to show up on search engines when suffering individuals plug certain phrases related to their pain into a search box. If you suspect that a loved one is in trouble, or if you yourself are struggling, you may search for “10 signs of depression”, “signs of depression in men” or simply “signs of depression” to learn more. Something like 6,000 people a day search those three terms alone.
If you’re lucky, you may find a website that tries to help you understand what depression means, the “why” of depression, but to find a resource that goes beyond negative self-statements and low serotonin is rare. The search for “meaning” isn’t strong in my profession these days, in large part because long-term psychoanalytic treatment (the “talking cure”) is expensive and out of favor. We live in a society that expects quick and easy answers. Short-term treatments based on cognitive behavioral theories, along with psychotropic medication, are preferred by the public as well as the insurance companies. Those insurers want the mental health professional to have a clear-cut diagnosis for the insured, with five of those 10 signs of depression; they want a set of goals and an expeditious plan for how to achieve those goals, with documented progress along the way.
A lengthy, meandering and difficult journey of self-discovery, without a well-defined route, doesn’t fit this model. In my experience, it’s the only way to learn anything of real and lasting value about those signs of depression and how you came to exhibit them. You won’t discover your unique and personal reasons for being depressed by searching for ’10 signs of depression in men’, or on any of the sites you’ll discover in your search results.
Finding Your Own Way:
I appreciate that many of you who have found this site are suffering intensely. I know you’re looking for answers and for relief from your pain. I wish I could offer you those answers; I wish I had a pill that would do the trick. I’ve been in the profession long enough now to have been through several cycles of new and miraculous anti-depressants. When I was in my 20s, Deseryl was all the rage. Then came “Listening to Prozac” and the other SSRIs. As I’ve pointed out before, recent studies have shown these drugs to be no more effective than a placebo. You can’t solve depression with a pill. There are no easy answers.
Depression has a meaning and a psychological genesis. Yes, one can inherit genetic tendencies; no doubt brain chemistry plays a role (though it’s an unresolved chicken-egg problem: does your brain chemistry cause your depression, or does your depression alter your brain chemistry?). Some of the posts on this site should get you started on your journey, particularly the posts that have to do with feelings of shame and problems of hatred. Another post discusses the meaning of different varieties of depression and the psychological issues behind them: rage, a fragmented sense of self or toxic levels of shame.
[NOTE: Depression and Bipolar Disorder are a central focus of this website; all related articles can be found under that subject heading in the category menu to the right. This post provides information about common symptoms of depression you may already have found on other sites; if you'd prefer to learn more about some of the emotional factors behind depression, you might want to read my post on hopelessness or another on psychotherapy issues involved in bipolar disorder, which discusses intolerable feelings of shame and psychological damage. I've also written about the different types of depression. If you're considering the use of medications to treat your depression, I strongly advise you to read my later three posts that analyze the dubious benefits and serious proven side-effects of these drugs. The first post deals with the completely unfounded theory that psychological illness is the result of a chemical imbalance in your brain; the second shows how, contrary to common perceptions, psychiatric medications have led to worse rather than improved outcomes for people taking those drugs; and the third discusses the false notion that anti-depressants are "like insulin for diabetes" and shows that SSRIs actually introduce a new imbalance into your brain chemistry where one did not before exist. To read about the role of SSRIs in the explosive rise in bipolar disorder as a diagnosis, click here.]