You’re Not as Depressed or as Anxious as You Think You Are – Part I

I’ve been saying this for a long time. Maybe you are not as depressed or anxious as you think you are. Surely, in my clinical opinion, for what it’s worth, you’re not that depressed or that anxious that you require medication.

You see, when I studied depression and anxiety almost 30 years ago, life was a lot different. Depression was a “mental disorder” we studied in “Abnormal Psychology”. Incident rates were expected to be less than 7% of the population. If you ask people today, 70% of the population is depressed!!

But what we are dealing with today, is not the depression I studied 30 years ago – it is a symptom of the changes in life; in the speed of life, that is leading to this “depression” and “anxiety”. But they are not the depression and anxiety I studied. Grad school did not prepare me for what we are dealing with today.

Fortulately, my studies in Logotherapy – the Psychology of Meaning, and Psychedelic Assisted Therapy – using ancient medicines for today’s issues – they have prepared me for today’s depression and anxiety.

But before we go there, I thought I would offer you a comparison – what the Diagnostic Manual (DSM-IV) I studied says compared to today’s diagnostic criteria. You tell me what you think – are you that depressed? Do you require medication? Or would some lifestyle changes – maybe some meaning or a profound spiritual experience make the changes you need, rather than a daily pill for the rest of your life?

Here’s what I was able to pull up comparing the “depression” of old – of my education – and what “The Manual” says today. Next week, I’ll tell you all about anxiety. – Dan

According to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), the criteria for Major Depressive Episode — which underlie a diagnosis of Major Depressive Disorder (MDD) — are as follows:

A. Presence of Five (or More) of the Following Symptoms

Symptoms must be present during the same 2-week period and represent a change from previous functioning.
At least one of the symptoms must be either:

Depressed mood most of the day, nearly every day (subjective report or observation).
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

In addition, four (or more) of the following:

Significant weight loss or gain (≥5% body weight in a month) or change in appetite.
Insomnia or hypersomnia nearly every day.
Psychomotor agitation or retardation nearly every day (observable by others).
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive/inappropriate guilt nearly every day.
Diminished ability to think or concentrate, or indecisiveness, nearly every day.
Recurrent thoughts of death, recurrent suicidal ideation, or a suicide attempt/plan.

B. The Symptoms Cause Clinically Significant Distress or Impairment

In social, occupational, or other important areas of functioning.

C. The Episode Is Not Due to Substance Use or a General Medical Condition

D. The Episode Is Not Better Accounted for by Schizoaffective Disorder, Schizophrenia, or Other Psychotic Disorders

E. There Has Never Been a Manic or Hypomanic Episode

(If such an episode has occurred, consider a diagnosis of bipolar disorder instead.)

Here’s a detailed comparison between the DSM-IV and DSM-5 criteria for Major Depressive Disorder (MDD) — focusing on what changed, what stayed the same, and why.

🧠 Core Criteria: What Stayed the Same

Both DSM-IV and DSM-5 define a Major Depressive Episode (MDE) as:

Five or more symptoms during a 2-week period, representing a change from previous functioning.
At least one symptom must be (1) depressed mood or (2) loss of interest/pleasure (anhedonia).

The nine core symptoms are identical across both editions:

Depressed mood
Diminished interest or pleasure
Significant weight or appetite change
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive guilt
Diminished concentration or indecisiveness
Recurrent thoughts of death or suicidal ideation

And both require:

Clinically significant distress or impairment,
No substance/medical cause,
No history of manic/hypomanic episode (i.e., not bipolar disorder).

⚖️ Key Differences: DSM-IV vs DSM-5

Category	DSM-IV	DSM-5	Implication
Bereavement exclusion	Excluded depression within 2 months of bereavement unless symptoms were prolonged/severe (e.g. guilt, worthlessness, suicidal thoughts).	Removed the bereavement exclusion. Grief-related depression can now be diagnosed as MDD if full criteria are met.	Recognizes that grief-related depression can be clinically significant; shifts from categorical exclusion to clinical judgment.
Specifiers	Fewer specifiers (e.g., “with melancholic features,” “with atypical features”).	Expanded specifiers (e.g., “with anxious distress,” “with mixed features,” “with peripartum onset”).	Adds nuance to describe individual variations in depression.
Chronic Depression Subtype	Separated “Chronic MDD” and “Dysthymic Disorder.”	Combined into Persistent Depressive Disorder (PDD) for symptoms ≥2 years.	Streamlines chronic depressive conditions into one diagnosis.
Mixed features	Not recognized for unipolar depression.	“With mixed features” specifier added — allows depressive episodes with some manic symptoms.	Reflects understanding of bipolar spectrum symptoms.
Focus on anxiety	Anxiety not formally addressed in MDD.	Added specifier “with anxious distress.”	Acknowledges high comorbidity between depression and anxiety.

🪶 Conceptual Shifts

1. From Exclusion to Clinical Judgment

DSM-IV excluded normal grief reactions; DSM-5 recognizes overlap and encourages clinicians to evaluate severity, duration, and functional impairment, not just context.

2. Dimensional Understanding

DSM-5 moves toward a dimensional view of mood disorders — specifiers like “anxious distress” or “mixed features” allow greater clinical precision.

3. Continuity of Depressive Disorders

MDD and PDD (formerly Dysthymia) are now seen as points on a spectrum rather than discrete entities.

🧩 Summary Table

Aspect	DSM-IV	DSM-5
Symptom list	Same (9 symptoms)	Same
Duration	≥ 2 weeks	≥ 2 weeks
Required symptoms	5 or more, including depressed mood or anhedonia	Same
Bereavement exclusion	Present	Removed
Specifiers	Limited	Expanded (anxious, mixed, peripartum, seasonal, etc.)
Chronic depression category	“Chronic MDD” and “Dysthymia” separate	Combined into “Persistent Depressive Disorder”
Mixed features	Not allowed	Allowed
Anxiety emphasis	Minimal	Recognized via “with anxious distress”