Clinical Depression

Clinical depression is one of the most common types of depression. This article defines clinical depression, explains how clinical depression is diagnosed, types of clinical depression, causes and risk factors of clinical depression, and treatment options for clinical depression.

Clinical depression - also known as major depressive disorder, unipolar disorder, and major depression - is a mental disorder known as a mood disorder because one of its key effects is a change in the person’s normal emotional state. It differs from the non-pathological experience of sadness and withdrawal that is a normal response to painful or unpleasant events of life and resolves on its own without the need for medical intervention. This article provides an overview of clinical depression.

What Is Clinical Depression and How Is it Diagnosed?

Clinical depression is classified as a disorder rather than a disease. While it interrupts the normal functioning of a person’s emotional and wider life, it has only symptoms, not physical signs, such as a high white blood cell count or a tender spleen, so it must be diagnosed from descriptions of how functionality has been disrupted.  Clinical depression is the diagnosis made if a person has at least five symptoms of depression and these symptoms have lasted for at least two weeks. The symptoms of depression include the following:

  • Emotional changes such as generally depressed mood and pervasive sadness
  • An altered view of the future, characterized by hopelessness and pessimism
  • Interference with one’s habitual activities normal habits, including insomnia and loss of appetite, withdrawal from characteristic activities and loss of pleasure in one’s usual pursuits
  • Diminishing of one’s self-image, such that one may primarily feel guilt, self-hatred, helplessness, and/or worthlessness
  • Changes to one’s level of energy, such that one feels fatigued or enervated
  • Increases in sensitivity such that one feels irritable, restless, and/or agitated  
  • Mental changes, including confusion, sluggishness, and trouble deciding
  • Suicidal thoughts and/or actions

Screening inventories may be used to aid in a diagnosis of depression. These tools are of two types: self-assessments completed by a patient and discussed in a subsequent conversation with a mental health professional and assessments completed by a mental health professional based on conversation with and observation of a patient. Some of the most often used include Beck Depression Inventory (BDI-II), Center for Epidemiologic Studies Depression Scale (CES-D),

Geriatric Depression Rating Scale, Goldberg Depression Questionnaire, Quick Inventory of Depressive Symptomatology - Self Report (QIDS-SR), and Wakefield Self-Report Questionnaire.

Types of Clinical Depression

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) from the American Psychiatric Association (APA) is the main way that depression is categorized in the US, and “clinical depression” is not a term it uses. Rather, you will find in this document categories of “major depressive disorder.” Episodes of major depressive disorder are categorized by what have been determined to be key distinguishing factors: whether it has occurred as a single episode or recurring; whether it is currently full-blown or in partial or full remission; whether it is mild, moderate, or severe; and whether it is accompanied by hallucinations or delusions (in which case, it would be noted as having psychotic features).

Causes and Risk Factors of Clinical Depression

Causes of clinical depression have not been identified with certainty and may, in fact, be different for different people or even for the same person who is depressed more than once. It is thought that clinical depression can grow out of non-pathological depression as well as from the postpartum depression aka the “baby blues” and other stressful life events. Having a first-degree relative with major depression increases one’s risk by 1.5 to 3 times according to the APA. Some researchers believe that having a pessimistic personality may make one prone to depression. And women are more than twice as likely than men to be depressed at some time in their lives, also according to the APA.

Treatment of Clinical Depression

Clinical depression may be treated with medication, psychotherapy, electroconvulsive therapy (ECT), or a combination of these. Both psychotherapy and medication may involve a variety of different approaches. Psychotherapy can be cognitive behavioral therapy, psychodynamic therapy, family therapy, or interpersonal therapy, some of which are short term and focused on the present, others of which are longer term and focus more on a patient’s context and relationships throughout life.

The medications used are generally antidepressants and these may be tricyclic antidepressant medications, selective serotonin reuptake inhibitors (SSRIs), other antidepressant medications, or monoamine oxidase inhibitors (MAOIs). Recent research, published by The Journal of the American Medical Association (JAMA) in January, 2010 has show that antidepressant therapy is most effective more people with the most severe depression and no more effective than a placebo for people whose depression is less severe. More information about treatment is available in the article “Treating Depression.”


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