Am I depressed?

It seems all of us have been talking about mental health issues in recent years, especially after the stress we all experienced during and after the covid-19 pandemic.

Sadly, it’s also become more common for us to ask ourselves: “Am I depressed?”

As you might imagine, anxiety and depression are among the most common mental health diagnoses as they affect millions of Americans today.

Did you know about 50% of the entire US population will, at some point in their lifetimes, have a diagnosable mental health disorder? It doesn’t mean we all need medications. It just means that it’s a really common experience and we’re never alone.

While most of us have experienced moments or days of sadness, does it mean we also had “clinical depression” and needed treatment? Not necessarily.

The technical term for clinical depression is Major Depressive Disorder (MDD) and about 8% of all Americans have had it in the last 12 months.

How do you know if you have MDD? The safest and most accurate way to find out is to start by meeting with your primary care provider (PCP) as they have a lot of experience screening for the condition and guiding you with next steps.

There are other ways to start understanding whether you are struggling with MDD that may require treatment. Keep in mind that MDD, like any medical condition, can present as mild, moderate, or severe. In other words, not all MDDs are the same.

Among mental health professionals, we rely on the DSM-5-TR, the most recent version of the Diagnostic and Statistical Manual of Mental Disorders. It’s the most comprehensive guide to help us work with our patients to accurately diagnose all mental illnesses and substance use disorders.

There are 9 signs or symptoms (aka “criteria”) that may be present during a major depressive episode. In order for a mental health professional to diagnose MDD, a patient must have had a major depressive episode, which means experiencing at least 5 of the criteria for a minimum of 2 weeks.

Importantly, either depressed mood or loss of pleasure must be among the criteria experienced by the patient.

Without further ado, here are the 9 criteria that the DSM-5-TR tells us to look for when determining whether a major depressive episode is present:

• Depressed mood most of the day, nearly every day.
• Severely decreased interest or pleasure in most things nearly every day;
• Unexpected weight changes that come from eating too little or too much.
• Changes in sleep patterns so that one is sleeping too little or too much.
• A change in level of activity so that others may have noticed that one is moving a lot more slowly than normal, or there is increased agitation and movement.
• Fatigue or loss of energy almost every day.
• Feeling worthless or very guilty almost every day. These feelings are often driven by a heightened sense of “not being enough” or of failing others.
• A decreased ability to think, concentrate, or make decisions. This should also be present almost every day during the 2-week period.
• Recurrent thoughts of death, a growing desire to die, or even a plan to kill oneself.

The more of the signs and symptoms a person has experienced for at least 2 weeks, the higher the severity of depression.

As a mental health professional, I also need to ask additional questions of the patient to better understand the diagnosis. For example:

• Are these signs and symptoms making it difficult to function at work, at home, or at school?
• Is the patient also suffering from a medical condition or is the patient misusing prescription or recreational drugs?
• What else is going on? Did the patient recently experience a significant loss, like the death of a loved one or a sudden financial hardship?

The most commonly used screening tool used by PCPs and many mental health professionals is the PHQ-9. It’s easy to use and is structured to ask about all 9 signs and symptoms associated with MDD.

This article is meant to help you better understand how we mental health professionals diagnose and think about MDD among our patients.

In general, I recommend that patients with mild to moderate MDD start treatment by engaging in psychotherapy or counseling. Medications may become necessary for patients who are struggling with moderate to severe MDD. Continuing therapy or counseling is always recommended even for patients who are also taking medications.