Depression

Diagnostic Classification and Symptoms

Depression is a whole-body illness that adversely affects both the body and mind of sufferers, including their thought patterns, eating, sleeping, and social interactions. Symptoms include persistent sadness and crying; rumination; feelings of hopelessness and worthlessness; loss of interest in pleasurable activities, including sex; irritability, pessimism, and self-criticism; difficulty concentrating, remembering and making decisions; insomnia or hypersomnia (oversleeping); excessive eating with weight gain or restricted eating with weight loss; withdrawal from social life, including school, work, and leisure activities; persistent aches and pains that are not responsive to treatment; fatigue, loss of energy and motivation; and thoughts of suicide and possible suicide attempts.

According to the DSM IV, MDD is diagnosed when some or all of these symptoms are present from at least two weeks to several months or more. Dysthymia, in contrast, is a chronic condition with milder symptoms lasting for at least two years. People with dysthymia may suffer comorbid disorders including episodes of MDD. Bipolar disorder, or “manic depression,” is characterized by disruptive cycles of depressive symptoms alternating with euphoria. There is an increase of risk-taking behaviors such as spending sprees and/or risky sexual escapades during the manic phase of the illness. Bipolar disorder is far less common than MDD and dysthymia.

Recent research in developing countries shows that the Western biomedical model of depression fails to capture culture-specific terminology and symptoms. People typically present with multiple somatic complaints [Page 381]such as headaches and fatigue, rather than depression. On closer inspection, however, these problems were not exclusively somatic disorders; further questioning elicited psychological information warranting diagnoses of depression. As such, more refined instruments are required to measure the true incidence of depression in developing countries. New symptom questionnaires such as the 14-item Shona Symptom Questionnaire (SSQ) in Zimbabwe, the Primary Care Psychiatric Questionnaire in India, and the Chinese Health Questionnaire were developed in conjunction with local languages, idioms, and categories of illness to more carefully screen for depression.

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