The Definition Applied – Part I

In my last post, I gave you the definition for Major Depressive Disorder. I concluded my post by outlining what I saw as the key elements of this definition, namely:

  1. duration,
  2. impairment in functioning over the entire duration,
  3. a lack of a physiological or general medical cause,
  4. clear physical affects that are more than mood,
  5. the presence of five (or more) affects throughout the entire duration which must include either depressed mood or loss of interest or pleasure.

In this post, I’ll expand on these key elements by exploring the patient interview and create the groundwork for my next post.


Image by geralt


The first clause of the definition is very clear that the symptoms must exist for two weeks on a near 24 x 7 basis. In reaching this duration, a balance has been struck between everyday bouts of sadness versus the chronic nature of the disorder. Everyone has bad days, everyone feels blue from time to time. That’s just a part of life. But the disorder goes beyond the everyday so the definition tries to discounts its presence by allowing time for it to pass.

The disorder is also, as I mentioned above, a chronic illness so this window for normal mood variation is necessarily short. Major Depressive Disorder is the second leading cause of disability in the United States (and a leading cause of disability globally). Forty percent or more sufferers of the disorder will consider suicide, with ten percent succeeding in their attempt. This translates to over two million deaths in the United States each year and far more globally.

Beyond duration, the definition presents a list of symptoms that require the diagnostician to investigate the patient’s history. Questions will be asked to confirm that the impairment in function experienced by him has in fact been experienced over the entire two weeks for most of the time. The impairment must be a recognizable departure from his normal functioning (poorer personal hygiene, reduced sociability, etc.) so the interview is structured to elicit anecdotal evidence to establish the baseline for normal functioning and the impairment of it. If necessary, anecdotal evidence from third parties, family members, friends, doctors, etc., will be sought to confirm the patient’s honesty.

Throughout the interview, the patient will be closely observed. Is her posture erect and alert, or are her shoulders slumped and her head down? Are her answers delivered clearly and articulately, or is there a slowness of speech and a hesitation in reply? Are her eyes open and clear suggesting alertness, or do they seem dull and vacant? Is she attentive throughout the interview answering precisely what is asked, or is she unfocussed, providing answers that tend to wander. Through observation, the diagnostician can verify that the anecdotal information is supported by the patient’s presentation.

To differentiate the diagnosis from other disorders or illnesses, the patient will be asked questions to determine whether or not there is another cause for his condition: is he a substance abuse; is there a physical disorder, like sleep apnea, that may be the root cause; is he experiencing bereavement or grief over a loss; is he suffering from another disorder (bipolar disorder, etc.). The goal is to be as precise as possible in diagnosis so that the proper treatment can be established. For instance, if the root cause may be sleep apnea, a sleep study will be required and a CPAP device prescribed to treat it (I will explore sleep apnea in a later post).

The interview is fairly comprehensive. It explores the patient’s medical history, her family history, her employment history, her social interactions and more. It’s also long to allow the diagnostician to spot any impairment in concentration or fatigue.

All of this requires that the patient is honest. Lies can lead to a misdiagnosis that might worsen, not improve, your mental and physical health. You may not want to admit to the severity of your symptoms, out of shame or guilt or stigma. but it’s that lack of openness that can lead to greater harm. Remember, I know. I kept quiet out of shame and guilt. Eventually, my silence led me to a point of such excessive isolation that my only escape was suicide. I survived through chance, but I took the opportunity that chance gave me and educated myself and developed new skills. It’s this education that I wish to impart to you in this blog. Perhaps, together, we can save a life!

Thus far, I’ve given you the definition for Major Depressive Disorder. I’ve also given you a general outline of the diagnosing interview and a sense of what the diagnostician is investigating. In my next post, I’ll give you a patient history and try to show you how all of this fits together.

I remind you that I’m not a mental health professional. I live with Major Depressive Disorder and, from time to time, I experience depressive episodes. The most recent depressive episode prompted my reaching out for help. My own research, the guidance and lessons shared by fellow-sufferers, the compassion of therapists, and so much more, have all inspired me to share what I’ve learned with you. It is information. It is not a diagnosis. If you believe that you’re in need of help, I urge you to speak to your family doctor. If you are experiencing suicidal thoughts, SEEK HELP IMMEDIATELY BY DIALING 911 OR VISITING YOUR LOCAL HOSPITAL EMERGENCY ROOM.