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How Do You Know That You Are Depressed?
Posted by Dr. Ben Kim on Jul 28, 2007
What’s In A Diagnosis?
How do you know that you are depressed? Is it just plain obvious to yourself and those who are closest to you? Did a doctor diagnose you with depression?
According to conventional medical guidelines, five or more of the following symptoms have to be present during the same 2-week period for you to receive an official diagnosis of a major depressive episode:
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (example: you feel sad or empty) or observation made by others (example: you appear tearful). In children and adolescents, this criterion can be irritable mood.
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day, as indicated by either subjective account or observation made by others.
- Significant weight loss when not dieting, or weight gain (a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. In children, this criterion can be failure to make expected weight gains.
- Insomnia or excessive sleep nearly every day.
- Psychomotor agitation or retardation nearly every day, observable by others, not just subjective feelings of restlessness or being slowed down.
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day.
- Diminished ability to think or concentrate, or indecisiveness, nearly every day, either by subjective account or as observed by others).
- 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.
Notes: for an official diagnosis of major depressive episode, at least one of your symptoms must be the first or second one on this list. Also, your symptoms cannot be due to the passing away of a loved one. Your symptoms cannot be the result of taking any types of drugs or due to another medical condition that is affecting your endocrine system. Finally, your symptoms must be causing significant distress or impairment in a social, occupational, or other important area of functioning.
Hopefully, you recognize that the processing of labeling a person with depression is not an exact science. It is another example of the medical profession coming up with a category that they can put people into for the purpose of prescribing treatment. And more often than not, the treatment for depression is one or more drugs that can alter the activity of your nervous system and produce a variety of unwanted physiological effects in the process, including depressed mood.
Every person who considers going on a prescription drug should be aware that doctors can be influenced by financial considerations and pharmaceutical companies when deciding to put their patients on drugs.
As I have written about before on this site, here in Ontario, Canada, medical doctors are paid an average of $27 per routine office visit, regardless of how long each visit lasts.
Put another way, for routine office visits, medical doctors here in Ontario have no financial motivation to take their time and consider their patients' food and lifestyle choices.
If a patient comes in with a chief complaint of depression, the doctor could spend an hour gathering critical information on the patient's diet, close relationships, and other life circumstances, and then go on to address any changes that could be made to address the depression.
Alternatively, the doctor could spend five minutes asking a few superficial questions about lifestyle and running through quick screening measures to make the patient feel like he or she has been adequately examined by an expert, and then write out a prescription.
Regardless of how much time the doctor takes to do his or her evaluation, the government pays the doctor $27.
Which route do you think most doctors take? My father once told me about a member of his church who was a very busy and wealthy psychiatrist. He would often boast of seeing 60 patients at work each day, going from room to room and handing out prescriptions like they were coupons for free groceries. Why would he spend a whole hour talking with a single patient for a few dollars when he could make a few thousand per day handing out prescriptions? My own clinical experiences have led me to believe that many psychiatrists practice in a similar fashion. God bless those who don't practice this way.
Here is a shocker for you: the pharmaceutical industry makes it well worth it for doctors to have drug-focused practices.
A family member who is a pharmaceutical sales representative once summarized his work for me as follows:
"I take the doctor out to dinner at a fancy restaurant, all expenses paid. As dinner winds down, I ask the doctor to recommend my company's brand for certain health conditions among his patients. Sometimes, the doctor will say that his office needs new equipment. I say how much? The doctor says $5,000. I say fine, but only if you write 100 scripts (prescriptions) for a specific drug made by our company each month. The doctor agrees, and we get him his new $5,000 machine."
Out of curiosity, I asked my relative how he and his company can be sure that the doctor will follow through on his word to write out 100 prescriptions of their drug each month. Can't the doctor just take his $5,000 machine and not follow through on his promise?
"No, all pharmaceutical companies pay big money to a huge, global corporation called IMS that tracks this type of data," was his instant reply.
For a fee, IMS can provide date-specific data to pharmaceutical companies that breaks down exactly how many prescriptions of each drug that each licensed doctor has handed out and how many of them have been fulfilled at licensed pharmacies.
In other words, the managers who work for pharmaceutical companies who approve $5,000 gifts have a sure-fire way of verifying that their gifts are properly reciprocated.
So let us pretend for a moment that you are a doctor who now has to write 100 prescriptions per month for a specific drug that is used to treat depression.
When a patient walks into your office with a chief complaint of feeling depressed, would you take an hour or a couple of hours or even several sessions to try to understand the root issues behind his or her depression? Or would you fire off a few standard questions and end up writing a prescription for an antidepressant that would bring your target for the month down to 99 prescriptions?
What is my point in writing about diagnoses, doctors, prescriptions, and the pharmaceutical industry? It's this: None of these entities should play a big role in the care of your mind, emotions, and body.
Am I alone in believing that it is ridiculous for anyone to take on the label of being clinically depressed because a doctor said so? What if, for instance, you can only identify with three or four of the criteria listed above for depression? Does this mean that you are not depressed enough to begin taking a powerful drug? Perhaps you need a few more disappointing events to occur in the days ahead in order to be able to say "ah, yes, now five of those symptoms apply to me – I am officially depressed."
I fully recognize that sometimes, a person can become so depressed that he or she may not be able to recover without significant outside help. But I want to encourage you to remember that even the toughest cases of depression are continuously getting better, getting worse, or running at a steady gallop in accordance with dietary and lifestyle choices that are made on a moment-to-moment basis.
Put another way, no one in this world has more power than you to determine the state of your emotional health.
Are you ready to give yourself a better diagnosis?
Part 1: Understanding and Overcoming Chronic Depression
Part 2: How Do You Know That You Are Depressed?
Part 3: Nutritional Considerations for Chronic Depression
Part 4: Mind-Body Exercises to Help You Transcend Chronic Depression
Part 5: How to Use Physical Exercise and Acupressure to Address Chronic Depression
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