Specifically here I want to focus on awareness of the symptoms of major depressive disorder (MDD). I’ve spent a large part of my life around people who in retrospect likely had undiagnosed MDD, and though the awareness for MDD has grown in recent years the rate of diagnosed depression has increased coincident to that1. Because of that this is also a disorder I’m likely to encounter in my future work and which other people are also likely to encounter either personally or among family and friends. So, it’s important to be able to pick up on the signs of depression, allowing it to be addressed early.
The Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition (DSM-5) provides a helpful guideline for evaluating the presence of any disorder. However, this guideline is more technical than most people might appreciate. Additionally, some of the symptoms of depression might not be visible when evaluating someone else. This means that there is a need to explicate the DSM as well as to describe how some of these symptoms may manifest in a visible way to others.
The following are signs and symptoms to look out for in yourself or others based on the DSM-5 qualifications2 :
- Depressed mood – This is the “feeling sad” part of the depression. If you are struggling with persistent feelings of sadness, emptiness, or hopelessness then you likely have this symptom. This can be recognized in others by observing their emotional expression and socialization. If they seem emotionally distant/socially withdrawn or if their conversations always stick on dark topics it might be indicative of a depressed mood. Even things that seem like jokes on dark topics could indicate a depressed mood, especially if that deviates from the norm of the person.
- Lost of interest or pleasure in activities – If you seem to be unable to enjoy previously enjoyable activities or feel a loss of purpose for your activities you likely fulfill this second symptom. In others this may manifest as a withdrawal from activities or a lack of enthusiasm for engaging with activities that is uncharacteristic of the individual.
- Significant weight change or change in appetite – This change goes both ways, individuals with depression will often begin eating more food to provide stimulation that distracts them from their thoughts, but they will also often lose the motivation to eat or their negative emotions may express themselves in a way that makes food unappealing. Either way, a significant shift in eating habits or weight is a sign of depression. Since people sometimes hide abnormal eating patterns it is good when observing others to not just look at visible eating patterns but also at visible signs of weight loss/gain.
- Insomnia or hypersomnia – These mean either too little sleep or too much sleep respectively. If you have a consistent pattern of failing to sleep as much as you intend or sleeping far beyond the period that you intent then that is indicative of this symptom. When observing others this may manifest as the individual being excessively and consistently tired.
- Psychomotor changes – This means either that the individual is either experiencing a slowing of their general physical and cognitive processes such as their walking or speech. Or, it means an increase in agitation present in their movements or speech which may be expressive of anxiety.
- Tiredness, fatigue, or low energy – This is related to 4. and 5. and the signs of this may overlap (general lethargy, oversleeping, complaint of lacking sleep). Generally, this will express itself in a seeming inability to complete tasks with the same effort as before, and it may appear as if they lack a “good work ethic”.
- Sense of worthlessness or excessive guilt – This is especially difficult to evaluate when observing someone else unless the individual expresses this to you. But, it may manifest in constant apologies over minor instances, self-degradation(even in jokes), and even actions which may on the surface look selfless or humble on the surface such as denying themselves due credit or allowing someone else to take a reward from them.
- Impaired ability to think, concentrate, or make decisions – This is usually expressed in a pattern of being unable to finish a train of thought, becoming more mistake prone, short term memory issues, or decision paralysis.
- Recurrent thoughts of death, suicidal ideation, or suicide attempts – If you believe that someone has suicidal ideation or has made suicide attempts, regardless of other symptoms, it is important that you help them. This can be identified through an individuals discussion of suicide, giving away of possessions, increased engagement in risky behaviors, signs of physical harm, etc.
If you notice any of these symptoms it may be indicative of MDD. However, while the presence of one of these symptoms makes the presence of MDD worth consideration there are certain factors necessary for the clinical diagnosis of the disorder.
- There must be at least 5 of these symptoms present during the same 2 week period, which constitutes a major depressive episode(MDE)
- There must be significant distress or impairment caused to the individual.
- The symptoms are not due to the direct physiological effects of a substance or a medical condition. If one symptom is disqualified by this, but there are 5 other symptoms which are unaffected by the substance/condition then the diagnosis for MDD can still be given.
- There is no history of a manic or hypomanic episode. This is because the history of manic/hypomanic episodes in conjunction with a MDE indicates bipolar disorder rather than MDD.
- The MDE is not better explained by schizophrenia or other psychotic disorders.
The steps taken if you notice the symptoms of MDD in yourself or others do not really change based on these disqualifying factors. You should leave it to a professional caregiver to judge these qualifications once the individual is receiving help.
After identifying that you or a loved one might have MDD and especially if they are exhibiting suicidal ideation please use these links to find support.
For supporting: https://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression/art-20045943
For suicidal ideation: https://www.nimh.nih.gov/health/publications/5-action-steps-to-help-someone-having-thoughts-of-suicide
https://www.mayoclinic.org/diseases-conditions/suicide/in-depth/suicide/art-20044707
For finding professional help: https://locator.apa.org/
1https://news.gallup.com/poll/694199/u.s.-depression-rate-remains-historically-high.aspx
dylansnellmddawareness.com 