You’ve probably heard of depression if you’ve listened to a radio or watched a TV in the past 25 years. You can’t miss the commercials for medications that treat it (“Depression hurts”). Depression is the common cold of mental disorders, because it affects so many people over the course of a lifetime. If you don’t end up having at least a mild case of it in your life, I bet you know a loved one who has. And while some minor depressive feelings may be a normal part of modern life, major depression (also known as clinical depression) is a more serious and debilitating condition.
The problem arises when depression overtakes your life and becomes your life’s focus. Nobody wants that, and it feels like a black hole that there’s no way you can climb out of (nor point in doing so). And unlike a broken arm, the insidious part of depression is that it takes away the drive to go get treatment.
Before most people seek treatment for a mental disorder these days, they go to see their family doctor. Family doctors usually are pretty good at recognizing the signs of depression and help a person seek appropriate treatment and followup care. But sometimes they misdiagnose depression when it’s really something else, because the symptoms a person (or their doctor) may focus on (like weight change or insomnia, the most physical symptoms of depression) are not unique to depression. Such symptoms are common to many mental disorders.
Like many mental disorders, depression has a symptom list that can be a little daunting to remember. There are nine general symptoms of depression, amongst other criteria, including those things that are common to other disorders. What if someone could simplify the depression criteria so it would be quicker and easier to diagnose?
Leave it to some intrepid researchers from Down Under to do just that. Andrews et. al. (2007) boiled down the diagnosis of depression to just 5 out of the typical 9 symptoms:
- Depressed mood (feelings of sadness or being blue)
- Lack of interest (in activities that you previously enjoyed)
- Feelings of worthlessness
- Poor concentration
- Thoughts of death
The researchers found in two data analyses that 99.6% and 96.8% of patients who met criteria for five or more of the nine traditional symptoms also met the restricted criteria for three or more of the five psychological symptoms. Diagnostic accuracy was maintained, according to the researchers, by using the simplified set of 5. And since 5 sets of symptoms are easier to remember than 9, the reliability of this diagnosis amongst even primary care physicians should also be increased.
Could this restricted set lead to overdiagnosis of depression, since according to the researchers a person could be accurately diagnosed with depression with just 3 criteria (out of 5) as opposed to the current 5 (out of 9)? Perhaps, but that would be something additional research would have to answer.
The bigger problem in mental health isn’t overdiagnosis (despite the media hype about ADHD overdiagnosis that pops up from time to time), it’s under-diagnosis. It’s people not bothering to talk to a professional about their emotional concerns or mood, because they’re anxious, uncertain, embarrassed or scared.
To try and help people take the first step in determining whether they may or may not have depression, we’ve designed a new quick screening test for depression based upon this latest research. Our new depression quiz has only 8 questions (as opposed to our usual 18). We hope you find it useful.
Reference: Andrews et al. (2007). Issues for DSM-V: Simplifying DSM-IV to Enhance Utility: The Case of Major Depressive Disorder. Am J Psychiatry, 164:1784-1785.
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Well, you just describe me after a year of self-promotion of my debut novel. As a therapist in a children’s mental health program, I know that I’ll bounce back, even if I did have high hopes to raise money from author proceeds to prevent child abuse. Following is the most recent book review. It’s by the Editor of Atomjack Science Fiction Magazine.
Please post the review, mention the project again, or anything else that you think would help. The third short story of the series will be in Beyond Centauri in January. The others were in Wingspan Quarterly and Atomjack (reprinted in Aphelion). Thanks. Robert
Rarity From the Hollow:
A Lacy Dawn Adventure
by Robert Eggleton
Review by Adicus Ryan Garton
Imagine “Wizard of Oz†and “Hitchhiker’s Guide to the Galaxy†smashed together and taking place in a hollow in the hills of West Virginia. Now you have an idea of what to expect when you sit down to read Rarity From the Hollow: A Lacy Dawn Adventure by Robert Eggleton.
This novel is an unabashed, unashamed exploration of the life of young Lacy Dawn, as she learns that she is the savior of the universe. The naked, genderless android, Dot-com, who lives in a ship in a cave, told her so. Add her abusive father, her weak-willed mother, a sexually-abused ghost for a best friend that was murdered by her own father, trees that talk to her, a dog that can communicate telepathically with cockroaches and so much more.
There is so much to this story, and its writing is so unblinkingly honest; Eggleton spares us nothing in his descriptions of her father beating her and her mother, the emotions that the mother and daughter go through, the dark creeping insanity that eats away at her Iraq-veteran father, and the life in general of people too poor, too uneducated to escape.
In part, it is a grueling exposition of what children endure when being physically and emotionally abused. Eggleton almost seems to suggest that the only way for a child to escape is to learn that she is the savior of the universe. Lacy Dawn is strong, tough, smart—all those attributes that any child should have—and she reminds us that children are survivors, adaptive and optimistic. Instead of giving us a story of escapism, Eggleton shows us a girl whose life follows her through the story.
But don’t think you’re going to be reading something harsh and brutal and tragic. This book is laugh-out-loud funny at times, satiric of almost everything it touches upon (some common themes are shopping, masturbation, welfare, growing and selling drugs, and the lives of cockroaches). The characters from the hollow and from the planet Shptiludrp (the Mall of the Universe) are funny almost to the point of tears.
I hate happy endings to stories that deal with any kind of oppression or abuse because they tend to suggest, “In this case, it worked out okay,†and the reader walks away with the impression that the world is a better place (think of all those inner-city sports movies about black kids who win the big championship despite being addicted to crack). I thought for a long time that this book was an escapist fantasy, and when the fantasy broke, it was going to be tragic. No one wants to see a little girl go through heaven only to learn that hell awaits her at the end. And then when I realized that Eggleton was not writing an escapist fantasy, I worried that this happy ending effect was going to take place, making me not like the book, despite all its positive attributes. But when I realized that Lacy Dawn had to fix her life first before the story could progress, and that this was IMPOSSIBLE except by extraterrestrial means, and that Lacy Dawn carried her past with her as part of her instead of in spite of, it made the prospect of a happy ending much better.
Go here, buy the book and read it. It’s absolutely fantastic, and the proceeds go to the Lacy Dawn Adventures project. It’s like buying ice cream for charity—everybody wins.
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More information about Robert Eggleton and the Lacy Dawn project can be found here.
“Stainless Steel”, the story of Lacy Dawn’s best friend, can be read right here in Atomjack.
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What is a book review doing in the middle of this…. arrggg!!! I’ve got to go and hit a wall in real life now that I’ve hit this wall!!! Not nice. It’s hard enough to focus without having to figure this out.
Depressed…. 5 out of 5. 9 out of 9. 18 out of 18. It is what it is. This kind of aggrevation makes it worse. I was looking for the test… I get a book review instead. Bummed!!
As a clinical psychologist diagnosed with MDD I am appalled that these 4 criteria were deemed disposable:
1) Weight loss/gain of over 5% in one month. Please find “Feeding and Eating Disorders†studies.
2) Sleep disturbances aggravate MDD. It definitely aggravated my MDD with relentless insomnia. Try functioning on 2 hours’ sleep.
3) I treated patients with psychomotor agitation/retardation. They are not separate discreet entities; they co-exist.They can be obvious. My patients prior to treatment refused to go out in public
4) Diminshed cognitive functioning including “thinking†cause depressed patients me too to feel even more worthless and inappropriate guilty
5) The 9th and final criterion which addresses death was included with the other 4 criteria deemed sufficient for diagnosing MDD. Unfortunately it was abbreviated from “recurrent thoughts of death†to thoughts of death.
It shocking excluded: recurrent suicidal ideation w/o a plan. That does not mean there is no plan. It may mean that the patient chose to keep any plans private to avoid inpatient admission; plans for committing suicide with or without plans; history of suicide attempts.
I am adding “successful suicide plan resulting in death of patientâ€.
I will end overly long commentary with suspicions re research especially in mental health based on concrete tangible evidence. I am sure they are applicable in Australia and everywhere else.
Research â–¶ï¸ Drug companies â–¶ï¸ Approval by FDA in US and its counterparts elsewhere for manufacture, prescription, and sale.
Follow The Money
My youngest brother and I shared a special understanding. He told me that I was the only person in his life that showed him, love, unconditionally. I knew he was fighting demons that genetics inflicted upon him. We had long talks where I tried to speak to his heart and help him believe he was a beautiful person who showed only compassion to others. The rest of my family of narcissists used him as a scapegoat and beat him down until he believed them. The 30 years I lived in OK kept me from seeing what he was truly living with. He retired last summer and I invited him to live with me, which he did. He displayed nothing but contentment and talked about the plans he was making. He was always looking forward and as much as I understood him, he did not confide his true plans. He took his own life last fall. I am well read and have much experience with mental illness. I did not see a single sign to alert me of his intention. His is the 3rd suicide of people I loved. There is one thing people need to realize. The closer you are to someone suffering from depression, the harder they work to spare you of their turmoil. The note he left said, “I love you and there was nothing you could have done”.