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Sometimes we have a tough day and that's okay. But if you find it difficult to enjoy things you used to like for more than two weeks, it's a good idea to seek help. Here we explain what clinical depression is and how you can get help.
Clinical depression
Clinical depression is a serious medical condition that negatively affects how a person feels, thinks and manages daily activities. For the diagnosis to be made, symptoms must have been present for at least two weeks.
Clinical depression is more than just feeling down or sad for a short period; it is a persistent feeling of sadness and loss of interest that is different from normal mood swings. But it can be helped in therapy.
Depression is a very common condition which affects more than 450,000 people in Ireland (one in ten) at any one time.
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Why do people get depressed?
Depression is a complex illness that is often caused by a combination of genetic, biological, environmental and psychological factors. Family history suggests that heredity may play a role. Imbalances in brain neurotransmitters such as serotonin and dopamine, which affect mood and emotional stability, may be involved. Hormonal changes during pregnancy, the postpartum period, menopause or thyroid problems can trigger depression symptoms. Certain personality traits such as low self-esteem and pessimism or increased sensitivity to stress can make individuals more likely to develop depression.
Criteria for diagnosis
For a diagnosis of clinical depression to be made according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the individual must exhibit a combination of symptoms that affect their mood, bodily functions and thinking.
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They must experience a marked depressive mood or a significant loss of interest or pleasure in most activities almost every day for at least two weeks. In addition, the individual should have experienced significant weight or appetite changes, sleep problems such as insomnia or excessive sleep, psychomotor agitation or inhibition that is noticeable by others. There is often a marked fatigue or loss of energy, feelings of worthlessness or unreasonable guilt. Depression can cause impaired ability to think, concentrate or make decisions, as well as recurrent thoughts of death including suicidal thoughts without a specific plan, suicide attempts or an elaborate plan to commit suicide.
To meet the criteria for the diagnosis, at least five of these symptoms must be present, at least one of which must be either depressive mood or loss of interest or pleasure. These symptoms must lead to impairment in social, occupational, or other important areas of functioning, and they cannot be the result of medical conditions, substance use, or other mental health problems. They should also not be explained by grief, i.e. after the loss of a loved one, which can produce similar symptoms but is a normal reaction to grief.
Symptoms of clinical depression
The symptoms of clinical depression include several emotional, physical and cognitive signs that affect a person’s ability to function in everyday life. These include:
- A persistent depressive mood, feelings of sadness or emptiness, or an irritable mood that is present most of the day, almost every day.
- A marked decrease in interest or enjoyment in all or almost all activities, almost every day.
- Significant weight loss when not having an appetite, weight gain, or decrease or increase in appetite.
- Insomnia or excessive sleep almost every day.
- Psychomotor agitation or inhibition that is observable by others, not just subjective feelings of restlessness or being depressed.
- Fatigue or loss of energy almost every day.
- Feelings of worthlessness or excessive or inappropriate guilt.
- Impaired ability to think, concentrate or make decisions, almost every day.
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal thoughts without a specific plan, a suicide attempt or a specific plan to commit suicide.
If you recognise these symptoms, it is good to seek help from a qualified health professional to help with treatment. Depression is a treatable and recoverable condition.
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Subgroups of clinical depression
Within the framework of clinical depression, there are several subgroups that help describe more specific forms of the illness. These subgroups can be helpful in better tailoring treatment to the patient’s unique needs and symptoms. Some of the most common subgroups or are:
- Depression with anxiety symptoms: It is very common to have both anxiety and depression. It is characterised by the presence of tension, worry, and a feeling that something bad is going to happen, which goes beyond the usual depression.
- Melancholic depression: A subgroup characterised by an almost total loss of the ability to feel joy in all or almost all activities, a deeper sense of sadness or depression, often worse in the morning, as well as other specific symptoms such as excessive or inappropriate guilt.
- Atypical depression: Characterised by the ability to temporarily feel better in response to positive events, increased appetite or weight gain, excessive drowsiness or sleep, a heavy feeling in the arms or legs, and a prolonged feeling of rejection.
- Seasonal depression: A form of depression that occurs at the same time each year, usually during fall and winter when there is less daylight.
- Peripartum depression: Formerly known as postpartum depression, this is depression that occurs during pregnancy or after childbirth and affects a woman’s ability to function.
- Psychotic depression: A severe form of depression where the individual also experiences some form of psychosis, such as delusions or hallucinations, often with themes of guilt, illness or worthlessness. This may be related to other mental health problems.
The definition of the specific form can inform a more detailed diagnosis and understanding of the depression, which can guide treatment choices and prognosis. Each subgroup has its own unique characteristics and may require different treatment strategies to effectively manage symptoms.
Treatment for clinical depression
Treatment for clinical depression is tailored to the individual and may include psychotherapy, such as talk therapy and interpersonal therapy, to address negative thought patterns, behaviors, and to improve social relationships. Antidepressants may also be used in combination with psychotherapy. For those with severe depression who do not respond to other treatments, electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS) may be offered. This is done in a psychiatric setting.
Lifestyle changes, including regular exercise, a balanced diet, and good sleep hygiene, along with stress management techniques such as mindfulness, can also help relieve depression symptoms. A combination of these treatment methods is often most effective, and it is important to receive treatment from qualified professionals to tailor treatment to the individual’s needs.
12 frequently asked questions about clinical depression
What is clinical depression?
Clinical depression is a mental illness characterised by a deep and persistent sense of sadness or loss of interest in activities that were previously enjoyable.
What are the most common symptoms of clinical depression?
The most common symptoms include persistent sadness, lack of energy, sleep problems, fatigue and irritability.
How is clinical depression diagnosed?
Diagnosis of clinical depression is usually done through interviews and assessment forms by a health professional such as a psychologist or doctor. Blood tests are also often taken to rule out other medical causes.
What causes clinical depression?
Depression is a complex illness that is often caused by a combination of genetic, biological, environmental and psychological factors.
How is clinical depression treated?
Treatment options vary but often include therapy, medication and lifestyle changes. Cognitive behavioral therapy (CBT) is a common form of psychological treatment.
How long is the treatment for clinical depression?
The length of treatment can vary depending on the severity and individual needs. Some people can experience relief within a few weeks, while others need longer treatment.
Is clinical depression hereditary?
Genetics can play a role in depression, but it is usually a combination of several factors that contribute to the illness.
Can exercise help with clinical depression?
Yes, regular physical activity can help but often more intervention is needed and physical activity should not replace professional care when needed.
What are the risk factors for clinical depression?
The risk factors for clinical depression are multiple and include a combination of genetic, biological, environmental and psychological elements, so it can be difficult to predict.
What is the difference between major depression and clinical depression?
Both terms describe the diagnosis of major depressive disorder (MDD) but major depression is episodic and is often used as a medical term to distinguish it from other illnesses such as bipolar disorder, while clinical depression is a term to describe that the depression requires clinical care.
How does clinical depression affect relationships?
Depression can make it difficult to maintain healthy relationships and can lead to social withdrawal. You may have less interest in being social.
Where can I get help?
If you experience symptoms of depression, it is important to seek professional help. Our psychologists and therapists are available for online or face-to-face sessions and can help you make the difficult things easier. If you have thoughts of self-harm or suicidal thoughts, contact 112 or the nearest emergency psychiatric clinic.
Step-by-step treatment for clinical depression
Treatment for clinical depression is individualised and may include a combination of the following strategies:
- Psychotherapy: Also known as talk therapy, with cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) being among the most effective forms. CBT focuses on identifying and changing negative thought patterns and behaviors that contribute to depression, while IPT focuses on improving the person’s relationships and social functioning.
- Antidepressant drugs: These drugs can help adjust the chemical imbalances in the brain that contribute to depression. There are several different classes of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). The choice of drugs depends on the patient’s specific symptoms, possible side effects, and other health conditions.
- Electroconvulsive therapy (ECT): For people with severe depression who do not respond to medication or psychotherapy, ECT can be an effective option. ECT involves passing electrical currents through the brain to trigger a brief seizure, which appears to adjust brain chemistry.
- Transcranial magnetic stimulation (TMS): A newer treatment method that uses magnetic fields to stimulate certain parts of the brain. TMS has been shown to be effective for some people with depression.
- Lifestyle changes: Regular physical activity, a nutritious diet, adequate sleep, and stress management techniques such as mindfulness and meditation can improve symptoms of depression.
The choice of treatment depends on the severity of the depression, the patient’s preferences, previous treatment results, and any co-existing medical conditions. A combination of treatments is often most effective. It is important to have an open dialog with your GP or health practitioner to find the treatment that works best for each individual.
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