Assessing Depression

Henry A. Virkler, Ph.D., is Associate Professor of Psychology and Counseling at Liberty University in Lynchburg, Virginia.
Psychiatrist Antonio Luis, M.D., is Director of North Gwinnett Center in Lawrenceville, Georgia.

Distinguishing between those depressions that include a significant biological component (and that therefore might respond to medication) and those that do not presents an important challenge for the non-medical therapist. The decision is complex and must consider the personality makeup, social context, and clinical presentation of the counselee. The process cannot be reduced to a checklist used to arrive at a definite conclusion. However, the following distinctions usually are true, and if clients show several symptoms Indicative of major depression, it probably is wise to refer them for a medication evaluation.

Mild depressions often occur as a reaction to an event, and will usually be diagnosed as adjustment disorders either with depressed mood or with mixed emotional features (DSM-III-R 309.00 or 309.28). Adjustment disorders that become severe and last for more than two weeks can become major depressive episodes.

A major depressive episode (sometimes called "neurotransmitter illness") occurs when the depression becomes intense enough that it not only affects one's thoughts and mood, but also affects the functioning of certain neurotransmitters (such as dopamine, serotonin, and norepinephrine) in the brain. These depressions usually should be diagnosed as a depressive disorder (either a single episode or recurrent; 296.2x or 296.3x). Major depressive episodes sometimes last up to eighteen months.

The major differences between milder depression and major depression are the duration and intensity of symptoms. The chart lists some typical differences between milder and major depression. Some experts suggest that antidepressants can be used profitably under any of the following situations:

	For depression that is significant, becomes worse as time progresses, and does not respond to counseling.
	Whenever there are two or more neurovegetative symptoms (those written in bold type on the chart).
	Whenever there is dysphoria (one cannot get away from the negative frame of mind), at least one neurovegetative symptom, and a few of the other symptoms of major depression.

Chart Instructions

Check as many symptoms as apply. If a person has several symptoms that meet the criteria for major depression, the non-medical therapist should not try to make a diagnosis of major depression. They may tell the counselee that they appear to have several symptoms of biological depression, and refer them to a physician or psychiatrist for evaluation and treatment. Such people can often benefit from continued supportive counseling in addition to medical treatment for the biological component of their depression.

Common Symptoms of Mild Depression
Known precipitant, degree of depression seems appropriate to the precipitating event.
Increased medical complaints, increased sensitivity to pain.
Sleeping difficulties, especially initial insomnia (difficulty falling asleep).
Appetite increase or decrease.
Family history variable (may or may not have relatives with major depression).
Usually self-limiting (duration of depression relates to seriousness of the precipitating event).
Usually feels best in the morning, and mood worsens as the day goes on.
Common Symptoms of Major Depression
Cause often unknown, or degree of depression seems excessive for the situation.
Increased medical complaints, increased sensitivity to pain.
Sleeping difficulties, frequently either early morning insomnia (waking up two or three hours before normal, and being unable to get back to sleep), middle insomnia (interrupted sleep, increased dream activity or nightmares), or hypersomnia (sleeping much longer than normal).
Usually reduced appetite. The person complains of little desire to eat, and that food has lost its taste. Some people develop carbohydrate (junk food) cravings.
Often family history is positive for major depression (siblings, parents, grandparents, aunts, or uncles).
Duration and intensity of depression seem out of proportion to the problem. May have had chronic depression or several cycles of major depression before.
Usually feels worst in mornings and feels a little better as the day goes on.
Anxiety and agitation.
Lack of energy.
Lack of enjoyment of previously pleasurable things. Note: Sometimes major depression manifests itself primarily with either this symptom or a lack of energy, without depression being the predominant symptom.
Problems in sexual functioning or lack of interest in sex.
Psychomotor retardation (person either is slowed down or imagines that he or she is).
Loss of interests. Discontinues involvement in hobbies and other things he or she once enjoyed.
Loss of self-esteem.
Hostility or irritability (person has a "short temper"). The person feels more irritable. Depending on personality style, may or may not express irritability.
Poor communication (person becomes more withdrawn into himself or herself).
Thoughts of suicide or death-wishing (wishing that death would come).
Dysphoria - cannot get away from the negative frame of mind.