Depression is a complex phenomenon, and the circumstances associated with its emergence vary in every patient presentation to some degree. Symptoms such as helplessness, hopelessness, tiredness, lack of motivation and difficulty experiencing pleasure are too generic and not descriptive enough to confirm a diagnosis of depression. Rather, it’s the characteristics of this disorder that will better help you confirm this diagnosis. Here are four such characteristics worthy of clinical attention:
Discouragement
In a depressed state, people tend to become discouraged rather easily. When something in their lives goes awry, it can easily trigger past discouragements and then morph into a prophecy that even more discouragement lies ahead in the future. Thus it’s hard for those with depression to reframe a disappointment as something that is likely only temporary and solvable. Molehills can grow into mountains rather easily, so we have to be continuously reinforcing that not every disappointment is predictive of doom and gloom and rarely catastrophic, and that the future is not inextricably linked to past failures. “Tell me why you’re thinking this is such a big deal?”
Anger
Many of us came up in the ranks being taught that with depression, anger is turned inward — that is, depressed people project anger onto themselves and not others. But this is not the case in as many as 30 percent of depressed patients, leading to an alternative consideration: Much anger is “self-anger,” and is redirected outward to preserve someone’s self-worth. I recognize this in my own practice and now routinely ask depressed clients if they ever lose their temper and have outbursts resulting in yelling or screaming at others. If they answer yes, I’ll include anger management and de-escalation strategies into our treatment plan.
Fear
Outside of legitimately objective fearful situations, most fear is imagined and is not happening in the moment. Depression fuels fear, turning it into a powerful motivator for staying stuck, and living a cocoon-like existence predicated on controlling one’s environment. This encourages social isolation which increases loneliness. The safer depressed people stay, the fewer challenges they take on, the less motivated they feel, and the sadder they become, because the scope of their lives becomes very restricted.
Image and Esteem Issues
I find it quite common that depressed people develop an imposter mentality. Poor parenting, or for that matter, hardly any parenting at all, set the tone for an inadequately nurtured child entering the real world ill-equipped to deal with the pressures of school, interaction with others, perseverance, making friends, and navigating conflict, disappointment and failure. This carries forward into adulthood where these same inadequacies manifest in marriages, job performance and parenting their own children. The prevailing, underlying principle is “I’m not good enough.” When assessing a client for depression, ask about self-esteem issues, or listen for statements or comments from the client indicating that their esteem and self-image may need some work.
Looking for the classic symptoms of a depression syndrome in a client is a good place to start, but evaluating for the possible presence of these four characteristics can aid in diagnostic confirmation.
Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.
To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.