4 ms·

The criteria for what "depression" is has changed over time, no wonder our results are changing. Almost everyone has depression given the current criteria [1].

The criteria for what "depression" is has changed over time, no wonder our results are changing. Almost everyone has depression given the current criteria [1]. Most people have 2,4,5,6,7. The criteria is so vague your study would have to control for each item on the list. Here, they're not even using that criteria, and instead just using a simple test which involves self-reports. Placebo could be a huge factor here. [1] https://www.psycom.net/depression-definition-dsm-5-diagnostic-criteria/ https://www.psycom.net/depression-definition-dsm-5-diagnosti...

simiones 7y ago
I would highly dispute that "almost everyone" experiences any of these symptoms (note that they must happen "(almost) every day"). You've also missed a very important requirement: "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." You might accuse this definition of being too subjective. But it is certainly not something that includes "almost everyone".
- solinent 7y ago
  > 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. I'd say most of the lower class has this issue. > But it is certainly not something that includes "almost everyone". How do you know this? edit: maybe almost everyone is too much, I mean about 97% of the population.
  - caymanjim 7y ago
    > I'd say most of the lower class has this issue. Why would you say that? Do you think that rich people are happy and poor people are depressed? Anecdotally, the poorest people I know are often the happiest and the richest people are often the most miserable. I was a whole lot happier when I was younger and poorer. One thing has nothing to do with the other.
    - solinent 7y ago
      > Why would you say that? Do you think that rich people are happy and poor people are depressed? There are numerous studies showing this, for almost all disease categories. All psychological illness is negatively corelated with socioeconomic status. https://en.wikipedia.org/wiki/Socioeconomic_status https://en.wikipedia.org/wiki/Socioeconomic_status I'd say it's hard to find good sources of nutrition and the time to exercise when you're part of the lower class. edit: negatively correlated...
      - caymanjim 7y ago
        A correlation between economic status and disease does not mean that most of the lower class is depressed.
        solinent 7y ago
        https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=+socioeconomic+status+depression&btnG= https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=+soc... Also depression. It took me one minute to find three sources, could you please make some effort here? I have other things to do. And you're right, it's not a causative factor necessarily, but I think there's pretty strong evidence at this point, it's hard to find a poor person who doesn't have some condition. [1] https://www.sciencedirect.com/science/article/abs/pii/S0022399902003033 https://www.sciencedirect.com/science/article/abs/pii/S00223... [2] https://psycnet.apa.org/doiLanding?doi=10.1037/0021-843X.111.4.578 https://psycnet.apa.org/doiLanding?doi=10.1037/0021-843X.111... [3] https://ajph.aphapublications.org/doi/full/10.2105/AJPH.93.11.1844 https://ajph.aphapublications.org/doi/full/10.2105/AJPH.93.1...
  - simiones 7y ago
    > Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day. If most people had this symptom, you wouldn't see the current movie, gaming, and music sales. Also, sex work would not be a lucrative job, and neither would the leisure industry (except perhaps casinos). > A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down). If an overwhelming majority of people had this symptom, the world would have crawled to a stop by now. One look out the window on a busy street shows that most people are walking around normally, often at a brisk pace. > Fatigue or loss of energy nearly every day. > Feelings of worthlessness or excessive or inappropriate guilt nearly every day. These ones I could grant are extremely common, especially among the working class, and are often encouraged by moder work and management practices. > Diminished ability to think or concentrate, or indecisiveness, nearly every day. If this were true of the vast majority of the population, you wouldn't have any kind of political life outside the elites, you wouldn't have any real amount of productive work, and you wouldn't see any art or creativity from the working class, which is obviously not true. Overall your claim that ~97% of the population suffers from all of these symptoms is simply obviously false. > I'd say most of the lower class has this issue. The lower class is not "in significant distress or impairment in social, occupational, or other important areas of functioning because they have depression-like symptoms. It is the other way around: a lot of them have horrible jobs where they are treated poorly, and that is causing depression-like symptoms (especially fatigue and feelings of guilt). It is not the fatigue that keeps them from living a better life, it is the life they are forced to live by our current economic and societal model that is causing their fatigue. Depression manifests very differently, especially if you are close enough to the depressed person to get a good glimpse into their life. Diminished pleasure or interest does not manifest by being slightly bored while watching TV or listening to soul-less pop. It manifests by sitting alone in the dark, sleep-less, for hours on end. It manifests by simply not feeling powerful enough to get out of bed, regardless of how hungry you are, or of how important your job is for your livelihood. It manifests by crippling guilt and long bouts of crying, regardless of how important for your future it is to greet customers with a smile at Walmart. People with clinical depression rarely hold down jobs, especially if they are untreated. They rarely hold down relationships of any kind. The symptoms described above sound vague, but they are actually very recognizable. Sure, you could say that 97% of the population has something that vaguely looks like these symptoms. But remember that this is a guide for trained psychiatrists, it is not meant for the general public to diagnose others.
0xcde4c3db 7y ago
Most people certainly do not meet all of the criteria you list, especially #2 ("Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day."). I can understand some confusion over #4 ("A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down)."), which can be read as describing ordinary fatigue but is actually about a different pattern called "psychomotor retardation" [1]. [1] https://en.wikipedia.org/wiki/Psychomotor_retardation https://en.wikipedia.org/wiki/Psychomotor_retardation
- solinent 7y ago
  With epidemology it's hard to tell the difference, there's no identified mechanism for depression or psychomotor retardation. Perhaps they're in the same category? All psychological disease categories are co-morbid with each other. What about existential crises? Do people who have those also have depression?
markroseman 7y ago
Applying the (current for any given time) criteria for depression requires a certain amount of training and skill, and the point form list of symptoms that you see as the first section in each diagnosis in the DSM-5 is not standalone. To mention one huge but often-overlooked example, something isn't a mental illness unless it significantly interferes with your life and functioning. Not to say that people don't incorrectly make diagnoses all the time. Many of these studies also rely on rating scales (typically HAMD or even PHQ9 for depression) that are a measure of depressive symptoms but don't in themselves have the power to make a diagnosis.
- solinent 7y ago
  > Many of these studies also rely on rating scales (typically HAMD or even PHQ9 for depression) that are a measure of depressive symptoms but don't in themselves have the power to make a diagnosis. This is my point again if you read my original post, thank you. :) I'd go further and say the DSM-V is pretty bad at narrowing down which medication to use for depression. I know so many people on damn SNRIs whose diet is complete trash.
  - markroseman 7y ago
    Totally agree on your last point. There's little connection between DSM and treatment guidelines (which do exist, separately). And treatment is so fragmented between multiple care providers (with most people accessing a small subset) that many obvious things get lost. (Caveat: my wife is a psychiatrist. We wrote a book on this: https://mhnav.com/book/ https://mhnav.com/book/)

simiones 7y ago

I would highly dispute that "almost everyone" experiences any of these symptoms (note that they must happen "(almost) every day"). You've also missed a very important requirement: "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." You might accuse this definition of being too subjective. But it is certainly not something that includes "almost everyone".

solinent 7y ago
> 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. I'd say most of the lower class has this issue. > But it is certainly not something that includes "almost everyone". How do you know this? edit: maybe almost everyone is too much, I mean about 97% of the population.
- caymanjim 7y ago
  > I'd say most of the lower class has this issue. Why would you say that? Do you think that rich people are happy and poor people are depressed? Anecdotally, the poorest people I know are often the happiest and the richest people are often the most miserable. I was a whole lot happier when I was younger and poorer. One thing has nothing to do with the other.
  - solinent 7y ago
    > Why would you say that? Do you think that rich people are happy and poor people are depressed? There are numerous studies showing this, for almost all disease categories. All psychological illness is negatively corelated with socioeconomic status. https://en.wikipedia.org/wiki/Socioeconomic_status https://en.wikipedia.org/wiki/Socioeconomic_status I'd say it's hard to find good sources of nutrition and the time to exercise when you're part of the lower class. edit: negatively correlated...
    - caymanjim 7y ago
      A correlation between economic status and disease does not mean that most of the lower class is depressed.
      - solinent 7y ago
        https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=+socioeconomic+status+depression&btnG= https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=+soc... Also depression. It took me one minute to find three sources, could you please make some effort here? I have other things to do. And you're right, it's not a causative factor necessarily, but I think there's pretty strong evidence at this point, it's hard to find a poor person who doesn't have some condition. [1] https://www.sciencedirect.com/science/article/abs/pii/S0022399902003033 https://www.sciencedirect.com/science/article/abs/pii/S00223... [2] https://psycnet.apa.org/doiLanding?doi=10.1037/0021-843X.111.4.578 https://psycnet.apa.org/doiLanding?doi=10.1037/0021-843X.111... [3] https://ajph.aphapublications.org/doi/full/10.2105/AJPH.93.11.1844 https://ajph.aphapublications.org/doi/full/10.2105/AJPH.93.1...
- simiones 7y ago
  > Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day. If most people had this symptom, you wouldn't see the current movie, gaming, and music sales. Also, sex work would not be a lucrative job, and neither would the leisure industry (except perhaps casinos). > A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down). If an overwhelming majority of people had this symptom, the world would have crawled to a stop by now. One look out the window on a busy street shows that most people are walking around normally, often at a brisk pace. > Fatigue or loss of energy nearly every day. > Feelings of worthlessness or excessive or inappropriate guilt nearly every day. These ones I could grant are extremely common, especially among the working class, and are often encouraged by moder work and management practices. > Diminished ability to think or concentrate, or indecisiveness, nearly every day. If this were true of the vast majority of the population, you wouldn't have any kind of political life outside the elites, you wouldn't have any real amount of productive work, and you wouldn't see any art or creativity from the working class, which is obviously not true. Overall your claim that ~97% of the population suffers from all of these symptoms is simply obviously false. > I'd say most of the lower class has this issue. The lower class is not "in significant distress or impairment in social, occupational, or other important areas of functioning because they have depression-like symptoms. It is the other way around: a lot of them have horrible jobs where they are treated poorly, and that is causing depression-like symptoms (especially fatigue and feelings of guilt). It is not the fatigue that keeps them from living a better life, it is the life they are forced to live by our current economic and societal model that is causing their fatigue. Depression manifests very differently, especially if you are close enough to the depressed person to get a good glimpse into their life. Diminished pleasure or interest does not manifest by being slightly bored while watching TV or listening to soul-less pop. It manifests by sitting alone in the dark, sleep-less, for hours on end. It manifests by simply not feeling powerful enough to get out of bed, regardless of how hungry you are, or of how important your job is for your livelihood. It manifests by crippling guilt and long bouts of crying, regardless of how important for your future it is to greet customers with a smile at Walmart. People with clinical depression rarely hold down jobs, especially if they are untreated. They rarely hold down relationships of any kind. The symptoms described above sound vague, but they are actually very recognizable. Sure, you could say that 97% of the population has something that vaguely looks like these symptoms. But remember that this is a guide for trained psychiatrists, it is not meant for the general public to diagnose others.

0xcde4c3db 7y ago

Most people certainly do not meet all of the criteria you list, especially #2 ("Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day."). I can understand some confusion over #4 ("A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down)."), which can be read as describing ordinary fatigue but is actually about a different pattern called "psychomotor retardation" [1]. [1] https://en.wikipedia.org/wiki/Psychomotor_retardation https://en.wikipedia.org/wiki/Psychomotor_retardation

solinent 7y ago
With epidemology it's hard to tell the difference, there's no identified mechanism for depression or psychomotor retardation. Perhaps they're in the same category? All psychological disease categories are co-morbid with each other. What about existential crises? Do people who have those also have depression?

markroseman 7y ago

Applying the (current for any given time) criteria for depression requires a certain amount of training and skill, and the point form list of symptoms that you see as the first section in each diagnosis in the DSM-5 is not standalone. To mention one huge but often-overlooked example, something isn't a mental illness unless it significantly interferes with your life and functioning. Not to say that people don't incorrectly make diagnoses all the time. Many of these studies also rely on rating scales (typically HAMD or even PHQ9 for depression) that are a measure of depressive symptoms but don't in themselves have the power to make a diagnosis.

solinent 7y ago
> Many of these studies also rely on rating scales (typically HAMD or even PHQ9 for depression) that are a measure of depressive symptoms but don't in themselves have the power to make a diagnosis. This is my point again if you read my original post, thank you. :) I'd go further and say the DSM-V is pretty bad at narrowing down which medication to use for depression. I know so many people on damn SNRIs whose diet is complete trash.
- markroseman 7y ago
  Totally agree on your last point. There's little connection between DSM and treatment guidelines (which do exist, separately). And treatment is so fragmented between multiple care providers (with most people accessing a small subset) that many obvious things get lost. (Caveat: my wife is a psychiatrist. We wrote a book on this: https://mhnav.com/book/ https://mhnav.com/book/)