Depression vs Clinical Depression – Everything You Need to Know

Clinical Depression (aka, “Major Depressive Disorder”): a mood disorder that causes severe symptoms affecting how a person feels, thinks, and manages daily activities (sleeping, eating, working, etc.). To be diagnosed with depression, symptoms must be present for at least two weeks.

Situational Depression (aka, “Reactive Depression”): short-term, stress-related depression that can develop after a traumatic event or series of events. Situational depression is an adjustment disorder that makes it hard to resume daily life following a traumatic event.

This article was medically reviewed by Dr. Troy Noonan, MD Psychiatry. Dr. Noonan received his M.D. from Finch University at the Chicago Medical School, Psychiatry Residency and fellowship at the University of South Florida (USF) College of Medicine. He is Certified by the American Board of Psychiatry & Neurology.


Depression vs Clinical Depression – Introduction

This article is a complete Depression vs Clinical Depression comparison, including history, definitions, symptoms, treatment options, and much more. 

Sadness is a normal part of life. Periods of sadness can follow traumatic experiences, like the death of a loved one, the loss of a job, or a debilitating accident. 

But what is the difference between periods of sadness and an episode of clinical depression? What are the other symptoms of clinical depression, and when should you start looking for treatment options? More importantly, can short term depression make you more prone to clinical depression, and, if so, how?

This article answers these questions and reveals how modern doctors are safely and effectively treating depression without medication. 

NOTE: Throughout this article, you will find the terms “clinical depression” and “major depression disorder” used interchangeably. You’ll also find the terms “depression,” “reactive depression,” “low-grade depression,” and “situational depression” used to describe non-clinical depression. 

Depression vs Clinical Depression – History, Symptoms, and Types

Clinical depression is a term used in psychology to describe the most common mental illness. According to the Centers for Disease Control (CDC), depression is one of the leading causes of disability worldwide. More than 264 million people in the world (from all age groups) suffer from depression, including 16 million American adults suffering clinical depression. 

A Brief History of Depression

Ancient (BCE) Mesopotamian writings seem to be the first historical references to depression, where it was associated with their idea of demonic possession. This led to the condition being dealt with by priests instead of physicians. This idea was present in many cultures of the ancient world, including Greece, Rome, China, Egypt, Babylon, just to name a few.

Ancient “treatments” sought to exercise the demons through everything from torture, to starvation, to imprisonment and banishment. Other treatments resemble those that are still used today, including gymnastics (similar to modern westernized Yoga), herbs, music therapy, massage, and diets. The famous Greek Physician Hippocrates referred to the illness as “Melancholia,” and theorized that it was the result of an imbalance in “humors” which included: blood, black bile, yellow bile, and phlegm. Specifically, Hippocrates believed Melancholia to be caused by excess of black bile in the spleen. This led to dangerous treatments like bloodletting, but also to treatment through exercise and diet. 

The letters of the Roman statesman Marcus Tullius Cicero (106-43 BCE) reveal physical and emotional symptoms that seem consistent with the modern idea of clinical depression. 

According to the letters, Cicero’s episodes of depression severely impaired his family relationships and his relationships with colleagues. Cicero believed that the condition was caused by rage, grief, and fear. Interestingly, Cicero’s view of depression as a psychological disease and Hippocrates’s biological view mirror the two main viewpoints taken by biologists and psychologists today. Those with a biological view of depression favor biological treatments like medication, while psychologists favor psychological methods like talk therapy. 

In the 5th Century, as Rome began losing power, spiritual theories about mental illness began to reemerge. The mentally ill were considered to be either possessed by demons, cursed by witches, or practitioners of witchcraft themselves. This led to theories about mental illness being contagious, and the belief that mentally ill people needed to be confined to asylums and even tortured as a means to exercise the demons.

Still the theories of Hippocrates and Cicero persisted and were being practiced by physicians of the Middle Ages. In the 14th and 15th Century, as the Renaissance began to spread throughout Europe, debate heated up between the superstitious theories of mental illness and the more scientific theories. In 1621, Robert Burton published his work Anatomy of Melancholy, where he described the psychological and social causes of depression. His theories about social causes included references to fear, poverty, and social isolation. Burton recommended treatments like diet, purgatives (cleansers to purge toxins from the body), bloodletting, herbs, music therapy, exercise, and travel.

In spite of Burton’s more objective and human approach to the subject, those with depression and other mental illnesses continued to be subject to inhumane treatment methods, including starvation, incarceration, and even lobotomy and electric shock therapy.  Thankfully, modern medical professionals have a better grasp on depression and the treatments have become much safer, more effective, and more humane. Still, depression remains one of the most common mental illnesses in the world. 

Depression Symptoms and Types

The most common symptoms of depression include:

Before we dive into our Depression vs Clinical Depression analysis, let’s cover a few names used to describe different types of depression (which can be found in the DSM-5). These symptoms mentioned above can be manifested in someone suffering from any of the following types of depression:

Winter Depression (aka, “Seasonal Affective Disorder”) is when depression occurs during winter months, during times of low natural sunlight. This type of depression is typically coupled with weight gain, social withdrawal, and excessive sleeping. Winter depression usually goes away during spring and summer, but often recurs during the winter.

Premenstrual Dysphoric Disorder (PMDD) a more severe form of premenstrual syndrome (PMS), characterized by depression, extreme irritability, or anxiety during the week or two before menstruation. Symptoms of PMDD typically go away a few days before the start of a woman’s period. 

Dopamine and Depression

Postpartum Depression is when major depression disorder occurs during pregnancy or after delivery, characterized by feelings of extreme sadness, exhaustion, and anxiety. Postpartum depression can make it challenging for new moms to care for their babies or return to their normal lives.

NOTE: Postpartum depression is more serious and persistent than “baby blues,” which is characterized by mild depressive and anxiety symptoms that clear up within a few weeks.

Persistent Depressive Disorder (aka, “Dysthymia”) is when a person’s depressed mood persists for two years or more. Persistent depressive disorder may be coupled with less severe symptoms of major depression disorder. 

Psychotic Depression is when a person experiences symptoms of major depression disorder coupled with some form of psychosis. Psychosis being false and fixed delusions, auditory or visual hallucinations, or theme-based delusions (based on specific things like guilt, shame, illness, or poverty).

Dysregulation Disorder is a pediatric mood disorder (diagnosed in children and adolescents) which is characterized by outbursts of severe anger. These outbursts make it hard for the child to function in social settings. 

Bipolar Depression is when people with bipolar disorder experience periods where their mood meets the criteria for clinical depression. These episodes of depression occur between periods of “mania,” when the bipolar person experiences a heightened mood of either euphoria or irritability. 

Depression vs Clinical Depression – DSM-5 Diagnosis

The following description comes from the DSM-5 Diagnosis guidelines for Major Depressive Disorder:

– START OF DSM-5 GUIDELINES –

Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. 

  • Depressed most of the day, nearly every day as indicated by subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful).
  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by subjective account or observation)
  • Significant weight loss when not dieting or weight gain (e.g., change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day
  • Insomnia or hypersomnia nearly every day 
  • Psychomotor agitation or retardation nearly every day (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 (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

ADDITIONAL NOTES FROM DSM-5 GUIDELINES:

  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The episode is not attributable to the physiological effects of a substance or to another medical condition.

Note: The above criteria represent a major depressive episode.

  • The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
  • There has never been a manic episode or a hypomanic episode.

Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance induced or are attributable to the physiological effects of another medical condition.

– END OF DSM-5 GUIDELINES –

As you can see, the diagnosis of clinical depression is based on the symptoms of the condition, not the triggering circumstances. Depression can start out as Postpartum Depression and be diagnosed as Clinical Depression. The same can happen when depression is triggered by other events, including job loss, divorce, debilitating accidents, death of a loved one, etc. 

In addition to these diagnosis guidelines, the following terms are also used to describe a patient’s various experiences with depression:

  • Episode: a time period where a person experiences depressed mood and other depression symptoms. In the context of major depressive disorder, an episode can last two weeks or more. Some depressive episodes can last weeks, months, or even years.
  • Recovery: in the context of clinical depression, recovery is when a person goes a period of time without experiencing an episode of depression. This time period is defined more clearly in the definition of remission below.
  • Remission: defined by American Psychiatric Association as a period of two months or more without major depressive symptoms.
  • Relapse (aka, “Recurrence”): a recurrence of major depression symptoms following a period of remission. 

Depression vs Clinical Depression – Treatment Options

Clinical Depression is commonly treated using medications called antidepressants. Some of the most popular antidepressants include:

ADD in Adults Medication

These antidepressants act on certain neurotransmitters to alleviate the symptoms of depression. Neurotransmitters are specialized chemicals that control everything from mood, hormone release, muscle movement, and gland activation.

Neurotransmitters come in two basic types: excitatory, and inhibitory. Excitatory neurotransmitters may be considered your “get up and go” chemicals. They initiate brain signals that cause increased activity in your brain and nervous system. 

Norepinephrine (aka, “noradrenaline”) is an excitatory neurotransmitter that energizes your brain and nervous system. Norepinephrine can cause euphoric feelings and is associated with hyperactivity, heightened blood pressure, and anxiety (panic) attacks. 

Low norepinephrine levels can cause depression-like symptoms, including lack of concentration (brain fog), and lethargy. It can also cause ADHD (attention deficit hyperactivity disorder). This is why some antidepressants (TCAs, Bupropion, MAOIs) are designed to increase norepinephrine levels. 

On the other hand, inhibitory neurotransmitters may be considered your “rest and relax” messengers. Inhibitory neurotransmitters block brain signals for the purpose of decreasing brain and nervous system activity. GABA, for example, is an inhibitory neurotransmitter that blocks or slows certain nerve signals, taming the “fight or flight” functions of the nervous system. Decreased GABA levels can lead to mental health problems, including anxiety disorder. 

The interaction of inhibitory and excitatory neurotransmitters work to stabilize and harmonize your “fight or flight” and “rest and digest” functions. Imbalances in neurotransmitter activity can lead to prolonged anxiety, hypervigilance, depression, etc. Antidepressants act on certain neurotransmitters to eliminate or reduce these symptoms and provide relief from the symptoms of clinical depression. 

However, 33% of the people who take antidepressants to treat depression will continue to experience symptoms. 

"Usually an antidepressant that's worked for a patient will keep working. But sometimes, a new episode of depression might come up that's not as responsive to that medication, or the medication might just stop working altogether."

-Paul Nestadt, M.D., psychiatrist and co-director of the Anxiety Disorders Clinic at Johns Hopkins Tweet

This is called “treatment-resistant depression” (TRD) or “refractory depression.” Treatment-resistant depression lasts months or even years. Antidepressants can also come with side effects including weight gain, nausea, insomnia, dry mouth, drowsiness, erectile dysfunction, tremors, constipation, etc. This combination of factors is motivating some people to look for ways to treat depression without medication, which we’ll discuss in a moment.

Measuring Response to Depression Treatments

Two of the most common and widely accepted instruments for measuring response to depression treatment include:

#1 – The Hamilton Rating Scale for Depression (HRSD): administered by a trained clinician to quantify the change in depression symptoms using seventeen items that use a three- or five-point scale, with the scores of all seventeen items added up to determine the total score. The HRSD is useful for cognitively impaired patients who might have problems self-reporting. 

TMS Therapy and PTSD

 

READ MORE: Hamilton Rating Scale for Depression

#2 – Geriatric Depression Rating Scale (GDRS): is a thirty-five item scale that combines the severity rating format from the HRSD with the content of the Geriatric Depression Scale (GDS). The GDRS is considered to have good psychometric properties for testing hospitalized, outpatient, or community-dwelling elderly people. 

A “response” to depression treatment is defined as a 50% or greater reduction in symptoms (as measured on the HRSD). Scores of 25-50% are considered a “reduction” in symptoms. 

When Antidepressants Fail

There’s no solid consensus on why antidepressants medications sometimes don’t work or why they can suddenly stop working. Here are some common speculations which we discuss in detail in another article:

Sometimes, medications help to relieve the symptoms of clinical depression. However, about 33% of such cases result in no improvement, or a relapse of symptoms. The good news is, modern doctors are treating depression without medication using a safe and effective FDA approved technology. 

Depression vs Clinical Depression –Medication Free Treatment

Most of the online information about treating depression without medication reads like generic self-help advice. But clinical depression is a very real biological illness, and those suffering from it deserve scientifically sound treatment options. 

Transcranial Magnetic Stimulation (TMS) is one such treatment. TMS is one of the safest and most effective methods for treating depression without medication. It was FDA approved in 2008 treating clinical depression and in 2018 for treating OCD (Obsessive Compulsive Disorder). TMS is not to be confused with ECT, as we explain in detail in our TMS vs ECT article. TMS uses magnetic fields (similar to those used in MRIs) to stimulate blood flow in the prefrontal cortex and promote neurotransmitters that play a role in depression. 

According to controlled clinical studies, 83% of Neurostar TMS patients see a positive response using TMS therapy. The clinical trials also showed TMS to have a 11% relapse rate across all patients, which is a lower rate than any other depression treatment.

Only 37% of TMS patients needed additional TMS, and 85% of these patients re-achieved clinical benefits. Unlike antidepressant medications, TMS doesn’t subject patients to a long list of negative side-effects.

Common Side-Effects of TMS Therapy

  • Scalp Discomfort: fleeting discomfort in the head or scalp where the TMS pulses are applied.
  • Facial Twitching: slight movement of the eyelid or jaw during stimulation. This happens because of superficial nerve branches and muscle groups being stimulated.
  • Headaches (non-migraine): sometimes reported after TMS treatment sessions. This is particularly common early during the treatment and typically decreases as the treatment progresses.

Rare Side-Effects of TMS Therapy

  • Manic or Hypomanic Symptoms: induction of manic/hypomanic symptoms (e.g., irritability, agitation). Most doctors put TMS therapy on pause until these symptoms have resolved, which they usually do.
  • Decreased Auditory Acuity: this can be avoided by wearing ear protection like foam earplugs. Most doctors require patients to wear earplugs during TMS treatments.
  • Syncope Vasovagal Response: a medical term for fainting or passing out, usually caused by temporary drop in blood flow to the brain. Other causes can be heightened anxiety, hypoglycemia, hyperventilation, or dehydration.
  • Seizure Induction: this is extremely rare during TMS (estimated 0.001%, or approximately 1 in 89,000 TMS treatments) and related to the motor cortex’s direct stimulation or stimulation of adjacent brain areas with the spread of neuronal excitation to the motor cortex.

TMS treatment sessions are non-invasive, require no medications or sedatives, and convenient enough to be done during a patient’s lunch break, after which they can return to their normal work day. TMS treatment cycles typically last six to eight weeks, with five 20-minute treatments per week.

“Transcranial magnetic stimulation has shown its potential to help patients suffering from depression and headaches,” said Carlos Peña, Ph.D., M.S., director of the Division of Neurological and Physical Medicine Devices in the FDA’s Center for Devices and Radiological Health. “With today’s marketing authorization, patients with OCD who have not responded to traditional treatments now have another option.”

-Carlos Peña, Ph.D., M.S., director of the Division of Neurological and Physical Medicine Devices in the FDA’s Center for Devices and Radiological Health Tweet

Anyone who wants a safe, effective way to overcome clinical depression without medication owes it to themselves to learn more about TMS. Mental Health Management Group is here to help. Mental Health Management Group’s doctors have practiced medicine since 1996. They have worked with hundreds of patients suffering from depression and other mental illnesses. 

They can also help you with the complicated process of meeting the TMS qualifications for your major insurance provider. To see if you or a family member qualify for TMS treatment, please fill out the patient referral form and one of our practitioners will call you. Life is too short to be weighed down by depression. Get your life back, contact us today. 

This concludes our analysis of Depression vs Clinical Depression. 

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