For the first article, let’s address one of the most straightforward and fundamental questions: what kind of disease is depression?
The core manifestations of depression
When it comes to the manifestations of depression, you probably know a little bit about it to a greater or lesser extent. There are two descriptions that I think are particularly accurate and can give non-depressed people an instant appreciation of the core manifestations of this illness.
The first description is that to the depressed person, the whole world seems gray. It is an extremely monotonous, heavy, even despairing color, a bit like the sea in the evening under dark clouds.
The second description is that for many people with severe depression, the whole body is like skin that has been hollowed out and completely deflated.
It takes a tremendous amount of strength to move even the simplest of arms and legs. In the experience of some depressed people, their minds are even completely detached from their bodies, and they look at their powerless bodies from the perspective of a bystander.
Of course, these figurative descriptions do not represent all depressed people, but they are powerful enough to show that depression is a very serious disease state.
In the dictionary, the word “illness” refers to a physical condition that affects certain normal functions of the body. Depression can seriously affect our mood, our daily life, and our work performance, and can even lead to behaviors such as suicide and self-harm, so of course, it is a disease, and it is a disease that must be taken seriously.
The special features of depression
Depression and many of the diseases we usually talk about, such as cancer, diabetes, and cardiovascular disease, seem to be really not quite the same.
In my opinion, it is these differences that make people’s understanding and awareness of depression quite biased. And correcting these biases is something that the clinical medical community is continuing to do.
The first difference is that the definition of depression is based on external manifestations rather than internal physiological indicators of the body.
Regarding this disorder, we do not have the ability to make an objective and precise definition in terms of structural changes in the body’s organs, so we have to describe the results it will bring in terms of external manifestations.
In fact, this is probably the greatest difficulty in the field of depression and in the field of mental illness in general.
When a disease can only be described by its external manifestations but cannot be detected by some objective, visible and tangible indicators, people will certainly have doubts about what it really is or even whether it really exists.
From this point of view, today, there are still a large number of people who do not acknowledge the existence of depression as a disease and are used to stigmatize it and associate it with character defects or even pretensions, which is certainly a misconception but also has its deep-rooted ideological basis.
The second difference is that depression is more directly influenced by environmental factors than many other disorders.
We can certainly say that all human illnesses are affected by a combination of external and internal factors. Depression, however, is indeed more likely to be triggered by major changes in life, such as the death of a loved one, financial ruin, or natural disasters.
Some statistics show that within one month after experiencing the tragic death of a loved one, about 40% of people show signs that meet the diagnostic criteria for depression. And it takes almost two years before this percentage decreases to normal levels. It has also been found that the percentage of people suffering from depression increases exponentially among those who are unemployed and disabled.
The question then arises: How do we distinguish between normal and excessive sadness? How can we distinguish whether a person is depressed in the face of a blow or whether he or she is really suffering from depression?
This is certainly a question that is not easy to answer. It is also true that many people confuse depression with the negative emotions that occur after a major blow and depression with psychological fragility.
The choice of the clinical medical profession is, since it is difficult to distinguish, then simply do not distinguish.
The diagnosis of depression
It is clear that depression is certainly a disease, and it is also discussed why this disease seems extraordinarily different. Let’s turn to a more specific question: How exactly is depression diagnosed in clinical medical practice?
A clear diagnosis of depression is the basis for recognizing it, treating it, and managing it. Specifically, for depression, there are two sets of highly integrated but slightly different diagnostic criteria that are prevalent in the world: the DSM-5 criteria in the United States and the ICD-11 criteria of the World Health Organization.
In simple terms, if a person experiences a persistent depressive mood or loss of interest and pleasure that lasts for more than 2 weeks; At the same time, he/she also experiences a range of symptoms such as weight loss, insomnia, fatigue, loss of concentration, feeling worthless, attempting suicide, etc., he/she can be clinically diagnosed with depression.
I don’t know how you feel after hearing this diagnostic criterion, do you think it is a bit too subjective and arbitrary?
We often joke that when a cancer patient or a diabetic patient walks into the hospital, the doctor will give him a whole bunch of tests, such as various blood tests, CT and MRI tests of the whole body, and even the most advanced genetic sequencing tests, and then give detailed diagnosis and treatment recommendations based on these test results.
But when a depressed patient walks into the hospital, the doctors will come up with a questionnaire and let the patient tick the boxes to calculate the score, and then combine it with a face-to-face interview between the doctor and the patient to make a diagnosis.
And this can naturally lead to a problem, which is – in clinical practice – the accuracy of the diagnosis of depression is very unpromising.
In detail, there are three potential reasons for this problem.
The diagnostic criteria for depression have a number of elements of subjective judgment, which, of course, makes it more difficult for doctors to judge. For example, in 2009, a large-scale study of 50,000 people showed that primary care physicians around the world were not very confident in their diagnosis of depression.
Simply put, suppose 100 people register for medical care, and 20 of them meet the DSM-5 clinical criteria for depression. How do the doctors fare then? They can only identify 10 patients, with a 50% correct diagnosis rate. And at the same time, they would see 15 people who were not sick as depressed.
And the second reason has to do with the diagnostic criteria for depression itself.
Using the same yardstick to measure a wide range of human mental activity, there are naturally many cases that cannot be accurately determined.
Let’s say that the DSM-5 criteria require symptoms to last at least two weeks to be considered depression, so if a person is depressed for ten days at a time, but comes back for a round in a few days, is he considered depressed?
Another example is that the DSM-5 criteria require patients to meet at least five of the nine criteria to be considered depressed, so if a person meets only three but all three are particularly severe, is he considered depressed? Should the doctor treat him for depression or send him home for observation?
For example, the percentage of Americans who suffer from depression in their lifetime is quite high, nearly 20%. Many European and American countries, such as France, the Netherlands, Belgium, and New Zealand, have similar rates. However, this figure for Asian countries is only 5-6%.
A distinct possibility is that although people from all over the world suffer from depression, people from different cultures and language backgrounds describe the illness quite differently. So the same set of criteria may not produce an accurate diagnosis for people all over the world.
For example, studies have long found that in several countries of East Asian cultures, people are used to “somatizing” emotional illnesses, projecting their emotional problems more onto physical symptoms such as heartburn, chest tightness, and nausea. These cultural differences, of course, can affect the accurate diagnosis of depression.
At this point in the discussion, we can make a brief summary of depression.
- depression is certainly a real illness that needs to be taken seriously, diagnosed, and treated.
- Depression is indeed a different disease from many common illnesses. Its characteristics make it easy to be stigmatized and interpreted by many people as a pretense, a weak mind, and a character flaw.
- Faced with this situation, doctors are making continuous efforts to help people better perceive and diagnose this disorder. The DSM-5 criteria provide a standardized approach that can help physicians around the world diagnose depression.
- However, although this method is very significant and really convenient, it is too subjective, and there is still huge room for improvement in accuracy.
Preview of the next article
I guess you may not be satisfied with this summary.
After all the talk, we can’t even give an accurate definition of the disease or a set of objective diagnostic criteria. How can we recognize this disease and help our loved ones who suffer from it?
Obviously, to solve these problems, we need to have a deeper understanding of depression. Starting with the next lecture, let us officially begin this process of discovery.
This exploratory process can eventually come back to help us find ways to diagnose and combat depression.
I’m Jessica, and I’ll see you in the next article.