Major depressive disorder (MDD) is a mental illness defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM provides the diagnostic criteria used by doctors for major depressive disorder (MDD) and all mental disorder diagnoses.

MDD Symptoms

The DSM major depressive disorder (MDD) diagnostic criteria require the occurrence of one or more major depressive episodes. Symptoms of a major depressive episode include the following:¹

• Depressed mood
• Anhedonia (diminished loss of interest or pleasure in almost all activities)
• Significant weight or appetite disturbance (read more about: Depression and Weight Gain, Weight Loss)
• Sleep disturbance
• Psychomotor agitation or retardation (a speeding or slowing of muscle movement)
• Loss of energy or fatigue
• Feelings of worthlessness (low self-esteem)
• Diminished ability to think, concentrate and make decisions
• Recurrent thoughts of death, dying or suicide
• Longstanding interpersonal rejection ideation (ie. others would be better off without me); specific suicide plan; suicide attempt

Additional DSM Major Depressive Disorder (MDD) Criteria

In MDD, the DSM states either a depressed mood or anhedonia must be present. In addition to the above DSM criteria for a major depressive episode, the episode must:

• Be at least two weeks long
• Cause significant distress or severely impact social, occupational or other important life areas
• Not be precipitated by drug use
• Not meet the criteria for another mental disorder like schizophrenia or bipolar disorder
• Not be better explained by bereavement (such as the loss experienced after a death)

Major depressive disorder can be rated mild, moderate or severe. The DSM also recognizes MDD may occur with psychotic symptoms. When the MDD continues for more than two years, the DSM labels it chronic depression or dysthymia.

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Major depressive disorder (MDD) is a very real illness that can cause significant suffering in many life areas including relationships, work, school, participation in daily activities, health, thought patterns, and emotions. In its Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the American Psychiatric Association describes it as the “classic condition” of all depressive disorders. MDD is often what people mean when they use the word “depression.” What, precisely, is meant by this heavy word? Read on to explore what MDD truly is, the epitome of major depressive disorders.

Knowing what MDD is not can help clarify a major depressive disorder definition. People use the word “depressed” loosely and often. Sometimes, it refers to negative feelings but doesn’t truly define MDD. This isn’t a period of sadness or feeling blue. It also isn’t exclusively a response to an event like a break-up, loss of a job, or other temporary, albeit difficult, hardship. The DSM-5 specifies that major depressive disorder is not the same as grief or bereavement.

This is an illness that has mental and physical components, in part because of hormones and neurotransmitter activity and physical changes in the brain that affect the mind and body alike ("What Are the Physical Symptoms of Depression?").  Because it’s so all-encompassing, MDD can be devastating.  

What Makes This Major Depressive Disorder? MDD Symptoms

Major depressive disorder is a type of mood disorder that, like other such disorders, occurs in episodes. People with MDD have periods of normal mood that are punctuated by bouts of serious depression. To be diagnosed with major depressive disorder, episodes must last two full weeks or longer (in major depressive disorder, the episodes typically last months or even years) and involve distinct changes in thinking, feeling, and behaving.

Beyond these criteria, MDD encompasses many possible symptoms. To be diagnosed with major depressive disorder, someone must experience at least five of the following symptoms almost all day, nearly every day, for at least two weeks. One MDD symptom must be the first and/or the second in the list:

• Depressed mood, such as sad or empty
• Loss of interest in activities and people
• Weight loss or gain without trying
• Sleeping too much or too little
• Overwhelming fatigue and loss of energy
• Sense of worthlessness
• Struggles with concentrating and decision-making
• Recurrent thoughts of death or a specific suicide plan

Major depression is also characterized by a pessimistic outlook. Chronic pessimism can create a sense of despair that can be crushing and further intensify the above symptoms.

One difference between MDD and the subjective feeling of being depressed is the degree to which depression impacts someone’s life. A major depressive disorder definition includes the criteria that the illness must cause “clinically significant distress or impairment in social, occupational, or other important areas of functioning. (American Psychiatric Association, 2013). Major depressive disorder isn’t a little annoyance or inconvenience. It’s an illness that lowers someone’s quality of life.

What Is It Like Living with Major Depression?

Major depression affects the entire person: the way they think (cognitive problems), emotions they feel or do not feel, things they do or do not do, and physical sensations. Together, these can make someone feel as though they’re watching their life from a foggy distance and they’re very sad to be just watching; however, they don’t know how to close the distance—and they’re not sure they really want to. MDD is confusing, frustrating, and crushing.

People who have lived with major depression describe problems like:

• Being easily distracted at work or with family
• Lack of motivation from feeling discouraged and hopeless
• Numbness or lack of any feelings at all
• Excessive or even delusional guilt that interferes in healthy relationships
• Frustration over the amount of time and effort even simple tasks take
• Irritability, frustration, and anger that lead to outbursts
• Constant aches and pains, cramps, digestive troubles, and/or headaches that don’t respond to pain killers or other medication and whose cause can’t be identified
• A belief that others would be better off without them and/or a desire to end suffering because the future seems full of more despair. (Help is available for anyone having suicidal thoughts. Get round-the-clock help from The National Suicide Prevention Lifeline at 1-800-273-8255 or https://suicidepreventionlifeline.org/.)

It’s important to remember that everyone is different. No two people with MDD have the exact same symptoms and experiences. Also, the level of impairment someone may experience falls on a spectrum ranging from very mild (it goes unnoticed because the person can hide their symptoms) to so severe it can be classified as a disability ("Is Depression a Disability? Can You Get Accommodations?").

Despite how it may seem to someone living with major depressive disorder, this illness is highly treatable. Depression treatment options include medication, therapy, learning coping skills, and sometimes electroconvulsive therapy (ECT). How your MDD is treated is up to you, your doctor, and/or your therapist. You can overcome major depressive disorder and live fully.

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Dysthymia disorder is a depressive mood disorder. Dysthymia is characterized by longstanding depression symptoms where the patient is depressed more days than not for a period of two years or longer. People who suffer from chronic depression often experience life-long depression. About 6% of people will experience dysthymia disorder at some point in their lifetime.¹

Dysthymia Defined

Dysthymia is defined as having depression most of the day, for most days, for two years or longer. Dysthymia is often called chronic depression due to its duration. For a diagnosis of dysthymia, a person must suffer from at least two of the following dysthymia symptoms:

• Lesser or greater appetite than normal
• Sleep too much (hypersomnia) or too little (insomnia)
• Low energy or fatigue
• Low self-esteem
• Trouble concentrating
• Decision-making difficulties
• Feelings of hopelessness

Dysthymia disorder is only diagnosed when no major depressive episodes have happened during the first two years of the illness and no manic periods are present. Periods of normal mood for up to two months may be present in dysthymia depression.

Signs and Symptoms of Dysthymia

Dysthymia was once considered less severe than major depression, and due to its elongated nature, its diagnosis was often missed. More and more though, clinicians are realizing dysthymia can have major consequences on a person's life and functioning.

Similar to major depression, dysthymia impairs everyday functioning, increases the risk of death from physical disease and increases the risks of suicide. As dysthymia is a depressive disorder, depressed and negative moods are common as well as restlessness, anxiety and irritability. Other dysthymia, or chronic depression, symptoms are:

• Unexplained periods of unhappiness in childhood
• Being overweight / underweight
• Loss of pleasure from activities previously found enjoyable
• Little time spent on hobbies and activities
• A family history of dysthymia
• Effort spent primarily on work and little left for social and personal relationships
• Substance abuse issues
• Increased negative reaction to criticism
• Slowed speech and minimal visible emotion

Risk Factors and Causes of Dysthymia

The causes of dysthymia have not been clearly established but dysthymia appears to share the same biological markers of major depression. In electroencephalogram (EEG) and polysomnogram testing, 25% of people with dysthymia disorder have sleep changes similar to those seen in major depression. Chronic stress and illness are associated with chronic depression (dysthymia) and it seems to run in families, occurring more often in women than in men. Many people with dysthymia have a long-term medical problem or another mental health disorder, such as anxiety, alcohol abuse, or drug addiction.

Dysthymia Treatment

The treatment of dysthymia is similar to the treatment of major depression: both antidepressant medication and psychotherapy are recommended (read more about: Depression Therapy). Therapy combined with medication has been found superior to either medication or therapy alone in dysthymia treatment. Types of dysthymia treatment recommended include:

• Short and long-term psychodynamic (talk) therapy
• Cognitive behavioral therapy (CBT) – individual or group settings
• Interpersonal therapy (IPT) – individual or group settings

Each of these therapies focus on the handling of current problems. Long-term psychodynamic therapy can also help someone with dysthymia get to any issues underlying their chronic depression or other problems, such as substance abuse.

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Clinical depression is the presence of depressive symptoms that rise to the level of major depressive disorder, a mental illness. Clinical depression defines the state in which the depression symptoms must be treated by a doctor.

The causes of clinical depression are not specifically defined. However, as with the causes of depression in general, the causes of clinical depression are thought to be a combination of genetic, biological and environmental factors.

Clinical Depression Symptoms

The signs and symptoms of clinical depression are often first noticed as physical complaints. These physical ailments may be the clinical depression symptoms first presented to a doctor. Physical complaints of those clinically depressed include:¹

• Headaches
• Stomach pain
• Fatigue
• Weight change
• Trouble sleeping

It is only later, generally during a diagnostic interview, that the classic symptoms of clinical depression, such as sadness and a lack of pleasure, become clear. See more on the symptoms of depression.

Clinical Depression Treatment

Treatment for clinical depression is typically begun with the prescription of an antidepressant. Many types of antidepressants are available, but doctors generally use a selective serotonin reuptake inhibitor (SSRI) as the frontline treatment. They include fluoxetine (Prozac), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro). Several medications may have to be tried in order to successfully treat clinical depression. Types of antidepressants other than SSRIs may also be used.

Clinical depression is also treated with psychotherapy, often in combination with medication. Several types of therapy have been shown to be useful. Psychotherapy used in the treatment of clinical depression includes:

• Cognitive behavioral therapy
• Interpersonal therapy
• Family therapy

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The term "atypical depression" suggests this type of depression is unusual when, in fact, it's thought to be quite common. Some doctors feel atypical depression is underdiagnosed, as it may not be as severe as the typical major depressive disorders. Others think those with atypical depression symptoms may have a less severe form of bipolar disorder.¹

As with any type of depression, there is no single known cause of atypical depression. The causes of atypical depression are thought to be both genetic and environmental. Having depression as a child or teenager puts you at higher risk for atypical depression as do the general risk factors for depression.²

Atypical Depression Symptoms

In addition to the typical depression symptoms like extreme sadness, loss of pleasure, fatigue and difficulty concentrating, atypical depression symptoms include mood reactivity. In other words, when something positive or negative happens, the patient's mood responds accordingly. Other atypical depression symptoms include:³

• Significantly increased weight and appetite
• Increased need for sleep
• Feelings of heaviness in the arms or sensitivities of the legs that are unexplained by outside stimuli and may extend beyond the mood episode; results in significant impairment in social or occupational functioning
• Sensitivity to rejection or criticism that impacts work or home life

Two of the above symptoms are required for a diagnosis of atypical depressive disorder. Also, the symptoms must not include melancholic or catatonic depression features.

Other atypical depression symptoms often seen but that are not specifically part of the diagnosis include:

• Relationship conflicts
• Trouble maintaining long-term relationships
• Fear of rejection that leads to avoidance of relationships

Atypical Depression Treatment

Atypical depression is treated in virtually the same way as typical major depressive disorder. This means an antidepressant, like a selective serotonin reuptake inhibitor (SSRI), will likely be prescribed initially for treatment. Other similar antidepressants, like those that target the neurotransmitters (brain chemicals) norepinephrine and dopamine, are also common. You can see a list of antidepressants here. As in major depression, several types of psychotherapy are useful in the treatment of atypical depression (read more about: Psychotherapy for Depression).

The two major things to keep in mind during atypical antidepressant treatment are:

• Any type of bipolar disorder must be ruled-out as the presence of bipolar disorder affects treatment decisions.
• Monoamine oxidase inhibitors (MAOIs) have been shown to be particularly useful in the treatment of atypical depression but these are often not the first choice due to the potential for serious side effects.³

Non-Medical Atypical Depression Treatment

Treatment for atypical depression should always be handled by a medical or mental health professional, but there are things you can do to improve the outcome of atypical depression treatment:

• Always stick to a treatment plan and take medications as prescribed
• Educate yourself about atypical depression
• Pay attention to early symptoms and warning signs of oncoming episodes
• Exercise
• Avoid drugs and alcohol
• Talk to your doctor about adding an omega-3 supplement
• Learn mind-body techniques like yoga or meditation

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Compulsive binge eating tends to isolate the binge eater and decrease their self-esteem, making it less likely that the compulsive binge eater will get help. Binge eating videos can be of help in overcoming compulsive overeating as they offer hope, support and they let the binge eater know that they are not alone. Compulsive overeaters may feel like they are the only one with an obsession with food and that to stop overeating is impossible, but videos on binge eating disorder can show overeaters that others have learned how to control binge eating and they can stop overeating too.

Overeating Videos - What is Compulsive Binge Eating?

Videos on binge eating disorder often use the terms overeating and binge eating, sometimes synonymously. This binge eating video expertly explains the difference between binge eating and overeating.

This binge eating video outlines how critical professional binge eating treatment is to stopping overeating. Dr. Ann Kulze also talks about what drives an average person to binge eat and how to control binge eating. Dr. Kulze strongly recommends exercise as a way to reduce or stop overeating.

Binge Eating Videos - Symptoms and Causes of Compulsive Binge Eating

Compulsive binge eating disorder is known to be primarily caused, or brought on, by extreme stress in a person's life. This binge eating video outlines stress as a binge eating cause.

This is one of many binge eating videos that outline the primary symptoms of binge eating disorder. The three primary compulsive binge eating symptoms are: eating past the point of being satisfied, eating until there is discomfort and being out of control while eating.

Overeating Videos - Binge Eating Disorder Long-Term Effects and Obesity

Videos on binge eating disorder often relate obesity and binge eating disorder directly. In other words, if a person is obese, they must have binge eating disorder and if a person has binge eating disorder then they must be obese. This video on binge eating disorder discusses the link between obesity and binge eating.

The primary long-term effect of binge eating disorder is obesity. This video on binge eating disorder outlines the health hazards associated with binge eating and obesity.

Effects of binge eating include mental, physical and public health problems. This binge eating video details health concerns including:

• The psychological effects of self-medication with compulsive binge eating
• Diabetes
• Heart disorder
• Joint problems
• A nation becoming more obese and needing binge eating help
• An increase in juvenile diabetes

Compulsive Eating Treatments and How to Control Binge Eating (Binge Eating Video)

Psychotherapist Joanna Poppink, M. F. T. discusses ways to stop overeating as part of a series of videos on binge eating disorder by EmpowerHER.

Poppink emphasizes preparing ahead of time for how to control binge eating before the urge to binge strikes. Poppink focuses on calm breathing and waiting for the urge to binge to pass. She explains the concept of "being the ocean and not the wave". She also talks about writing down feelings to help stop overeating.

How to Stop Binge Eating Video

In this binge eating video, Star talks about how to stop binge eating by taking care of yourself.

Eating disorders are mental illnesses that can be life-threatening and should always be taken seriously (more on What Are Eating Disorders). It is critical to know the warning signs of eating disorders so they can be assessed and the identified eating disorder can be treated as early as possible. Many of the eating disorder signs are similar for different illnesses; however, so a professional should always be consulted for an evaluation. (Note: any time eating habits become a problem, an eating disorder specialist should be consulted as they may fall into a less common type of eating disorder.)

The following information is provided as a general list; only a doctor can evaluate and diagnose an eating disorder. You do not have to have all signs of an eating disorder to be diagnosed with an eating disorder.

Signs of Eating Disorder: Anorexia

Physical eating disorder signs of anorexia can be very serious and should be reviewed by a doctor immediately.

They include:

• Gradual or abrupt weight loss that can't be explained by another condition
• Insomnia or excessive sleeping
• Irregular or no menstrual periods (amenorrhea)
• Pale complexion
• Discolored skin and nails (nails are also brittle)
• Dull eyes
• Hair falls out and is brittle
• Bruise easily or are prone to injuries
• Bruises or injuries take longer to heal
• Dizziness or fainting spells
• Feeling tired and run down
• Flat affect (diminishment / absence of emotional response)

Psychological eating disorders signs of anorexia may only be seen by the anorexic herself:

• Being perfectionistic and hard on yourself
• Always trying to please people, never saying "no"
• Black and white thinking; everything is right or wrong with nothing in between
• Low self-esteem
• Attaching self-esteem to the number of calories eaten or weight
• Depression, mood swings, irritability - especially around food
• Feeling out of control / feeling your body is the only thing you can control
• Disbelief in the opinions of others
• Weight determines how you feel on any given day

Behavioral warning signs of an eating disorder like anorexia can often by overlooked, particularly in the beginning. Behaviors include:

• Self-isolation
• Obsessing over calories, weight, food, etc.
• Showing a great interest in reading recipes, cooking shows, cooking for others, etc.
• Wearing baggy clothes (to hide weight loss or because cold)
• Restricting calorie intake until hungry most of the time
• Cutting food in shapes, grouping it in numbers, "playing" with food
• Food rituals (for example, only eating off one, specific plate and only at certain times)
• Avoiding social gatherings and outings where food is involved
• Abusing diet / herbal / laxative pills and other medication
• Exercising compulsively
• Hoarding or sneaking food
• Constantly checking weight
• Searching through books and web pages on eating disorders looking for tips to further weight loss
• Current or past problems with drug and alcohol addiction, stealing, and/or sexual promiscuity
• Overly dependent on others

Bulimia Eating Disorder Signs

Physical signs of an eating disorder like bulimia can be similar to those of anorexia, but may or may not be accompanied with severe weight loss.

• Weight shifts 5-10 pounds frequently which can't be explained by another condition
• Insomnia or excessive sleeping
• Irregular or no menstrual periods (amenorrhea)
• Pale complexion
• Discolored skin and nails (nails are also brittle)
• Dull eyes; eye vessels broken or have blood-shot appearance
• Hair falls out and is brittle
• Bruise easily or are prone to injuries
• Bruises or injuries take longer to heal
• Dizziness or fainting spells
• Feeling tired and run down
• Throwing up blood, stomach aches
• Chronic sore throats
• Frequent headaches
• Knuckles appearing callused and/or are scratched or bruised
• Frequent heartburn, especially after purging
• Swollen throat glands giving the appearance of a chipmunk
• Retaining water
• Hands and breath smelling of vomit

Psychological aspects of bulimia can be devastating, but these eating disorder signs can often be addressed in therapy and include:

• Being perfectionistic and hard on yourself
• Always trying to please people, never saying "no"
• Black and white thinking; everything is right or wrong with nothing in between
• Low self-esteem
• Attaching self-esteem to the number of calories eaten or weight
• Depression, mood swings, irritability - especially around food
• Feeling out of control / feeling that your body and purging food are the only things you can control
• Disbelief in the opinions of others
• Weight determines how you feel on any given day
• Feeling worthless after eating a certain number of calories or after gaining weight
• Feeling like you don't belong

Behavioral eating disorder signs in bulimia are most easily seen by the bulimic themselves.

• Repeatedly forcing yourself to purge
• Self-isolation
• Obsessing over calories, weight, food, where/when you can binge/purge, etc.
• Severely restricting calorie intake during the day and secretly bingeing at night
• Wanting to always eat alone
• Avoiding social gatherings and outings where food is involved
• Abusing diet / herbal / laxative pills and other medication
• Exercising compulsively
• Hoarding food
• Constantly checking weight
• Searching through books and web pages on eating disorders looking for tips to further weight loss
• Current or past problems with drug and alcohol addiction, stealing, and/or sexual promiscuity
• Continually going on "diets" and sticking to diet foods until bingeing

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If you are wondering "Do I Have an Eating Disorder?," taking the Eating Attitudes Test or a shorter eating disorder quiz may provide helpful information you can share with your doctor or therapist.

Discover why many people with mental illness, especially schizophrenia and bipolar disorder, are susceptible to diabetes. Plus why many diabetics develop depression.

"I see a lot of diabetes in my clients." exclaims Dr. William H. Wilson, Professor of Psychiatry and Director of Inpatient Psychiatric Services at Oregon Health & Science University.

A simple statement that means so much. Considering that Dr. Wilson is a psychiatrist who works in psychiatric wards, you would not think that diabetes would be such a concern. In the past, the treatment goal was often to minimize psychiatric symptoms first and if the person was lucky and had access to more general care, the physical body second. This has all changed in the past few years.

Mental health professionals and organizations now know that there can't be a separation between a brain and body when it comes to effective psychiatric treatment. This connection has been ignored for too many years and the result is a higher death rate for those with psychiatric disorders from the illnesses associated with metabolic syndrome- including diabetes. Luckily, times have changed. New research has opened the way to more awareness as to what must be done, as well as more education for those with mental illnesses and the people who care about them.

Blood Sugar and Moods

There are varying opinions in the mental health profession regarding blood sugar and its effect on mood. Most agree that blood sugar can affect depression, as improving blood glucose levels seems to make a person feel better. And yet, when it comes to bipolar disorder and schizophrenia, there is little research that blood sugar affects the mania, depression and psychosis found in the illnesses.

Dr. Wilson notes, "I do see a difference in blood sugar levels and depression, but I have not seen a case that controlling blood sugar helps bipolar disorder or schizophrenia."

On the other side, those who approach mental health from a holistic perspective believe that dietary imbalances are an integral part of mental health diagnosis and management; no matter what the psychiatric disorder. Julie Foster, a nurse practitioner in Portland, Oregon notes, "Everything a person eats affects all aspects of physical and mental health and thus a dietary and supplement plan that stabilizes the mood plays a large role in psychiatric disorder treatment."

Another complication is that the fatigue that often comes from blood sugar fluctuations can be seen as depression. For now, the role that blood sugar plays in psychiatric disorders is not conclusive. Dr. Andrew Ahmann, Director of the Harold Schnitzer Diabetes Health Center at Oregon Health and Science University, provides this explanation: "I don't think there has ever been evidence that if you improve blood glucose levels, you reduce mental illness symptoms, but if you go the other way and improve the depression that can come with diabetes, you do improve blood glucose. When people are faced with a diabetes diagnosis, this can lead to depression as they feel a lack of control. I don't think it's the glucose levels. I think it's overstated when people talk about the role of blood sugar and moods from a mental health perspective."

The debate about the role of blood sugar and moods continues, as there are so many differing views among researchers and other healthcare professionals. However, there is one thing that all mental health professionals can agree on: reducing fat and sugar in order to maintain a healthy weight and balance blood sugar levels is always a good idea. There's also agreement that having a healthy body certainly helps improve mood. People who are healthy always feel better than those who eat too much and lead a sedentary lifestyle. The challenge is helping those with psychiatric disorders make needed changes.

The Relationship Between Diabetes and Mental Health, Part I

ED. NOTE: This section on Diabetes and Mental Health includes information from interviews with:

• Dr. William Wilson, M.D. Professor of Psychiatry and Director, Inpatient Psychiatric Services Oregon Health and Science University
• Dr. Andrew Ahmann, Director of the Harold Schnitzer Diabetes Health Center at Oregon Health and Science University

and the research of Dr. John Newcomer, Department of Psychiatry, Washington University and Dr. Peter Weiden, Department of Psychiatry, the University of Illinois at Chicago.

A Picture of a Depressed Child

In major depression, a child with no other psychiatric problems suddenly becomes depressed, sometimes for little or no reason. Sometimes their sleep is disturbed. They are not hungry, have no energy, are afraid of all sorts of things, think life is hopeless, can not concentrate at all, are less social and are very irritable.

Examples of Clinical Depression in Children

4-7 years old

Sara is 5. She has been in preschool all fall and overall, she enjoys it and does fairly well. After Thanksgiving, she seemed to become less and less excited about pre-school. She thought the others were bugging her. She didn't want to go some days, but her parents made her. At home, it was the same. Nothing was right. When bedtime came, she couldn't sleep and wanted to sleep with her mom. She lost interest in playing with her cousin. She didn't get even get that excited about Christmas. She started telling her parents, "You don't like me". When they took her out to McDonalds, she liked it, but she was never enthusiastic like she used to be. Her mother would notice her sitting in a chair with a horrible look on her face doing nothing.

7-12 years old

Ryan is 11. He is in 4th grade and has always been an average student. Of their three children, he gave his parents the least cause for concern until these last few months. It started with him calling home from school to talk with his mom or dad. He just wanted to tell them what was going on. It was never good. He was worrying about passing, even though he was doing fine. Then he started saying that he just couldn't do the work. When his parents would ask why, he would just get mad and tell them they didn't understand. He refused to play hockey in the winter. He wouldn't go hunting with his Dad. The only thing he did was go to scouts and watch TV. So his parents decided to start restricting the TV. Ryan told them that if he couldn't watch TV, he might as well just die. They didn't take it seriously. He was sleeping all day, eating constantly and failing in school. His friends no longer came around. One day his father went to use the bathroom and didn't realize Ryan was in there. He wasn't using the toilet. He had a bunch of pills poured out on the sink.

13-17 years old

Tessa is 15. When she was 13, her parents remembered her being a little irritable and to herself, but it was nothing like it is now. Whenever they say anything to her, she returns it with some nasty comment. It is very hard to live with. Tessa has stopped going out very much. She sits in her room with the door locked and listens to music. Sometimes she slams things around in there. Before, Tessa would usually be asleep by 10:30 at the latest. Now she is up later than her parents. Sometimes her mother will come in and ask her if something is bothering her. "What's bothering me?" "Do you really want to know?" Yes, her mother did. So Tessa told her. Tessa felt she was the dumbest, ugliest, most useless piece of crap that God had ever made. She hated herself, her family, and her friends. She told her mother she just wished she could die and then starting crying for about an hour while her mother held her.

More comprehensive information about Child Depression Symptoms.

Dysthymia in Children

This is a milder depression that goes on for years at a time. Children and adolescents with Dysthymia often have been depressed so long that they can not recall what not being depressed is like. People think it is part of their personality. Typically they are irritable, hard to please, unhappy with nearly everything and very trying to be around. They tend to have fewer problems with sleep and appetite than children with major depression. To have this disorder you must be depressed or irritable for at least a year straight with at least two of the following:

1. poor appetite or overeating
2. insomnia or excess sleeping
3. low energy or fatigue
4. low self esteem
5. poor concentration or difficulty making decisions
6. feelings of hopelessness

Children with dysthymia often can still enjoy some activities. Children with dysthymia are at a very high risk to get MDD. Over 70% of dysthymic children will get severely depressed, and 12% will get manic depressive disorder. Rather than recover, they often go back to their dysthymic selves. A long episode of Dysthymia will mess up a child's life far more than a brief episode of severe depression.

continue: Double Depression and Psychotic Depression in Children

Examples of Dysthymia in Children

4-7 years old

Lynn's parents didn't really notice anything unusual about her until they had another child when Lynn was 2 years old. Now Lynn is 5 and Andrew is 3. Andrew gets excited about stuff. He is enthusiastic about life. He is happy when he can do something new and he is excited to tell everyone. Lynn, on the other hand, never gets that excited about anything. If everything is going exactly her way, she is happy. the rest of the time, which is mostly, she is upset at someone or something for ruining her day. Most things seem to be an effort for her. She would spend endless hours watching TV if her mother let her. When Andrew watches TV, he is sometimes interested or bored or scared. Lynn is just vacant. Lynn is the same way with other children. Her parents hate to compare, but Lynn is a hard child to love. She is so hard to please and so rarely upbeat about anything.

7-12 years old

Daryl is 9. He spends a fair amount of time thinking about the good old days. For him, this was when he was in grade primary and grade 1. Then life was fun. School was easy, there was nothing to worry about and he was happy. He goes for walks and wishes he was in grade 1 again. Now life is not to good. School is hard for him. Many days he tells the teacher that he just can't do the work. His teacher encourages him to try and lots of time he can, but he is very tense the whole time. One night out of the blue he asked his mom what it was like to be 35 years old. She said it was pretty good. Daryl couldn't imagine living that long. "You know, mom, I don't think I can live that long. Life is so hard and there is so much work." His mother was so stunned she forgot to remind him to eat his dinner.

13-17 years old

Yvette is 16. She saw a school counselor and the counselor asked how long she had been feeling blue. Yvette looked at the calendar. "Only 16 years, 4 months, and 14 days", she said. Yvette could never remember feeling happy for more than a few days at a time in her whole life. Not that you would usually notice it. At school she did her work, had some friends, and participated in the church youth group. She tried very hard to make her face look like the others. At home, she let down her guard. She was usually exhausted. She could come home from school and sleep two hours and go to bed at 9:30 and sleep all night. If her parents let her, she would just sit in her room and read to try and not think about everything. The main thing she thought about was what could she do to make herself really happy? She had decided that if she could just find the right guy, maybe she would be happy. Sure, she thought, but who would want a dirtball like me?

Double Depression in Children

Many children with dysthymia will go on to develop episodes of major depressive disorder. When they do, their episodes of depression plus dysthymia are more serious. The illness lasts longer, is more severe, they are more disabled, and these children more likely to kill themselves.

Example of Double Depression in Children

Martin is now 14. About the time he started school, he became a little more irritable and not quite as easy of a child as he had been before then. At about age 10, he worsened just a little more. It took more push on his parents part to get him to go do stuff. He almost always had trouble sleeping and was quite irritable most days. Sometimes he would have a few good days back to back. One time, his mom decided that she was going to enjoy this good day herself. She pulled Martin out of school for the day and they went and did all sorts of fun things. She is so glad she did that. Now there are almost no good days. His self esteem has gone right down the tubes. He is losing weight. He can't sleep. He is doing worse and worse in school because he can't concentrate..

Martin first had a few symptoms of depression, but not even dysthymia. Then he developed dysthymia. Now he has full Major Depressive Disorder.

Psychotic Depression in Children

Some children will develop signs of psychosis along with their depression. A child might have hallucinations. The child might be very paranoid. The child might develop all sorts of bizarre and unusual ideas. Psychotic Depression is the most serious type of depression. It is also quite uncommon..

Example of Psychotic Depression in Children

Shelly is 14. Since Christmas, she has not been herself. She knows she is no good. She tells her parents that everyone hates her and says bad things about her. They call her all sorts of obscene things and she doesn't want to go to school anymore. She wants to just get away from them forever. At home she just eats, sleeps, listens to music and occasionally irritates her sister. So her mom decided to go to school and see what was going on. Amazingly, no one had noticed any teasing, but they had noticed that Shelly was much more withdrawn and inattentive in school. The next day she was able to get Shelly to come with her and go shopping. As they went in mall, Shelly was telling her mom, "Do you see what I mean? Listen to those two girls over there." Shelly couldn't stand it more than a few minutes. She pointed out to her mother a couple groups of kids who were saying bad things about her and talking behind her back. She noticed that they had scratched "Shelly sucks" on the window. Shelly's mom did not see or hear any of this. Shelly's mom saw something far worse. She saw that her daughter was very, very ill.

continue: Bipolar Disorder and Seasonal Affective Disorder in Children

Comorbid Depression in Children

Comorbidity means that certain disorders occur more often together than one would expect by chance. For example, diabeties and obesity. The concept of comorbidity is very important in psychiatry. It is very common that a person with depression will also have another childhood neuropsychiatric disorder.

In this situation, a child has a preexisting chronic psychiatric illness and then becomes depressed. The episode of depression occurs along with the other disorder so that the child actually shows signs of two or three psychiatric disorders at the same time. About 50% of children with depression also have conduct disorder or oppositional defiant disorder, 40% of children with depression have anxiety disorder, and 25% of children with depression have attention deficit disorder. Often the episode of depression will go away and leave the other psychiatric problem unchanged.

Bipolar Depression in Children

In this case, children have episodes of depression, some episodes of wellness, and also some episodes of mania, which is the opposite of depression. The depression looks pretty much the same as above. Sometimes children are depressed and manic at the same time. (Read more info abuot bipolar disorder in children)

Seasonal Affective Disorder (SAD) in Children

It has become clear in the last few years that some children have depression only in one season, usually winter. It starts to worsen in late October and reaches its peak in January. By March things are usually on the mend. This can be extremely disabling, as this is usually when the hardest school work is.

Approximately 3-4% of school-age children have SAD disorder. There are many studies to show that light boxes can help adults with this condition. There are also studies in which this technique is used in children. This usually means sitting in front of a specially made light box and doing something for about 30 minutes five times a week. These boxes are not hard to make or purchase. Unfortunately, children are sometimes not compliant with them. Another technique is a dawn simulator, which is a light which gets steadily brighter, mimicking a spring or summer morning.

A food and mood diary is one of the best and easiest ways to keep track of how food affects your moods. Exactly as it sounds, a food and mood diary (aka food and mood journal or chart) is used to track the foods you eat and document what impact they have on your mood.

What Does a Food and Mood Diary Look Like?

Despite the word diary or journal potentially making it sound like a super laborious endeavor, they’re actually pretty simple to use. A food and mood diary provides space to write down what you’ve eaten at given parts of the day and then record how you feel afterward.

A quick browse online will show you that various other pen-and-paper diaries have a few different options. Some look like standard charts where you write down the time you ate, what you ate, and then how it made you feel, as well as any other thoughts you might have. Others are as simplistic as a table dividing meal times and days of the week with a space to put what you’ve eaten and then the option to indicate whether the food made you feel good or bad.

There are also apps you can download onto your smartphone or tablet. Searching “food and mood tracker” or “food and mood diary” brings up several options to choose from that work on the same premise as traditional paper journals. Try them out and find one that works best for you.

One site recommended waiting an hour before logging how each food item has made you feel, presumably to allow time for the digestion process to kick in.

How Does a Food and Mood Diary Help Mental Health?

Using a food and mood journal or chart will help you start to notice patterns in how the foods you’re eating might have a greater impact on your mental health. While you can try to keep track of that information in your mind, having something in writing comes in handy so you don’t forget information along the way.

Because of the effects food can have on your mental health, it’s good to know the best foods for mental health; which foods hurt and which foods help your mental health. The food and mood diary, then, is a great tool allowing you to have data on which foods to have more of and which ones to avoid or only have in moderation.

Not only can this help improve your mental health in the time surrounding the food consumption, but it will help create better eating habits to improve mental health in the long-run as well.

Where to Get a Food and Mood Diary

As mentioned above, there are a few apps that can be downloaded to a smartphone or tablet. You can find them by searching for “food and mood diaries or trackers”. Here are 3 food and mood diary apps that seem to be very popular.

1. MyFitnessPal
2. MySymptoms Food and Symptom Tracker
3. FoodUcate

Other than that, there are several free food and mood journal templates online that can be found by using the same keyword search. You can print them or make your own based off what you find. If you’re going on this food and mood journey with your doctor, check in to see if he or she has any recommendations of diaries, charts, or journals to try.

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