Dr. Judy Silberkleit


Depression is a disorder with both physical and mental characteristics that negatively disrupt an individual’s ability to function day to day in social and work environments. People who are depressed are often overwhelmed by sadness or at times feel incapable of experiencing emotion. Another major symptom is loss of interest or pleasure in an activity or pastimes, as well as changes in sleep patterns to either extreme, insomnia or excessive sleep. Restlessness, slowed movements, and mental or physical fatigue may also indicate depression. Other feelings that may be present include guilt, helplessness, hopelessness, and decreased self esteem.

The Diagnostic and Statistical Manual of Mental Disorders (4th Ed; DSM-IV) is the book used by qualified mental health professionals to make diagnoses. The following is a summary of the required symptom makeup to be used as a guide. However, it is important to know that only a qualified professional who also relies on clinical judgment can make an accurate diagnosis.

DSM IV Criteria for Depressive Episode

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.

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).

(2) 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).

(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.

(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 symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

D. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.


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