- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels
sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and
adolescents, 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.)
- 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. (Note: In children, consider failure to make expected weight gain.)
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day (observable by others, not merely 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 (not merely self-reproach or guilt about being sick).
- 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.
One criterion that isn’t included in this symptom set but is sometimes observed in practice is what we might call “meta-depression” – feeling depressed about one’s depression. Sample thoughts might include, “I’ve been feeling depressed for so long, I can’t take it!”, “I’m so sad that I have to go through this,” or “Why is this happening again?” Accompanying feelings might include hopelessness or despair. The experience is clear. Part of why you are depressed is because you are depressed, creating a loop of suffering.
Depression is not a choice. Multiple factors, including genetics and biology, trauma, and life circumstances, can all interact to cause a depressive episode. Many of these factors exist outside your personal control, though choosing treatment is a volitional decision that incorporates other choices, such as behavioral activation, identifying and challenging thoughts, processing trauma, addressing co-occurring conditions, and potentially going on medication.
Another aspect that you can control is how you experience your depression. Do you fight against it, trying to ward it off, denying it exists? Are you angry at it, or the universe for sending it to you, a sign of meta-depression? Or, do you accept that you are depressed and try to do what you can to get the help you need? We know from Dialectical Behavior Therapy (DBT) and from Acceptance and Commitment Therapy (ACT) that acceptance plays a powerful part in the recovery from various symptoms and disorders. Instead of fighting against challenging thoughts and feelings, accepting them can defuse them and often leads to their passing more quickly. DBT’s concept of radical acceptance, accepting life as it is, removes the struggle from many of our experiences. As we know, depression is draining enough, and using our energy to deny or refuse to accept it is energy that could be used toward recovery. The next time you find yourself depressed that you’re depressed (or experiencing meta-depression), see if you can toss aside the “meta” – depression is challenging enough to address; you don’t need this additional battle to fight.