How to understand that you have depression, how it differs from a bad mood, and what to do if you suspect depression in a loved one person,” says psychiatrist and psychotherapist Christo van Meer.
Many people believe that we, psychiatrists, deal exclusively with people who hear voices or run naked on the streets. And they are very surprised when they find out that the majority of our patients are people with depressive disorders.
Depression has many faces and many causes. In general, depression is one of the most common mental health disorders, which can also lead to suicide. Around the world, about 280 million people suffer from various types of depression, which is about 5% of the adult population.
Facts about depression
- The greatest risk of development is in adolescents, middle-aged women and older people over 60 years old.
- Depressive conditions are a common cause of disability and one of the most common causes of suicide.
- From 15 to 40% of people in adolescence experience depressive disorders.
- According to WHO, in low- and middle-income countries 76-85 % of patients do not receive treatment due to incorrect diagnosis, lack of qualified doctors and negative perception from society.
There are a number of formal diagnostic criteria that we use to make a diagnosis. We will focus on the International Classification of Diseases, 10th revision (ICD-10), which will be valid until December 31, 2021. From January 1, 2022, ICD-11 will come into force, which will have a slightly different classification. I'll tell you about the one that is in effect now.
The first group is the main criteria, the second group is additional. When making a diagnosis, at least two main criteria and at least three additional criteria must be met. If these symptoms persist for at least two weeks, your doctor may diagnose you with depression. Remember this period — two weeks. Now let's look at all the symptoms and look true depression in the face.
Depressive triad — a reason to seek help
Doctors call the three main symptoms of depression the “depressive triad,” and they are quite easy to remember.
Depressed mood that does not depend on circumstances
This means that nothing is happening in a person’s life no negative events, everything is fine with his social status, no one has died, he does not have any global problems, but at the same time he has a mostly depressed mood.
Anhedonia
A person loses interest in life and loses the ability to have fun. He is not interested in anything and does not want anything, he forgets about his previous hobbies, but he is not interested in anything new. He becomes uninterested in living. Anhedonia is often accompanied by the onset of self-esteem problems.
Lack of plans for the future
A person has no plans for the future, there are not even thoughts about the future, he has difficulty articulating his goals and expectations.
Many people are wildly annoyed by HR managers who ask questions when applying for a job: where do you see yourself in 5-10 years. But it is questions like these that help us, doctors, make the correct diagnosis. If a person finds it difficult to say how he sees his life in a year or two, this may be a sign that he needs to dig deeper.
Depending on the type of depression, we can add to these three key signs:
- pessimism, that is, a negative perception of reality,
- feelings of guilt, worthlessness,
- fears and any phobias.
- obsessive thoughts about death or suicide.
Thoughts about death or suicide are an important diagnostic criterion and an indication for emergency psychotherapeutic intervention. Moreover, this is often a reason for hospitalization.
The fact is that suicidal thoughts develop sharply and can end in tragedy. There is usually very little time between the appearance of thoughts about death and a suicide attempt. Friends, relatives and doctors should remember this and try not to leave the person alone with these thoughts.
< img src="/wp-content/uploads/2023/10/dd59bc452b8eed8015adf87358ccd8fa.jpg" /> Christo van Meer 
expert
Psychotherapist, psychiatrist, psychologist 
The connection between suicide and depression is quite clear. As among ordinary people:
So on December 2, in the Chelyabinsk region, a 48-year-old firefighter committed suicide due to burnout and depression.
Two months earlier, in the north of Moscow, a 33-year-old woman, who had previously been treated for depression, fell out of a high-rise building window with her children.
It’s the same among celebrities:
For example, the greatest Dutch post-impressionist artist, Vincent van Gogh, suffered from depression for many years and eventually committed suicide.
And the famous American actress Halle Berry admitted that she had struggled with depression for many years and had several suicide attempts.
The connection with suicide is especially clear in post-Covid depression. They develop very sharply and very often give rise to suicidal ideation, that is, persistent suicidal thoughts. When a person is lying, and it constantly occurs to him that he should “cut himself out” and simply end this endless circle of suffering.
Although I repeat, depression is a story that should not be associated with negative external factors for making a diagnosis.
Additional symptoms of depression that cannot be missed
I will list additional symptoms of depression that are also important for diagnosis. They, like the symptoms of the main depressive triad, should bother a person for at least two weeks.
Sleep disorders
This can be either insomnia, that is, insomnia, or oversleeping, that is, hypersomnia. Some people stop sleeping altogether, often wake up, and then suffer and cannot fall asleep without sleeping pills. Other people, on the contrary, sleep all day and find it difficult to wake up and get down to business.
Instability of appetite
< p>When people are depressed, their attitude towards food changes. They may not touch food at all for a long time. If you sit them down at the table, they will only eat a couple of spoons and refuse the dish. If a person is depressed, withdrawn and at the same time clearly losing weight (up to 5 kg per month), this may indicate a deep depressive state.
Other patients, on the contrary, experience hypertrophied hunger and constantly overeat. Most of all, sweets are used — according to the patients themselves, it helps to distract from difficult thoughts. Because of this, problems with digestion and metabolism develop. Pain appears in the pit of the stomach, severe weakness due to lack of sugar. Patients rapidly gain weight and cannot control it.
Depression can be divided into classic and atypical. For example, with classical depression in a broad sense, people often do not sleep and lose weight, but with atypical depression, on the contrary, they gain a lot of weight. They can have a voracious appetite and can sleep for 12-16 hours. And it will still be a real depression.
Inability to concentrate and make decisions
A person may forget about meetings and agreements, stop working and studying effectively, and lose things . It is difficult for him to make decisions, translate them into actions and be responsible for the result.
Decreased self-esteem
A person suffers from lack of self-confidence, in his own abilities and strengths. He constantly criticizes himself and does not recognize his strengths.
In addition to these symptoms, a depressed person may have some individual signs of depression, depending on the type of depression. For example, he may experience strange bodily sensations or even pains that have nothing to do with his physical health. This is the so-called somatization, which occurs due to the fact that the psyche and body are connected much more strongly than we think about it. And often the body reacts according to how the psyche feels. Therefore, with depression, so-called phantom pains and unpleasant bodily sensations can spontaneously arise.
Depression according to Freud
Austrian psychologist and psychiatrist Sigmund Freud associated the onset of depression with narcissism, which develops along the lines of “Nobody loves me.” The scientist believed that at this stage the disease manifests itself in the fact that a person begins to feel self-hatred. Freud considered typical examples of depressed patients to be individuals who tend to think that they deserve even greater hatred from others.
I repeat, when diagnosing depression, at least two main criteria and at least three additional ones must be met. An official diagnosis can only be made by a psychiatrist or psychotherapist.
If in doubt, take a depression test
Depression is a difficult thing, but we have a large number of, roughly speaking, under-depressive or semi-depressive states. For example, a slight decrease in mood, which is not enough to make a diagnosis of depression. The main difference between these conditions and depression is that they are not so intense and can pass over time, pass situationally or occur periodically. And their severity is not sufficient to make a diagnosis of depression.
For example, people often confuse with depression a banal adaptation disorder that occurs due to changes in external conditions, due to some kind of conflict situation or traumatic experience. She may have depressive symptoms, but it is not true depression. Adaptation disorder goes away on its own over time, especially if the person has a strong psyche and everything is fine with logic.
You can distinguish one from the other by the signs that I listed above and by the depression scale. If you doubt whether you have depression or just a bad mood, take one or more free online tests for self-diagnosis. I recommend taking the Beck Depression Inventory and the Zang Depression Inventory. These are quantitative, very accurate and small tests.
If you suspect your loved one is depressed but can't get them to see a specialist, ask them to take one of these tests. It’s not difficult and “not embarrassing,” and he will understand a lot about himself. In our society, it is still not very common to consult a doctor for such problems. Many people are afraid that they will be considered crazy if they turn to a psychiatrist or psychotherapist. In this sense, the test results can encourage a person to be more attentive to their own mental health.
If the tests indicate the presence of depression, it is advisable to consult a doctor. Because the majority of depression does not go away on its own, they require psychotherapeutic or pharmacological intervention. Believe me, by reaching a specialist, you will save many years of life and kilometers of neurons for both yourself and those around you.
We usually treat depression on an outpatient basis, that is, at home. But if a person has thoughts about death or suicidal thoughts, in this case he needs to go to a hospital under the supervision of doctors.
The material was prepared based on communication between listeners and doctors on the GOLOS social audio network.
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