Is It Clinical Depression or Sadness?

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Although depression is often thought of as being an extreme state of sadness, there is a vast difference between clinical depression and sadness. Sadness is a part of being human—a natural reaction to painful circumstances. All of us will experience sadness at some point in our lives. Depression, however, is a physical illness with many more symptoms than an unhappy mood.

The person with clinical depression finds that there is not always a logical reason for his dark feelings.

Exhortations from well-meaning friends and family for him to "snap out of it" provide only frustration, for he can no more "snap out of it" than a person with diabetes can will his pancreas to produce more insulin.

Sadness is a transient feeling that passes as a person comes to terms with his troubles. Depression can linger for weeks, months, or even years. The sad person feels bad but continues to cope with living. A person with clinical depression may feel overwhelmed and hopeless.

To clarify the differences between normal sadness and depression, there are specific, defined criteria for the diagnosis of major depressive disorder, which are found in a handbook called The Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5)

First, a person with this disorder must have been either feeling depressed or has lost interest in things that he used to find pleasurable for at least two weeks.

In addition, these symptoms should be different from his usual state and should interfere with how he functions in his daily life.

If a person's depressed feelings have been caused by drugs (legal or illegal), alcohol, or a medical condition other than depression, then they would not qualify for a diagnosis of major depressive disorder.

Having a history of bipolar disorder or having depression which is more likely due to schizoaffective disorder and it not superimposed on schizophrenia would also exclude a person from being diagnosed with major depressive disorder.

In cases of bereavement, it used to be under the previous edition of the DSM-5 that symptoms had to last for over two months before a major depressive disorder diagnosis would be considered. However, the fifth edition did away from this arbitrary exclusion and added a footnote to help clinicians better distinguish between normal grief and major depressive disorder at any point after a loss. 

Finally, a person would need to have at least five of the following symptoms in order to be considered to have major depressive disorder:

  • Depressed mood most of the time
  • Decreased pleasure or interest in most daily activities, most of the time
  • Significant weight or appetite changes
  • Problems falling asleep or sleeping too much most days
  • Psychomotor retardation or agitation on most days
  • Tiredness or low energy most days
  • Feeling worthless or extremely guilty most days
  • Having problems with thought, concentration, and making decisions most days
  • Frequent thoughts of dying or suicide

If you are still uncertain as to whether you (or a loved one) may be suffering from depression, screening tests exist that can help you determine whether seeking a professional evaluation is advised. 

Sources:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) 

"Highlights of Changes from DSM-4TR to DSM-5". American Psychiatric Association. May 17, 2013.

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