Hi guys, might as well drop by.
Right now I feel like I've stopped caring about my life. I'm not happy, but I'm far from really being down in the dumps either.
If I want to put it in another way is that I feel like I'm underwater. Things happen all around me but I feel emotionally distant about it. It's like my head is taking the quote 'That's life' to extreme measures.
Is this depression, or is it normal.
It's important to remember that depression is a clinical diagnosis - you do not make it based on laboratory values or pathology specimens. As everyone else has said, you really need to see a doctor to confirm a diagnosis.
Having said that, you can get a sense of whether or not you might be depressed by looking at the nine cardinal symptoms of depression. For each symptom, award points as follows: Over the last two weeks, how often have you experienced this symptom? [a simpler form of the test requires you to just say yes or no]
Never - 0 points.
Fewer than half of the days - 1 point.
More than half of the days- 2 days.
All the time or nearly all the time - 3 points.
1.) Depressed mood - feeling down, depressed, or hopeless
2.) Interest - a lack of interest in your normal activities and hobbies
[A diagnosis of depression requires the presence of 1 or 2]
3.) Guilt - feeling that you've let people down
4.) Sleep - either sleeping too much or having trouble getting enough sleep
5.) Energy - feeling fatigued, tired, not having your normal amount of energy
6.) Concentration - difficulty...concentrating
7.) Appetite - eating more or less than usual
8.) Psychomotor - feeling, or having others feel like, you're moving/speaking/thinking either slower than usual or faster than usual
9.) Suicide - feelings that you would be better off dead, frequent thoughts of suicide, or an active intent to end your own life
The med school acronym is "SIG E CAPS" (which is old-school shorthand for a prescription for energy pills), but that's fucking dumb. That's 8 symptoms, and you've left of
depressed mood (!). So, recently, I developed "Bagel's Depression Mnemonic":
DIGS E CAPS
It has all of the symptoms and, if you look back 2 weeks and award 0-3 points as described above, that's a PHQ-9, a commonly used and well validated screening tool for depression. You can use just the first 2 questions and that's a PHQ-2, which is actually a decent way to screen patients if you're too dumb to remember my incredible mnemonic or just REALLY pressed for time.
Also, "digs" is wonderfully dated beatnik slang which I really want to bring back.
The clinical diagnosis of depression requires the presence of symptom 1 or 2, and a total of 5 or more of the symptoms, total.
So, just saying yes or no, you need 5 symptoms for at least 2 weeks.
If you award the points, you can get a better idea of how depressed someone is. Having someone do the test at frequent intervals can give you a good sense of how effective a particular intervention is. A score of 5 points or less is generally taken as a sign that someone is in remission. An effective treatment should give you a 50% or greater reduction in the PHQ-9 score (f
eel free to call it a "Bagels' score").
The last piece of the PHQ-9 is to ask: "how difficult have these things made it to live your life? If you have a score of 10, but it has not impacted your ability to live your life at all, I'd hesitate to call that depression. But if you're score is 6, but you've been completely unable to live your life as usual, that's a huge problem (imagine getting a 3 for depressed mood and suicidality).
The key point being that diagnoses in psychiatry need to be correlated with some level of impairment. This is the difference between being a little shy, say, and being unable to leave your house because seeing other people is so traumatizing. One is just a normal aspect of a person's personality, and the other is potentially a medical problem.
The last word of caution is that these symptoms should NOT be due to something like the loss of a loved one. You need to account for culturally appropriate normal human reactions to life events. Bereavement is not a medical condition. If it lasts a really long time (in blah US culture, 6 months is usually given as the average amount of time it takes someone to deal with the initial stages of bereavement, but that can obviously vary), or the symptoms are way out of proportion (again, this needs to be calibrated for cultural and personal norms), or the symptoms are causing significant impairment to one's ability to live life as normal, you might pass from normal human behavior into the realm of medical illness.
So, you can use my INCREDIBLE rule to screen yourself for possible depression, but the diagnosis does require a detailed history from a healthcare provider. And, if suicidality is a concern, aggressive management is indicated. If you want to die, please get help. That is not normal, or a healthy sign that you've somehow come to terms with whatever is going on. It is a very real, very serious problem, with unbelievable consequences - the personal consequences are obviously at a maximum, but there are ramifications for friends, family, teachers, healthcare providers, coworkers, etc.
The other thing to note is that depression, particularly depression that has progressed to suicidal ideations, is very treatable. The actively suicidal may be candidates for ECT, inpatient treatment, medications, therapy - anything you can think of. And the cure rate for something like ECT is very high.
