When Does Clinical Depression Start?

Depression is the most prevalent of all psychological disorders. It is estimated that about 17 million Americans suffer from this condition. But while it is very widespread, the disease is often undiagnosed and therefore untreated. The reason for this is that people do not generally know the difference between "normal" sadness and depression that is an unfortunate part of life sometimes, and "clinical depression" which is a medical condition that requires treatment.

Feeling sad and being depressed is often a natural reaction to a stressful life situation. When one goes through a difficult breakup, experiences a death in the family, loses one's home or business, or learns that he has cancer, it is normal for him to feel deeply sad and upset. As a result, he may have trouble sleeping or eating, and he may want to be alone and not see people or leave the house. But after a few days or weeks, and perhaps after venting out his sorrows to a friend, he will feel better and slowly go back to his old routine. This is the "normal" kind of depression.

In contrast, clinical depression involves a significant change in mood, thoughts and behavior that persists for two weeks or longer. Instead of abating, the depression lingers and even seems to worsen at times. Clinically depressed people may then continue to feel sad, eat badly and lose weight, and stay inside their home for months. They continue to be bothered and upset, to avoid work, and to not see friends and family. Worse, they can start contemplating suicide and act on it if unchecked.

When this happens, the person must seek professional treatment. Often, he will not be able to initiate this action because of his depression. Friends and family will then have to help him and convince him to see a health professional.

To diagnose this condition, the doctor will conduct a complete physical and psychological evaluation to find out if the person has a depressive illness. He may use a standard questionnaire that identifies the possible presence of major depression. He may also interview the person, starting with questions that have to do with the symptoms of depression. These symptoms are the following:

• Intense feelings of sadness, emptiness and hopelessness
• Sleep and eating disturbances (that may include insomnia, oversleeping, under- and over-eating)
• Fatigue, lack of energy
• Loss of interest in daily activities, and in things that were once enjoyed, including sex, hobbies and sports
• Lack of desire for company or social interactions
• Not caring about one's responsibilities and appearance
• Difficulties concentrating, remembering and deciding
• Crying bouts
• Suicidal thoughts or attempts

The doctor will often ask when the symptoms began, what possibly triggered them, how long they have lasted, how severe were they, and if they have taken place before. If they occurred before, the doctor will ask about any treatment taken and if it was successful. Additionally, he will inquire about the person's alcohol and drug use, and any family history of depression or psychological disorders. He will probe thoroughly using interviews, physical examinations, mental status and laboratory tests.

Once the tests are done, the doctor will evaluate if the person is suffering from a major depression. If it turns out that the person does have the disorder, the doctor will then ascertain what type of depression it is.

The person, his family and friends are often the first to suspect depression, but it is a qualified physician who makes the diagnosis of clinical depression. This diagnosis is the crucial first step to identifying and treating the disorder. It is the beginning of the often lengthy but necessary process that will lead a person back to a normal life.