Am I depressed?: The answer is best discovered through collaborative dialogue with a therapist instead of a symptom checklist 

It’s reasonable for someone to want to know: Am I depressed? What are the symptoms of depression? Many people assume that a diagnosis of depression is clear and definitive. They imagine that a therapist simply knows what questions to ask and, then, gives a clear answer, much like a doctor would diagnose strep throat or a broken clavicle. Yes, there are specific diagnostic criteria for depression, but they’re somewhat vague and largely hang on the lived experience of a patient.

Because of this, there should be some caution in defining the symptoms of depression too narrowly. In practice, the question of “Am I depressed?” is defined much more by a collaborative dialogue with a therapist than a symptom checklist.

Depression symptoms are not all the same

One of the reasons why simply ticking the boxes of depression symptoms can be so complicated is that many depression symptoms are counterintuitive or present as opposite from person to person. For some, depression causes them to eat all the time; for others, it takes away their appetite. There is a similar phenomenon at work with sleep. Some people with depression feel like sleeping all day. Others struggle with sleeping at all. And yet others endure day-night inversion where depression keeps them awake at night and exhausted during the day.

Depression is not just sadness

Depression is often discussed as a kind of extreme or prolonged sadness. It can be but isn’t always. Depression is frequently experienced more as a kind of numbness—less an intensely sad feeling and more like a blockage of sad feelings altogether. In fact, the solution to depression may very well be sadness itself.

Irritability and anger are depression symptoms that get overlooked (even by therapists)

Irritability and anger are symptoms of depression that tend to be dismissed as aspects of personality. To put it kindly, a person with these symptoms is often seen as simply a jerk. These symptoms of depression are overlooked exactly because they’re unpleasant. Spouses and therapists alike don’t like dealing with these symptoms and it takes a certain kind of work to receive irritability or anger with curiosity.

However, when irritability or anger are considered as a part of a broader affective process of depression, we can see them as difficulties in tolerating pain, discomfort, annoyance, or distraction. In other words, they are secondary symptoms of a struggle to feel okay. 

People may not even realize they are depressed 

As much of a struggle as depression can be, people can also get used to the experience, losing a sense of baseline in the process. In fact, they may not even be aware that they’re depressed since this emotional experience has become so normalized. In these cases, depression is often misunderstood as a lack of motivation or laziness.

Almost always a realization that depression may be at work comes when someone else suggests this to them—someone who is willing to look beyond characterological or moral explanations and consider the pain that might underlie their behaviors. This tends to be a therapist. For instance, a college student presents with a struggle to complete work and has poor grades relative to her capacity. The tool that helps the underlying depression be discovered is compassionate curiosity. What might be going on underneath what is readily apparent?

The bigger question: Is depression a useful way to understand what is happening to me?

Rather than trying to identify if all the symptoms of depression line up with a given experience, there are more meaningful questions to consider with a therapist. Is depression a useful way to understand what is happening? Does it ring true? Does deciding that you’re depressed or that you’re suffering from depression help both you and a therapist approach the (far more important) question of how to help you feel better

These questions are much more helpful because they avoid getting stuck in the matter of description (“Am I depressed?”). Instead, the project in therapy is to co-create an understanding towards the goal of actually feeling better, getting better, and having a more meaningful life. We so easily get stuck in the diagnostic questions at the expense of curative questions. It is the therapist’s job to ask better questions and relate to the “local truth” (i.e. the experience of the patient in front of them) as more important than appealing to a so-called “objective truth” (the DSM-V).

Matt Lundquist headshot

Meet our founder and clinical director, Matt Lundquist, LCSW, MSEd

A Columbia University-trained psychotherapist with more than two decades of clinical experience, I've built a practice where my team and I help individuals, couples, and families get help to work through difficult experiences and create their lives.

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