By Edward L. Oriole L.C.P.C. N.C.C.
In the course of everyday life. We often ask ourselves when does “feeling blue” rise to the level of depression. I have often observed this in my practice when individuals don’t recognize when “feeling blue” becomes mild, moderate or even severe depression. The Diagnostic and Statistical Manual or DSM V gives me some guidance if I observe symptoms like: 1. Feeling sad or empty, most of the day, nearly every day; 2. Markedly diminished interest or pleasure in all or nearly all activities; 3. Significant weight loss or weight gain; 4. Insomnia or hypersomnia nearly every day; 5. Feelings of restlessness or agitation; 6. Fatigue or loss of energy nearly every day; 7. Feelings of worthlessness nearly every day; 8. Diminished ability to think or concentrate nearly every day; or 9. Recurrent thoughts of death, recurrent suicide ideation even without a specific plan.
The American Psychiatric Association prescribes that only five of the above symptoms are needed for a provisional diagnosis of Depressive Episode. At this point I look deeper. For example I examine if the five or more symptoms cause significant distress or impairment in the individual’s life. In what areas is the functioning impaired? For example, social functioning, work functioning, or perhaps, family functioning. I also examine if the symptoms are due to the physiological effects of drug abuse or prescription medication. Perhaps even the presence of an underlying medical condition could be the cause. Finally, I discuss if there is the presence of bereavement after the loss of a loved one.
Once the duration (more than two weeks) and the severity (mild, moderate and sever) are determined, I can establish a “therapeutic alliance” between myself and the client. When this is firmly in place we can jointly uncover the causal origin of the depression. For example the cause(s) may be psycho-social. Life and environmental events often precede rather then follow the stressor. The theory is that a significant stressor results in long-lasting changes in the brain’s biology. The brain’s neuro-transmitters are altered even without the external stressor. If I suspect that the cause(s) are psycho-dynamic, I examine the: a. Attachment between the client and the primary caregiver. b. A real or imagines object loss. c. Use of a defense mechanism to block the impact of the object’s loss. d. Is the object’s loss viewed with love or hate? Is the hate turned inwards to the self?
Of course there could be other causes: Trauma, personality factors or a simple predisposition to depression. The salient point that I am making is that a competent therapist can guide the client to an accurate assessment of the depth and breadth of the emotional dysregulation.
Feeling hopeless or helpless
Overwhelming of negative thoughts
Significant loss or increase in appetite
Increase in irritability, anger or aggression
Increase in alcohol consumption or reckless behavior
Thoughts that life is not worth living.
Edward L. Oriole L.C.P.C. N.N.C.
Staff member The Lighthouse Emotional Wellness Center
1930 Thoreau Suit 170
Arlington Heights, Il 60173
Tel. 847 253 9769