I want to send over some information on depression and anxiety. If you believe any of these things apply to you, I highly encourage you to seek out support from a therapist. You can do that through an app like BetterHelp, call your insurance company and see who is in network, or search for therapists in your area and see if they offer reasonable rates or a sliding scale fee.
What is Depression?
Depression, otherwise known as major depressive disorder or clinical depression, is a common and serious mood disorder. Those who suffer from depression experience persistent feelings of sadness and hopelessness and lose interest in activities they once enjoyed. Aside from the emotional problems caused by depression, individuals can also present with a physical symptom such as chronic pain or digestive issues. To be diagnosed with depression, symptoms must be present for at least two weeks.
Depression DSM-5 Diagnostic Criteria
The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.
Depressed mood most of the day, nearly every day.
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
Diminished ability to think or concentrate, or indecisiveness, nearly every day.
Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.
Major depressive disorder is associated with high mortality, much of which is accounted for by suicide. As a result, if you think someone you care about may be suffering from depression it is important to know the warning signs of suicide and to take suicidal statements extremely seriously. An active statement by someone with suicidal ideation might be something like, “I’m going to kill myself,” but other passive statements such as, “I wish I could just go to sleep and never wake up,” are equally worrying. If someone with depression exhibits these verbal markers, encourage them to consult a mental health professional immediately.
Depressed individuals also present with irritability, brooding, and obsessive rumination, and report anxiety, phobias, excessive worry over physical health, and complain of pain.
New Specifiers for Depression in DSM-5
The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5, added two specifiers to further classify diagnoses:
With Mixed Features – This specifier allows for the presence of manic symptoms as part of the depression diagnosis in patients who do not meet the full criteria for a manic episode.
With Anxious Distress – The presence of anxiety in patients may affect prognosis, treatment options, and the patient’s response to them. Clinicians will need to assess whether or not the individual experiencing depression also presents with anxious distress.
How is Depression Different from Sadness?
What is the difference between depression and sadness? Given that the primary symptom associated with depression is sadness it can be hard to know how to make a distinction between the two psychological states.
But depression is more than just sadness, and not simply by a measure of degree. The difference doesn’t lie in the extent to which a person feels down, but rather in a combination of factors relating to the duration of these negative feelings, other symptoms, bodily impact, and the effect upon the individual’s ability to function in daily life.
Sadness is a normal emotion that everyone will experience at some point in his or her life. Be it the loss of a job, the end of a relationship, or the death of a loved one, sadness is usually caused by a specific situation, person, or event. When it comes to depression, however, no such trigger is needed. A person suffering from depression feels sad or hopeless about everything. This person may have every reason in the world to be happy and yet they lose the ability to experience joy or pleasure.
With sadness, you might feel down in the dumps for a day or two, but you’re still able to enjoy simple things like your favorite TV show, food, or spending time with friends. This isn’t the case when someone is dealing with depression. Even activities that they once enjoyed are no longer interesting or pleasurable.
What’s more, when you experience sadness triggered by a certain something you’re still able to sleep as you usually would, remain motivated to do things, and maintain your desire to eat. Depression, on the other hand, is associated with serious disruption of normal eating and sleeping patterns, as well as not wanting to get out of bed all day.
In sadness, you might feel regret or remorse for something you said or did, but you won’t experience any permanent sense of worthlessness or guilt as you might with depression. One of the diagnostic features of depression is this kind of self-diminishing, negative thought patterns.
Finally, self-harm and suicidal inclinations don’t arise from non-depressive sadness. Those struggling with severe depression may have thoughts of self-harm, death, or suicide, or have a suicide plan.
If you’re feeling suicidal or just need to talk, call the National Suicide Prevention Lifeline for free at 1-800-273-8255.
Depression and Loss
Although there is a clear distinction to be made between depression and sadness, it is possible for major depressive disorder to occur in addition to sadness resulting from a significant loss, such as bereavement, financial ruin, or a serious medical illness. The decision as to whether a diagnosis of depression should be made will depend on the judgment of the clinician treating the individual.
How To Get Help
If you think you or someone you care about may be suffering from depression, we encourage you to seek help from a mental health professional. The following online directories can be consulted to find a therapist in your area:
• PsychCentral: https://psychcentral.com/find-help/• Psychology Today: https://therapists.psychologytoday.com/rms• GoodTherapy.org: http://www.goodtherapy.org/find-therapist.html
If you’re thinking about suicide, are worried about someone else, or just need emotional support, the emergency Lifeline network is available 24/7. You can call 1-800-273-8255 or go to their website for a live chat.
Generalized anxiety disorder (GAD) can be a challenge to diagnose. People consider panic attacks a hallmark of all anxiety disorders, but GAD is different in that there are generally no panic attacks associated with the condition.1
As a result of this misconception, without the experience of panic attacks, a person may think they are "just worrying too much." Their struggles with constant worry may be minimized or dismissed and, in turn, not properly diagnosed or treated.1
Most of us experience worry and situations that can cause us to feel anxious, so what are professionals looking for to help determine if someone's worry and anxiety are related to GAD?
An evaluation of symptom criteria, as outlined in "The Diagnostic and Statistical Manual of Mental Disorders," 5th Edition (also known as the DSM-5), is the first step. Mental health professionals look for factors like excessive, hindering worry paired with a variety of physical symptoms,2 then use proven diagnostic assessments to make a diagnosis and rule out other possibilities.
Verywell / Cindy Chung
The DSM-5 outlines specific criteria to help professionals diagnose generalized anxiety disorder. Having a standard set of symptoms to reference when assessing clients helps them to more accurately diagnose mental health concerns and, in turn, create a more effective plan of care.
Criteria for Diagnosing GAD
When assessing for GAD, clinical professionals are looking for the following:
The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least six months and is clearly excessive.
The worry is experienced as very challenging to control. The worry in both adults and children may easily shift from one topic to another.
The anxiety and worry are accompanied by at least three of the following physical or cognitive symptoms (In children, only one of these symptoms is necessary for a diagnosis of GAD):
Edginess or restlessness
Tiring easily; more fatigued than usual
Impaired concentration or feeling as though the mind goes blank
Irritability (which may or may not be observable to others)
Increased muscle aches or soreness
Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep)
Excessive worry means worrying even when there is no specific threat present or in a manner that is disproportionate to the actual risk.3 Someone struggling with GAD experiences a high percentage of their waking hours worrying about something. The worry may be accompanied by reassurance-seeking from others.4
In adults, the worry can be about job responsibilities or performance, one’s own health or the health of family members, financial matters, and other everyday, typical life circumstances. In children, the worry is more likely to be about their abilities or the quality of their performance (for example, in school).5 Many people with GAD also experience symptoms such as sweating, nausea, or diarrhea.6
The anxiety, worry, and other associated symptoms make it hard to carry out day-to-day activities and responsibilities. They may cause problems in relationships, at work, or in other important areas of life.7
In order to give a diagnosis of GAD, these symptoms also must be unrelated to any other medical conditions and cannot be explained by a different mental disorder or by the effect of substance use, including prescription medication, alcohol, or recreational drugs.8
During an assessment, your clinician will use the diagnostic criteria, standardized assessments, and their clinical judgment to make a diagnosis.
Generally, they will ask about your symptoms in an open-ended way, but you may also be asked to complete self-report questionnaires. These typically brief measures can help determine the diagnosis (as the Generalized Anxiety Disorder Scale-7 does) or severity of symptoms.9
In specialized care settings, like an anxiety disorders clinic, standardized assessment tools are sometimes used to evaluate symptoms. In this case, your clinician conducts a semi-structured interview. The interview is likely to include a standardized set of questions, and your answers will help your clinician to make an accurate diagnosis.
Commonly used and well-validated diagnostic interviews for adults include the Structured Clinical Interview for DSM Disorders (SCID) and the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5). There is a child version of the ADIS, in which both the parent and the child are asked about the child’s symptoms. These interviews also evaluate the presence of other associated conditions such as depression.
Remember to be honest with your provider at the first visit—both when filling out forms and discussing your symptoms face-to-face. Being upfront and honest can help determine what is happening and put together a plan of care specifically tailored to your needs.
If you are wondering whether you or your child might have GAD, you can consider completing a brief online self-screening tool for adults or for children provided by the Anxiety and Depression Association of America (ADAA).10 If you do this, you should still speak with a mental health professional or your physician for a proper diagnosis and treatment.
When to Seek Help
Many people who struggle with GAD experience symptoms for a long time before seeking help. Reaching out for a diagnosis can feel challenging, especially when anxiety feels so constant and widespread.
Only around 20% of people who have symptoms of anxiety seek treatment. In 2020, a national coalition of women's health professionals recommended that all women aged 13 and older should be screened for anxiety.11 The lifetime prevalence of anxiety disorders is approximately two times higher in women than in men, so preventative screenings may be helpful in ensuring that women and girls receive appropriate interventions to improve health and well-being.
Contacting a mental health or other clinical provider is a courageous step that can help clarify what is happening and, in turn, lead to creating a plan of care that can help you find relief and regain a sense of well-being.
When deciding to seek help, something to consider is how difficult it is to feel any sense of calm, comfort, and reassurance around your worry.
If you find yourself constantly seeking reassurance from others, or repeatedly trying different methods of stress management and relaxation to no avail, it may be worth contacting a professional.
Also, know that not experiencing panic attacks is another primary reason people don't seek help for their anxiety. Their worry may be chronic and concerning but, because there are no periods of acute panic attacks, they simply chalk the challenges up to being a "worrywart."
They may even be told this by others when seeking reassurance or trying to find comfort. Remember, however, that GAD is different in that panic attacks aren't typically present, so don't let this factor stop you from seeking help.
Additionally, take note of the physical symptoms that are accompanying your worry. As the anxiety continues, you may find more and more challenges with things like headaches, digestion, restlessness, and fatigue.1 Should you find that your worry feels excessive and begins leading to other physical symptoms, you may benefit from talking with a mental health or other care providers.
Finding a Clinician
Take time to research and seek out providers who specialize in the treatment of anxiety. Because anxiety is present in so many mental health conditions, you will want to talk with someone who understands the specific criteria required so you can be accurately diagnosed and treated.
Primary care physicians can often provide referrals to trusted and specialized mental health providers. Otherwise, to find a psychotherapist in your area, consult referral resources such as:
Anxiety and Depression Association of America
Association for Behavioral and Cognitive Therapies
Association for Contextual Behavioral Science
The American Psychiatric Association (APA) is a national organization of psychiatrists that can also provide recommendations for local providers who are able to provide psychiatric evaluation and prescribe medications.
Another option is to try an online therapy program.
The Best Online Anxiety Support Groups
Anxiety symptoms can be found in many categories of mental health conditions listed in the DSM-5, such as within mood disorders, eating disorders, and cognitive disorders. Within the category of anxiety disorders, there are many symptoms that will overlap and anxiety conditions can sometimes be confused with one another.
While sitting with a mental health provider, they will be seeking information that will help them to best diagnose your condition. To give a differential diagnosis means to distinguish one condition from another when there are symptoms that overlap.
Some conditions that may need to be ruled out include:1
Obsessive-compulsive disorder (OCD)
Social anxiety disorder
Although some of these conditions are discussed more casually by the general public, there are specific criteria that would need to be met in order for one of these (or other conditions) to be properly diagnosed.
There can be other behaviors and symptoms that can be present with anxiety. For example, when someone engages in self-sabotaging behavior, such as procrastination, they can be perceived as struggling with self-regulation and behavioral conditions. Overlooking elements of anxiety related to this behavior can end up creating an obstacle for someone to receive effective treatment.
Sitting with a qualified professional to determine an accurate diagnosis is key. Having the willingness to reach out for help, being honest with your provider, and participating actively in treatment can help you regain a sense of well-being.