What Is Clinical Depression, and How Does It Feel?
Medically reviewed by Kathleen Daly, MD
Everyone has off days. When you feel off more than on, this could be a sign of a bigger problem. About 10% of all people experience depression in their lifetime, but a clinical depression diagnosis requires you to meet a particular set of criteria. Diagnosing depression can be tricky since it is based on what you feel or experience instead of what your healthcare provider can observe or touch.
This article will explore how clinical depression is diagnosed, who you should see for care, and available treatment options.
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Related: Mood Disorders
Clinical Depression and MDD: One and the Same, or Different?
"Clinical depression" and "major depressive disorder" (MDD) are different names for the same condition. Mental healthcare providers use an established set of screenings outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to help categorize specific mental health issues and standardize the diagnosis process.
These tools aim to offer a template to your healthcare provider to help you get the proper care and treatment and—if you have health insurance—to make sure your insurance provider covers it.
What Is Depression?
Depression is an ongoing feeling of negativity, sadness, or despair. Everyone experiences times in which they feel sad, but not everyone who feels sad has depression. Clinical depression is a consistent dark mood or feeling that can affect your interests, relationships, and activities on a daily basis.
Learn More: Do I Have Depression?
Characteristics of Clinical Depression Episodes
Symptoms of depression can vary from person to person and can range from mild to severe, and may include the following:
Sadness
Lack of interest in activities you once enjoyed
Appetite changes
Sleeping too much or too little
Loss of energy or increased fatigue
Changes in speech patterns or tone
Restlessness and other purposeless movements
Feelings of worthlessness or guilt
Difficulty concentrating or making decisions
Thoughts of death or self-harm
Typically, for a healthcare provider to officially diagnose you with clinical depression, these symptoms need to be significant enough that the people around you begin to notice, and your symptoms last longer than two weeks and adversely affect your ability to carry out your daily routine.
Diagnosing Depression
Under DSM-5 criteria, a clinical depression, or MDD, diagnosis requires that you experience five or more symptoms of depression for two weeks or more. One of those symptoms should be either a depressed mood or a loss of pleasure in things you once enjoyed.
Your primary healthcare provider may diagnose clinical depression and refer you to a psychiatrist or psychologist for further diagnosis and support.
Learn More: What Is Atypical Depression?
Factors That Affect Clinical Depression Symptoms
Your physical health, gender, socioeconomic status, employment, age, and other factors can impact the type and severity of your depression symptoms. Some medical conditions can cause or coexist with depression, so it's important to see a healthcare provider when you experience depression symptoms.
There isn't an established scale in the DSM-5 to assign levels of depression. Still, there are other clinical tools, such as the Hamilton Depression Rating Scale (HDRS or HAM-D), used to differentiate between mild and severe clinical depression.
Depending on your situation and the duration and frequency of symptoms, a diagnosis may specify the type of depression you are experiencing. Examples of categories or subtypes of depression include the following:
Perinatal depression
The Link Between Depression and Pain
Chronic pain can cause you to feel down or depressed, while depression can cause physical symptoms of pain and discomfort, creating a feedback loop.
If you experience pain alongside symptoms of depression, talk to your primary or mental healthcare provider. It's important to rule out any conditions or problems that might be occurring along with your depression, chronic pain, or other illnesses.
Clinical Depression Hospitalization
Being under the regular care of a healthcare or mental health professional will help you manage clinical depression continuously. Still, there are times when your symptoms might become worse than usual. When depression symptoms intensify and put you or others at risk for harm or affect your ability to care for yourself or others, it's called a mental health crisis.
There is no black-and-white guide to qualifying for hospitalization for depression. If your symptoms are not improving—or worsening—even with treatment, you may consider admission to a hospital or psychiatric facility.
If you experience symptoms that leave you unable to function or cause thoughts of suicide or self-harm, seek immediate care. There are many mental health crisis facilities available nationally, including:
Walk-in mental health crisis centers
Emergency departments
911 services
24-hour crisis hotlines
Emergency Mental Healthcare
If you or someone you know is experiencing a mental health crisis, text or call 988 to reach the 988 Suicide & Crisis Lifeline. When online, visit 988lifeline.org for its chat line. The Substance Abuse and Mental Health Services Administration (SAMHSA) can also help by calling 800-662-HELP (4357).
What Treatments Are Available for Clinical Depression?
Many medications are available to help treat depression and other mental health symptoms. Those will be discussed more below, but your healthcare provider may recommend that you start treatment with some nonpharmaceutical options like:
The appropriate treatment for you depends on the type and severity of depression. It is a decision best made by you and your healthcare provider and may require some trial and error.
Clinical Depression Medications
Antidepressants are the class of medications usually used to treat depression, and they work by increasing the levels or effects of chemical messengers in your brain (neurotransmitters) like serotonin and norepinephrine. Many medications fall into this class. If you're considering antidepressants, talk to a healthcare provider about these drugs' benefits versus the side effects.
Most medications used to treat depression are started at a low dose, which is increased over time under a healthcare provider's supervision, until the desired effect is achieved.
Never discontinue or change the dosage of your prescription medications without talking to a healthcare provider first. You should also ensure your healthcare provider knows about other drugs or substances you use to avoid unintentional side effects.
Commonly Prescribed Antidepressants
Many medications are used as antidepressants. Examples of some you may see prescribed are:
Celexa (citalopram)
Klonopin (clonazepam)
Cymbalta (duloxetine)
Lexapro (escitalopram)
Spravato (esketamine)
Prozac (fluoxetine)
Paxil (paroxetine)
Zoloft (sertraline)
Effexor (venlafaxine)
Make sure you discuss the side effects of these medications with your provider and how to take them.
Clinical Depression Medication Adjustments
Antidepressants don't work immediately, and it can take weeks and months to experience the true impact of these medications. If antidepressants don't work for you, your provider may consider other psychotropic drugs (medications affecting your mental state), and in some cases, they may prescribe more than one medication.
These adjustments in dose or medication type should only be made under the direction of a healthcare professional since there is a high potential for withdrawal or side effects from dosing changes.
Self-Care With Clinical Depression
Self-care is essential when it comes to your mental health overall, not just regarding clinical depression. Getting help from a mental health provider or other healthcare professional is the most crucial step in self-care for many people.
Taking the time to understand and address your mental health needs, set boundaries, or limit harmful influences can all be a part of the self-care process. A counselor or therapist can be helpful when it comes to identifying triggers and contributors to your depression and suggesting techniques to manage them.
Some lifestyle changes to consider include:
Taking more time for yourself
Scheduling a vacation
Changing your profession or work schedule
Examining your relationships
Managing your physical health
Complementary Therapies for Clinical Depression
Once you've identified your triggers and factors that make your depression worse, as well as what helps you feel better, you can add complementary therapies to your mental health care regimen. This does not mean you should stop or change your medications without talking to your healthcare provider first.
Some examples of complementary therapies to help boost mental health are:
Eating a healthy diet
Exercise
Aromatherapy
Massage
Art therapy
Meditation
Clinical Depression Support and Resources
There is no singular cure-all for clinical depression, and it's not likely a healthcare problem you can cure completely. Learning to manage and support your mental health can involve many things, including clinical care, medications, and nondrug therapies or self-care.
The following services offer resources to help you find support online or locally:
If you are experiencing a mental health crisis or have thoughts of hurting yourself, call 911 or go to your nearest emergency room.
Disparities in Depression Care
One study examining Medicaid claims data of 599,421 people found that Black and Hispanic Americans and those in low-income and other socially or racially diverse groups were less likely to receive depression treatment and medications than their White counterparts. Access to care, cost, cultural beliefs, the stigma around mental health, and environments when seeking mental health care all contribute to these disparities.
Summary
Clinical depression, or MDD, is usually diagnosed with symptoms of sadness or disinterest in activities plus other signs for two weeks or more. Once you are diagnosed with depression, a healthcare provider may refer you to a psychologist or psychiatrist for additional diagnoses and support. Never wait to get help in a mental health crisis. Call 911 or text 988 if you feel you can no longer control your emotions or actions.
Read the original article on Verywell Health.
