Symptoms of Depression

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Normal feelings of depression: When used as a descriptive word, "depression" can mean low mood, dejection, boredom, disappointment etc. These feeling states are not an illness of depression, and are normal feelings or reactions for everyone. Dejection may be triggered by situations that stimulate minor defects in one's self esteem that everyone has and that are not usually in conscious awareness. These might be when ignored by peers, passed up at work for a good job, rejection in romance, etc. These problems are usually mild and self-limiting and not in need of any intervention such as counseling unless the stress or sensitivity is really great.

Personality disorder and depression: Personality is an enduring and pervasive way that persons relate to themselves and the world. Persons with deeper or a greater number of deficits in their self identity (i.e., having core issues or mental schemas of feeling unloved, unwanted, belittled, unvalidated, incompetent, etc.), may have a more pervasive nature of low mood related to these core issues or deficits in their self identity or personality, and this low mood may be worsened by situations that stimulate these deficits (like being ignored, rejected, etc.). Persons with personality disorder by definition also use maladaptive mechanisms of dealing with these feelings (i.e., they may be clingy in romantic relationships, they may try to control others, they may behave in egoistic or grandiose ways, etc.). These persons may be dejected, frustrated, and disappointed, but they do not have a mood illness. An important difference between personality and illness is that persons with illness such as mood disorder usually have neuro-vegetative (physical) symptoms such as sleep, appetite, or energy changes associated with mood shifting, difficulty enjoying things, and sometimes vague aches and pains, and that these symptoms are usually a change from the person's usual way of functioning. Intensive psychotherapy is usually required to treat personality problems.

Clinical Depression: Also called major depression, clinical depression is one type of Mood Disorder in wich low mood is one of the major symptoms. These persons also have many symptoms besides low mood that can be seen in their behavior (slowness, lethargy), cognition (poor concentration, paucity of thought, memory), social relations (avoidance, feeling inferior to others), self esteem (low self-esteem may lead to guilt, hopelessness and suicidal feelings), and physical symptoms (often sleep and appetite disturbance and decreased libido; and sometimes headache, ringing in the ears, dizziness, GI upset, constipation, muscle aches, etc.). Life stress, poor reaction to stress, psychological and/or brain-chemistry vulnerability may predispose persons to states of depression. Similar symptoms are commonly seen in new mothers who have a postpartum depression.

A common misconception is that persons with a depression must be crying in the corner and unable to move all day. However, many persons with depression have mild chronic symptoms that may come and go and seem to function normally. These persons often recalibrate themselves to believe that it is normal to have low mood, tend to have a persevering personality style, and will often not accept the diagnosis or therapy In this sense it is almost better to be clearly ill and receive therapy than to linger for years or decades in a low-level depression that affects one's social relations and potential in career. Following one's degree of depression with a formal depression test, and looking at one's life pattern of depression and its relationship to life events, are powerful ways to qualify and classify the type of depression and its antecedents, as well as to gauge the efficacy of therapy.

The criteria for clinical depression currently accepted by psychiatrists is presented below. if you have 3 or more of these symptoms you may have a mild or partial depression, 5 or more symptoms suggests you fit the diagnosis of depression. Even if you only have a couple of these symptoms, you should consult with a mental health professional if they are severe or concerning. Psychopharmacology-integrated psychotherapy is usually necessary to treat a clinical depression, although psychotherapy along with non-medical interventions may also be helpful in specific cases. If there is a clear stress that would be expected to cause a depression (i.e., divorce, loss of a job, serious illness, etc.), then removal of the stress, time, and psychotherapy may be effective. Psychopharmacology may be necessary if the symptoms do not abate even with these interventions.

Symptom Criteria For Clinical Depression

  • Depressed mood, feeling blue, dejected, or empty most of the time; or a heightened sensitivity to rejection from others.
  • Decrease in interest or pleasure in previously pleasurable activities most of the time.
  • Decrease in appetite or need for food intake; or an increase of appetite or food intake.
  • Trouble falling asleep, staying asleep, or early morning awakening; or oversleeping.
  • Body movements reflecting either irritability or fretfulness; or a languid unenergetic state.
  • Decrease in energy or becoming tired easily most of the time.
  • Feelings of worthlessness, excessive pessimism, or guiltly feelings.
  • Difficulty in concentrating or making decisions.
  • A tendency to think about death, dying, or feeling that life is not worth living anymore.

While the above description may describe the common symptoms of major depression, other kinds of depression, i.e., atypical depression, dysthymia (mild chronic depression), bipolar disorder (manic-depression), recurrent brief depression, and others may not fit this description well. An evaluation by a mental-health professional is required to confirm the exact situation of each individual and what kinds of intervention are warranted. Feel free to contact the Tokyo Meguro Counseling Center if you or a loved one seems to suffer from a problem in their mood.

The above symptom list is based on the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, and the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10), classified by the World Health Organization (WHO), and has been modified by the Meguro Counseling Center for use on this page.

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The Meguro Counseling Center consists of Western-trained therapists able to provide face-to-face mental-health care for the international community in Tokyo. With extensive experience in Japan, these therapists have a deep understanding of the stresses of living in Japan.