Clinically Significant Depression Overview

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The word depression is often casually used to describe symptoms ranging from sadness to irritability. However, clinically significant depression occurs when a person's symptoms reach a specific threshold and qualify as an official diagnosis.

To meet the criteria for clinically significant depression, an individual's distress level must impair daily functioning—which is not the same as feeling down or sad.

Everyone feels down sometimes and periods of sadness can be normal. However, a person with clinically significant depression experience sadness, diminished interest in activities they used to enjoy, and several other symptoms of depression to such an extent that it interferes with their ability to function in their daily lives.

Someone who is sad but can still work and socialize typically doesn’t meet the threshold for clinically significant depression. However, a person who has been missing classes at school because they are unable to get out of bed or has fallen behind in their work due to the inability to concentrate may be clinically depressed.

Symptoms

The symptoms of clinically significant depression are differentiated from occasional feelings of low mood and sadness because they are persistent. 

depresion
Illustration by Joshua Seong. © Verywell, 2018.

Someone who feels sad for a day or even a week generally won't meet the criteria for clinically significant depression, assuming the symptoms resolve. If symptoms don’t get better after two weeks and cause a major change to a person’s ability to function, they may be experiencing clinically significant depression. 

Symptoms that may indicate depression include:

  • Sadness, tearfulness, or frequent crying
  • Guilty, hopeless, or worthless feelings
  • Insomnia or sleeping too much 
  • Fatigue, low energy, and reduced motivation
  • Eating more or less than usual; weight loss or gain
  • Restlessness, feeling “fidgety,” agitation, and anxiety
  • Trouble completing tasks such as self-care and household chores
  • No interest or enjoyment of activities you used to like (hobbies)
  • Difficulty concentrating, focusing, and making decisions 
  • Thinking about death or dying, having suicidal thoughts, or self-harm

Depression vs. Grief

It can be difficult to diagnose clinically significant depression in someone who is experiencing grief. Distinguishing grief from depression can be a challenge because although they are distinct from one another, they can coexist.

It’s expected that someone could feel overwhelming sadness and other symptoms of clinical depression after experiencing a major loss. The symptoms usually get better over time, but if they don’t someone who is grieving may be diagnosed with depression.

An individual whose symptoms aren't clinically significant may still experience distress even if they do not meet criteria for a depressive disorder.

Sadness may resolve on its own over time or with support from friends and family. However, if it progresses to clinically significant depression, a person may need to seek treatment from their doctor or mental health professional. 

Causes

Depression is thought to have many potential causes and researchers generally believe that many different factors come together for the condition to develop.

Certain factors like one's environment and genetics can make someone more prone to becoming depressed in their lifetime. Biological and physical changes, such as shifting hormones during puberty, pregnancy, and menopause can also lead to symptoms of depression.

The cause of depression may not be obviously linked to a predisposition or event in one's life. Sometimes people develop depression and feel there is no "reason" for them to feel down. However, the ways in which the brain, it's chemistry, and other parts of the body (such as the gut) contribute to depression are very complex.

Causes of depression
Illustration by Joshua Seong. © Verywell, 2018.

While the causes may be different for each person with the condition, depression itself is very common. The World Health Organization estimates that around 300 million people in the world are depressed. An estimated 6.7% of adults in the United States have experienced a major depressive episode at some point in the past year.

Anyone can experience an episode of clinically significant depression at any stage of life—including children and teens. Around 3.2 million youth between the ages of 12-17 in the U.S. report experiencing at least one episode of major depression in the last year.

Unfortunately, many ​kids and teens with depression do not get diagnosed or treated, as the symptoms of depression may be missed or attributed to other reasons, such as behavioral problems. 

Older adults and the elderly are also at risk for depression. Factors like social isolation, health problems, and the emotional process of aging may contribute to clinically significant symptoms of depression. 

Diagnosis

There are several different types of depression. Each varies in duration, timing, presumed causes, and symptoms. The most effective treatment will also vary for each type as well as each person. 

Some of the most common depressive disorders categorized in the Diagnostic and Statistical Manual of Mental Disorders (DSM) include:

  • Disruptive mood dysregulation disorder. Diagnosis for children who have frequent temper outbursts, anger, and irritability.
  • Major depressive disorder. Diagnosed after a two week period of intense sadness and/or loss of interest in almost all activities with several other common symptoms of depression.
  • Persistent depressive disorder. Chronic symptoms of depression that can last for two or more years.
  • Premenstrual dysphoric disorder. Depressive symptoms that begin shortly before the onset of menses in the majority of menstrual cycles.

The criteria for diagnosing mood disorders and their clinical significance is set by the Diagnostic and Statistical Manual of Mental Disorders (DSM). Every few years, the DSM is updated and the criteria for diagnosing mental illnesses can change. 

Throughout the history of the DSM, the criteria for depressive disorders has shifted several times. The DSM-III had a broad set of diagnostic criteria for mental illness. In 2000, the DSM-IV added "clinically significant distress and impairment” to the diagnostic criteria for all mental disorders. 

The team of professionals who contribute to the updated DSM added "clinically significant distress and impairment” to narrow mental illness diagnosis from people who are showing symptoms to those whose symptoms create serious problems for them in their daily lives. 

When the DSM-5 was released in 2013, the standards for clinical significance carried over. The editors also added several severity measures to fine-tune the diagnostic criteria.

Treatment 

If your doctor determines you have clinically significant symptoms of depression, they will likely want to discuss treatment. The options for treatment will depend on how you experience your symptoms as well as your doctor’s perception of them as they relate to the DSM criteria.

Your doctor may suggest you try treatment for your symptoms even if they are not certain of your diagnosis. You will need to weigh the treatment’s pros and cons and decide if this is a course of action you are comfortable with. 

Your doctor may want to “watch and wait” to see if your symptoms get better on their own—particularly if they are situational (i.e. they began after a major change or loss in your life). During this time, your doctor may suggest you make some lifestyle changes to help manage stress and improve your mood, such as regular exercise. 

Once you have started treatment for depression, it may take time for you to feel the benefits. You may need to try more than one type of treatment or even use multiple treatments at the same time to effectively manage your symptoms. 

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Many people with depression find a combination of antidepressant medications and therapy to be helpful. You may decide to try one or the other—or neither. There are also other ways to approach treating depression, such as cognitive-behavioral therapy (CBT), electroconvulsive therapy (ECT), alternative and complementary treatments, and lifestyle changes. 

Coping

As with any mental illness, there are ways to cope with your symptoms and live well with depression. If you are having symptoms of depression but your doctor is not yet sure if they are clinically significant, you may be unsure of what (if any) steps you should take.

Even if your doctor has not yet recommended treatment, such as medication or therapy, there are some things you can do to help manage your symptoms. 

  • Build a support system. Having people in your life who are positive, supportive, and accepting is essential for mental health and wellbeing even if you don’t have depression. When you’re having trouble coping with your day-to-day life due to symptoms of depression, having a solid support system in place is even more vital. Look to friends, family, and your community for people you can trust and be yourself around. Doctors and mental health professionals are also part of your team, so it’s important you feel comfortable speaking openly with them about how you feel. 
  • Take care of your body. Eating a varied and balanced diet, staying hydrated, avoiding drugs, tobacco, and alcohol, getting regular exercise, and sticking to a sleep routine are all lifestyle changes you can undertake on your own to help manage symptoms of depression. Sometimes, making changes in these areas significantly improves mood.  
  • Keep stress in check. Learning to identify sources of stress in your life, how it affects your mind and body, and finding effective ways to cope are all part of managing symptoms of depression whether they are temporary or long-term. Stress can have a profound impact on your physical and mental health. Finding healthy ways to manage it is one of the most important things you can do for your overall well-being. 

A Word From Verywell

If you’re having symptoms of depression, talk to your doctor. Although the DSM does provide guidelines for diagnosing and treating depressive disorders, your experience of your symptoms as well as your doctor’s perception of them are largely subjective, which can make it difficult to determine if you have clinically significant depression. Your doctor may want to wait and see if your symptoms improve with time (especially if they develop after a major life event or loss). However, if your symptoms interfere with your daily life at school or work or are keeping you from socializing, you may meet the diagnostic criteria for clinically significant depression, in which case your doctor may suggest treatment options for you to consider. 

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Article Sources

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