Identification and diagnosis of clinical depression

Identifying depression is not always easy, as its manifestations can be highly varied.

Although there are different types of depressive disorders—such as perinatal, seasonal, or bipolar—this section focuses on major depressive disorder, also known as clinical depression, as it is addressed in professional mental health contexts.

This type of depression affects both the emotional state and the body and social relationships.

To better understand its complexity, it is useful to group the symptoms into three broad categories: emotional, physical, and behavioral.

Emotional indicators

This dimension is characterized by persistent feelings of sadness, emptiness, or apathy. The person may experience a noticeable loss of interest in activities that previously brought them well-being.

Added to this is a pessimistic view of oneself and the future, feelings of failure, unfounded guilt, or constant irritability.

In the most severe cases, thoughts related to suicide or self-harm may arise.

Physical manifestations

Depression also expresses itself physically. Sleep disturbances, such as difficulty sleeping or excessive sleepiness, are common.

There may also be changes in appetite, with weight loss or gain, without a specific medical cause.

Other signs include constant exhaustion, slowness in movement or speech, physical discomfort without medical explanation (such as pain or digestive problems), and hormonal changes, which can affect menstrual cycles in women or decrease libido.

Changes in social behavior

This disorder has a direct impact on daily life. Those affected tend to isolate themselves, neglect their social and work commitments, and become emotionally distant from those around them.

Performance at work, school, or daily tasks deteriorates, which exacerbates the distress and feelings of worthlessness.

Diagnostic evaluation. DSM-5 criteria

The Diagnostic and Statistical Manual of Mental Disorders, in its fifth edition (DSM-5), establishes precise parameters for diagnosing major depressive disorder.

According to this guide, at least five specific symptoms must be present for a minimum of two weeks, most days and for most of the day.

Symptoms considered by the DSM-5 include:

• Depressed mood.

• Significant loss of interest or pleasure.

• Changes in weight or appetite.

• Insomnia or excessive sleepiness.

• Agitation or physical slowing.

• Persistent fatigue.

• Intense feelings of worthlessness or guilt.

• Problems concentrating or making decisions.

• Recurrent thoughts of death or suicide.

At least one of the mandatory symptoms must be depressed mood or loss of interest.

In addition, the symptoms must significantly interfere with personal, occupational, or social functioning and not be explained by substance use or another psychiatric diagnosis, such as schizophrenia.