The American Psychiatric Association requires any five of nine symptoms for a diagnosis of major depression. As the definition implies, these symptoms do not all appear in everyone who is depressed. Two studies explore the consequences for the understanding of depression and come to contrasting conclusions.
One study suggests that an individual patient’s symptoms are not consistent, but change more or less unpredictably from one episode of depression to the next. The other study suggests that there are several sets of depressive symptoms that are distinguishable genetically and therefore likely to persist in a given individual.
American researchers studying 78 hospitalized patients who had had at least 2 episodes of severe depression found that, with a few exceptions, it was impossible to predict reliably from the symptoms of one episode which symptoms would appear in the next episode. The researchers also looked for the persistence of sets of symptoms that are regarded as characteristic of specific types of depression:
- atypical depression (excessive sleep and eating and weight gain, feelings of worthlessness)
- melancholic depression (insomnia, anxiety, appetite loss, slowed movements, feeling worse in the morning)
- and psychotic depression (paranoia, guilt, hypochondria, hopelessness).
Again, there was no consistency. For example, a patient who had psychotic symptoms in the first episode and one who had melancholic symptoms in the first episode were equally likely to show psychotic (or melancholic) symptoms in the second episode. Among these patients, there were apparently no distinct types of depression. Instead, the same underlying illness was taking different forms at different times.
European researchers found evidence to the contrary in a large international genetic study including more than 1,000 biologically related siblings with recurrent depression. From answers to standard clinical interviews, they identified five groups of symptoms that often went together, which they call “dimensions” of depression:
- sadness, hopelessness, loss of pleasure and interest in life
- slow movements; lethargy; loss of energy, sexual interest, and initiative
- anxiety
- restlessness, agitation, irritability, guilt, and suicidal tendencies
- excessive sleep and appetite
The second, third, and fourth dimensions were more highly correlated among siblings than among unrelated persons. For example, if one sibling had mainly the low-energy symptoms, the other sibling was far more likely than average to have those symptoms as well. The authors suggest that these dimensions may help to identify genetically distinct types of depression.
Are these study results consistent with how you experience depression? Do you find that your symptoms vary over time? Do you find such categories helpful for thinking about or understanding depression?
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Comments: 10
I have lived with depression my whole life;both parents having thyroid problems.I have been to many doctors, although the thyroid has calcified nodules,labs come back normal.I feel further exacting lab work could be done.Hormonal imbalances;pituatary,etc.I have been diagnosed with fibromyalgia/post traumatic stress disorder.In researching the p.t.s.d. from lifelong abuse; I find that stress could possibly have altered or dwarfed the functions in the brain.I may never lose the insideous weight that has crept up and up...
If you could steer me in more appropriote paths to research impact of stress in conjunction with body,I would appreciate it.I am in search of a book,The balance Within,which addresses this association.
I found your post interesting but have to disagree on levels.I have experienced all levels;but that may well be the impact of lifelong abuse.
care giving, abandonment after horrible efforts, loss of self esteem.. all have brought on a shopping list of these sort of symptoms, and the pendulum swings wildly in both directions.. i.e. insomnia and wanting to day sleep in the same week, NOT due to over tiredness.
and promises to keep.... promises to keep,
Your comments underscore one thing that many researchers believe now, that depression has many, many causes. Probably the causes are too numerous to count.
One message I take away from the article is that depression is very hard to define. Even though the diagnostic manual gives us a standard definition, depression looks different from person to person, and it often looks different in the same person at different times.
That's why it is important to keep an open mind when trying to find solutions for mood problems. It is always a good idea to onsider mood symptoms from every angle — including some of the ones you suggest, such as hormone problems and stress.
Although I think omega-3 oils are very interesting substances, I can't agree with your recommendation that everyone should take them. There just is not enough evidence that they help. We can't rule out that some people find them helpful, but they are probably not for everybody.
And I also think it is too wide a generalization to say that depression is caused by overprocessed food. Or caffeine or computer use.
You are write to point out that caffeine is everywhere! If you drink caffeine every day, the draggy feeling or headache you have before your first cup of coffee is probably a sign of caffeine withdrawal, but — it probably doesn't cause depression on its own.
You are right however to ask people to think about their diet. Some people may run into problems because they are eating a diet that is not nourishing enough for them, or an unhealthy diet is making them just that: unhealthy
Exercise is very good for improving mood. It actually makes the brain work better! Even doing a half-hour a day of low impact exercise, such as walking, can make a difference.
Regular exercise and a healthy diet probably do reduce depressive symptoms on average, but many people — even the most active people who carefully watch what they eat — may still need the medications they take for depression.
Ack! If this is true, we're all screwed! ;)
but empowering ourself with the will, desire and courage to take responsibility to change will save us.
I believe that society today feels the isolation brought on by use of computers versus going out in the world and create relationship with others who needs us as much as we need them. We need other people to grow and be happy not machines and virtual friends alone
Go out and join a dance class if you can.
Set boundary for those who cause you to be depressed.
Make friends who are joyful people.
Volunteer for something.
love a lot.
The studies done on a large number of people, including siblings, probably is a better line of research. But my symptoms don't particularly fit all that neatly into any of their slots, either. The first study's slots, 1) atypical depression (excessive sleep and eating and weight gain, feelings of worthlessness), 2) melancholic depression (insomnia, anxiety, appetite loss, slowed movements, feeling worse in the morning), and 3) and psychotic depression (paranoia, guilt, hypochondria, hopelessness) don't fit me well at all. I had excessive sleep (or at least *wanting* to sleep, falling asleep any time I sat still, etc.), weight gain over the course of my entire life, feelings of worthlessness, insomnia (or at least not being ABLE to sleep when it was appropriate except for short periods of time), slowed movements (and thought; I always figured it was from being tired), feeling worse in the morning then better, then worse again in the afternoon, paranoia (no one likes me, they're talking about me), guilt (I do everything wrong, can't do anything right), hypochondria (there HAS to be SOMETHING wrong with me to make me feel so awful), hopelessness (it's just never going to get better).
So ... I had it all??
The second study's categories seem better, but I still cross them... 1) sadness, hopelessness, loss of pleasure and interest in life (definitely), 2) slow movements; lethargy; loss of energy, sexual interest, and initiative (yup), 3) anxiety (intermittantly), 4) restlessness, agitation, irritability, guilt, and suicidal tendencies (this set would alternate with #1), and 5) excessive sleep and appetite (always).
So I still don't fit it all. Or do I fit most of it?
I think while trying to categorize can help researchers and doctors understand it better, I also think that you'll never be able to completely categorize it, because there would be as many categories as you have people to study.
There are SO many factors that go into depression, so many causes, so many things that make it worse, that trying to put people into categories is likely to *hinder* some diagnoses. I spent years trying to get help, but just being shuttled from one doctor to another, and one place to another. Until I learned the "key words" to say, no one seemed to take me seriously. Even the time I ended up in the hospital for a failed (basically I chickened out) suicide attempt I really wasn't taken seriously, because I chose aspirin. You really CAN kill yourself with aspirin. You just have to be persistant about it. The look on the doctor's face was very, very different after he got the lab results back. Very different. But all they did was make me promise to "get help" and sent me on my way. Then sent me a bill for thousands of dollars!
And all that happened after that was my friends stopped talking to me or visiting me because they "didn't want to bother me with their problems." Wow, that was a big help!
All I can say about MY depression is that I've had it for as long as I can remember (I've had suicidal feelings since I was 6 years old) and even with maxing out on medication, going to counseling, doing meditation and everything other coping mechanism I've ever learned, it's not completely gone. It's always there in the background waiting to jump me. :\
We all have bad moments, life is never smooth. But if hope is there then tomorrow will be better. My attitude helps me a lot.
I try to be cheerful and forget my problems while I help others.
Try to improve one thing at the time, self control in changing is the catalyst for improvement.