Depression is often a self-perpetuating disorder that can affect many aspects of the person experiencing it. For example, one symptom of feeling depressed is a sense of fatigue and low energy, which can lead people to resist spending energy on engaging in activities that might help them feel better such as exercising, eating well, socializing, or doing something enjoyable. The less people engage in these kind of activities, the more depressed and fatigued they are likely to feel, which can lead to even less engagement in activities that will help.
The bad news is that depression can impact so many aspects of life, while the good news is that intervening on any one of those aspects stands a chance of impacting many others, making it possible to spin the “wheel” in the other, more positive, direction.
The other thing I’ve found in working with people with depression is that a willingness to pick up the “fight” against it is necessary. While it may not be possible to sustain a serious effort to battle the depression every moment, the commitment to push against it is central to significant progress.
Major Depressive Disorder
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly everyday (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of bodyweight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. 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.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or to another medical condition.