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Diagnosing Depression

In the United States, the American Psychiatric Association's Diagnostic and Statistical Manual
(DSM, version IV) is the standard diagnostic classification system for mental disorders. The DSM
system divides depression into “major” and less severe categories. Major depression occurs in
approximately 20 percent of people at least once during the course of their lifetimes, though at any
single point in time only 1 to 2 percent of the population suffers from this condition.

DSM-IV Symptom Criteria for Major Depression

Major depression is indicated by the presence of either persistent depressed mood or pervasive lack
of interest or pleasure in activities, accompanied by four or more of the following symptoms:

loss of sleep or excessive sleep
loss of appetite or excessive eating
poor concentration
excessive guilt
suicidal thoughts or actions
a feeling of hopelessness
psychomotor (physical) retardation (slowing down) or agitation
diurnal variation of mood (consistently feeling worse every morning or evening)

Most depressed people do not have such severe symptoms. Many people function moderately well
but have always had a negative attitude toward life— the glass is always half empty. These people
used to be classified as having “depressive personality” or “depressive neurosis,” but now we think
of them as having low-level forms of depressive illness that can respond to treatment. All of us can
point to family members, friends, and coworkers who tend to be grouchy and grumpy— people with
a negative approach to every task that they face. Their numbers have diminished in recent years,
probably because many of them are taking antidepressant medications. In fact, in the mid-1990s, the
Wall Street Journal ran a front-page article suggesting that widespread use of the antidepressant
Prozac had led to less absenteeism and improved labor productivity in the United States. But if
you're not depressed, these medications are not going to be of much