What Is Depression Exactly?

Anyone who treats depression has in her arsenal of resources the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). It contains descriptions of every psychiatric disorder along with diagnostic information. Depression for adults is clearly explained, but not so for children. The DSM-IV lists the following symptoms necessary for a diagnosis:

A. Five or more of the following symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

  • Depressed mood most of the day, nearly every day, as indicated by either subjective reports or observations made by others. Note: In children and adolescents, can be irritable mood.

  • Markedly diminished interest or pleasure in all, or almost all activities most of the day, nearly every day (as indicated by either subjective account or observation made by others).

  • Significant weight loss when not dieting or weight gain (e.g., a change of more than five percent of body weight within a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

  • Insomnia (sleeplessness) or hypersomnia (getting too much sleep) nearly every day.

  • Psychomotor agitation or retardation (slow physical movement) nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).

  • Fatigue or loss of energy nearly every day.

  • Feelings or worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about not being sick).

  • Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).

  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation (thoughts) without a specific plan, or a suicidal attempt or a specific plan for committing suicide.

B. The symptoms do not meet the criteria for mixed episode (of depression and mania).

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (like hypothyroidism).

E. The symptoms are not better accounted for by bereavement, such as the loss of a loved one, the symptoms persist for longer than two months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Doesn't this list make your head spin? What's even more frustrating is that this is a list for adults with only two mentions of how the symptoms manifest themselves in children.

Essential

Remember that the DSM-IV is a manual for professionals to use in making their findings and treatment recommendations. It is not a book for a parent or another layperson. Your interpretations of the DSM-IV may lead to an inaccurate diagnosis and could slow down the treatment process.

While this is the official list of symptoms for depression, there is much more to making a diagnosis than just reading this list. More symptoms and their manifestations will be discussed later.

Depression Versus Sadness

How do you figure out if your child is depressed versus just sad? The biggest thing you can watch for is whether the symptoms you are observing are causing a substantial amount of interference in his day-to-day functioning. Children do not always have the two-week rule where the symptoms have to be present constantly. In kids, the symptoms can come and go, but watch for them to frequently pop up over that time frame.

Another way to see if your child is in a funk or really depressed is to take the HALT test. Ask these questions about your child:

  • Is he Hungry?

  • Is he Angry?

  • Is he Lonely?

  • Is he Tired?

If the answer is yes to any of these, it may be the blues. Easy ways to treat it are for your child to grab a snack, take a nap, or get some exercise.

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