[jdietrich]

>This is advice for sadness, not depression. This is the opening quote in the article: "Sadness is when you feel down because things aren’t going your way. Depression is when you feel down even when all is going well."

There's no mention of that in the DSM or the ICD.

People with miserable lives can still be depressed; people can have miserable lives without recognising that their lives are miserable. There is no such thing as an "objectively great" life; attempting to define the quality of your life in reference to fixed external criteria is arguably pathological in itself. Part of living a good life is developing an individual and personal sense of what is valuable and meaningful.

The current gold standard of treatment for depression, cognitive behavioural therapy, is in large part a coaching programme to encourage patients to do things to improve their lives. The cognitive aspect of CBT is secondary to the behavioural aspect - cognitive and metacognitive skills are taught in order to facilitate behavioural change.

[yellowapple]

"There's no mention of that in the DSM or the ICD."

Maybe not in those words, but the DSM does appear to distinguish between a depressive episode and e.g. bereavement: http://www.mental-health-today.com/dep/dsm.htm (I don't think this is the actual text, but it's the best I can find without a copy of the DSM-IV-TR on hand).

IANAPsychologist, but as an ordinary person, the article's distinction between sadness and depression seems reasonable and intuitive enough for a layperson to understand, and that's a step in the right direction in a world where laypeople (including people who might very well themselves have depression) rarely understand anything about the actual nature of depression.

[cpncrunch]

Having a crappy job or psychotic boss is more long-term than an "episode" such as bereavement, and definitely can lead to depression.

[yellowapple]

Perhaps. This is probably why I ain't a psychologist :)

The definition linked above does seem to generally imply (and in some cases explicitly state) that depressive episode/disorder symptoms better explained by some other diagnosis or situation (like schizophrenia or bipolar disorder) should be taken as further symptoms of that disorder/situation rather than a separate diagnosis of MDE/MDD. I guess the question is whether or not symptoms induced primarily by external stimuli (as opposed to when the symptoms are expressed as irrational thoughts regardless of external stimuli) ought to be under a similar banner of "these are symptoms of $SOME_OTHER_CONDITION rather than depression". My (again: non-professional) opinion leans in favor of "yes" being the answer, since it likely has different treatment implications (remove patient from symptom-causing stimuli v. prescribe cognitive behavioral therapy and/or medication to patient), but that's the thing about brains: nobody really understands how the brain (and thus the mind) works, and thus it's unclear whether or not such a distinction would actually be useful.

[cpncrunch]

It's difficult to determine whether or not depression is caused by life situation, unless there is something obvious like a recent bereavement.

It seems likely that both external stressors and internal thought processes can both be the cause of depression (and in many cases, a combination). CBT addresses the internal thought processes, but doesn't do anything to address external factors. My wife underwent CBT and took antidepressants, but they didn't really cure the depression. Quitting her crappy job fixed it for good.

[kkielhofner]

Much has been written about the removal of the "bereavement exclusion" from the DSM 5.

[yellowapple]

Good to know. The vast majority of what little knowledge I have of psychology is based around the DSM-IV, so that's where I tend to stick.

Do the other factors in that particular condition still apply? Namely, "the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation."?

[mmirate]

> attempting to define the quality of your life in reference to fixed external criteria is arguably pathological in itself

Isn't this merely inaccurate rather than pathological, since external criteria are almost never fixed? (cf. inflation)

[lightedman]

"There's no mention of that in the DSM"

The DSM changes so often that I wouldn't really rely upon it for a definition.

[yellowapple]

Our understanding of psychology and the human brain changes so often that I'd have a hard time trusting a source that hasn't been recently updated.

Even with that said, the average time between DSM revisions is, what, every 15 years, give or take? I wouldn't exactly call that "often".

[lightedman]

I can't trust the DSM because so many studies, experiments, and results regarding psychology and psychiatry simply cannot be reproduced or repeated with any degree of reliability.