Depression - Assessment

Diagnosis
The diagnosis may be applied when an individual meets a sufficient number of the symptomatic criteria for the depression spectrum as suggested in the DSM-IV-TR or ICD-9/ICD-10. An individual is often seen to suffer from what is termed a "clinical depression" without fully meeting the various criteria advanced for a specific diagnosis on the depression spectrum. There is an ongoing debate regarding the relative importance of genetic or environmental factors, or gross brain problems versus psychosocial functioning.

According to the DSM-IV-TR criteria for diagnosing a major depressive disorder one of the following two elements must be present (See the DSM cautionary statement.):


 * Depressed mood, or
 * Loss of interest or pleasure in nearly all activities.

It is sufficient to have either of these symptoms in conjunction with five of a list of other symptoms over a two-week period. These include


 * Feelings of overwhelming sadness or fear or the seeming inability to feel emotion (emptiness).
 * A decrease in the amount of interest or pleasure in all, or almost all, activities of the day, nearly everyday.
 * Changing appetite and marked weight gain or loss.
 * Disturbed sleep patterns, such as insomnia, loss of REM sleep, or excessive sleep.
 * psychomotor agitation or retardation nearly everyday.
 * Fatigue, mental or physical, also loss of energy.
 * Feelings of guilt, helplessness, hopelessness, anxiety, or fear.
 * Trouble concentrating or making decisions or a generalized slowing and obtunding of cognition, including memory.
 * 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.

Other symptoms sometimes reported but not usually taken into account in diagnosis include
 * A decrease in self-esteem.
 * Inattention to personal hygiene.
 * Sensitivity to noise.
 * Physical aches and pains, and the belief these may be signs of serious illness.
 * Fear of 'going mad'.
 * Change in perception of time.

Depression in children is not as obvious as it is in adults. Here are some symptoms that children might display:


 * Loss of appetite.
 * Irritability.
 * Sleep problems, such as recurrent nightmares.
 * Learning or memory problems where none existed before.
 * Significant behavioral changes; such as withdrawal, social isolation, and aggression.

An additional indicator could be the excessive use of drugs or alcohol. Depressed adolescents are at particular risk of further destructive behaviors, such as eating disorders and self-harm.

One of the most widely used instruments for measuring depression severity is the Beck Depression Inventory, a 21-question multiple choice survey.

It is hard for people who have not experienced clinical depression, either personally or by regular exposure to people suffering it, to understand its emotional impact and severity, interpreting it instead as being similar to "having the blues" or "feeling down." As the list of symptoms above indicates, clinical depression is a serious, potentially lethal systemic disorder characterized by interlocking physical, affective, and cognitive symptoms that have consequences for function and survival well beyond sad or painful feelings.

Mnemonics
Mnemonics commonly used to remember the DSM-IV criteria are SIGECAPS (sleep, interest (anhedonia), guilt, energy, concentration, appetite, psychomotor, suicidality) and DEAD SWAMP (depressed mood, energy, anhedonia, death (thoughts of), sleep, worthlessness/guilt, appetite, mentation, psychomotor).