What Constitutes a Depressive Episode?

Depression affects individuals of all ages and parts of the population. Its adverse symptoms are known to cause harmful effects to one’s well-being, hindering their ability to lead a healthy, happy life. A diagnosis of depression is based first and foremost on the appearance of depressive episodes—but what is a depressive episode? And how is it different from other aspects of this disorder? Read on to find out.

Depressive Episodes: Times of Acute Depression

The American Psychological Association (APA) defines a depressive episode as a period in one’s life of at least two weeks, during which they exhibit the requisite symptoms of major depressive disorder (MDD). The symptoms of MDD are diverse, and include the following:

  •     Low mood.
  •     Sadness (more on that later).
  •     Hopelessness that things might improve.
  •     Anhedonia (the inability to feel joy).
  •     Distractibility and difficulty concentrating.
  •     Emptiness, and sense of longing for something or someone who has been lost.
  •     Psychomotor functioning difficulties.
  •     Significant weight changes when not dieting.
  •     Insomnia or hypersomnia.
  •     A sense of guilt.
  •     A sense of worthlessness.
  •     Suicidality.

The APA’s Diagnostic and Statistical Manual’s fifth edition (DSM-V) states that a depressive episode must include a number of the above and other symptoms in order to meet the requirements for an official depressive episode diagnosis.

An official MDD diagnosis can be given even after a single depressive episode has been recorded, in which case it would be considered a single-episode instance of MDD. An MDD diagnosis could also include more than one depressive episode, in which case it would be considered a recurrent episode case of MDD.

Depressive Episodes vs. Grief

Grief is considered the closest to a depressive episode (and to depression as a whole) one can experience. Indeed, grief and depressive episodes share many aspects, such as a deep and unrelenting emotional pain tied to a terrible sense of loss.

They differ, however, in both the recognized source of their pain, and in which of their shared features are more commonly related to each experience.

Firstly, it should be noted that unlike depression, grief is not considered a disorder, but a normative part of being alive. A deep and unrelenting emotional pain that one experiences following a significant loss, grief could appear due to the death of a loved one, the loss of one’s social standing, a financial disaster, a debilitating illness, or even the loss of an idea, e.g., the belief in a “happily ever after,” following a divorce. We all deal with loss, and we all grieve for the more important aspects we have come to rely on which are no longer parts of our lives.

If grief and depression are so similar, though, why is one considered normal and the other an illness? According to the father of psychoanalysis, Sigmund Freud, the difference lies in one’s unconscious. Freud determined that depressive episodes are, in fact, cases in which the patient is unaware of their own mourning, or parts of it. An individual who, for instance, is reckoning with the loss of a grandparent, might find it unbearable to contend with painful aspects of their relationship, and as a result internalize any negative emotions they might still harbor toward their deceased grandparent, effectively turning their anger, hurt or frustration toward themselves. This unresolved energy continues to draw on the patient’s emotional reserves, weighing them down and keeping them preoccupied—unconsciously—with the loss they have experienced, never allowing them to truly let go. According to Freud, this unprocessed, submerged form of grief eventually turns into depression.

It is this inability to come to terms with what makes depression a mental health disorder, and the main difference between it and the grieving process. That said, several distinctions between the two have also been noted: according to the DSM-V, depressive episodes are usually marked by a lowered mood and an inability to feel happiness or enjoy oneself. Grief, on the other hand, is marked more by feelings of emptiness and loss.

Another distinction observed by the APA is that grief tends to come in waves of nostalgia, as reminders of the deceased return to the mourner. This allows for positive emotions and coping mechanisms, such as humor, to offer a momentary reprieve from the sadness they have come to experience. With depressive episodes, though, one’s depressed mood is commonly persistent in its intensity throughout this period, offering little-to-no symptoms alleviation.

A third difference that has been noted by both Freud and the APA focuses on thought content. With mourning, the individual’s self-esteem is usually preserved, as they find themselves preoccupied more with memories of the person they lost. An individual facing depression, however, becomes much more self-critical, with thoughts of their personal, perceived shortcomings saturating their mind.

Depressive Episodes vs. Sadness

Like grief, depressive episodes are often linked to sadness. An emotional pain marked by feelings of longing or lacking, sadness can sometimes be hard to distinguish from the characteristics of a depressive episode.

But despite their similarities, depressive episodes are distinct from moments of sadness. For starters, sadness, like mourning, is not considered a mental health disorder, but a part of life.

Secondly, sadness usually lasts for much longer periods of time, compared to the minimum two-week requirements for a depressive episode diagnosis.

Sadness also lasts for a much shorter part of each day, as opposed to a depressive episode, which can last most and even the entirety of one’s day.

Finally, while a depressive episode is considered a mental health issue due to the intensity of its symptoms and their detrimental effect on an individual’s quality of life or daily functioning, sadness is a less severe experience, and normally passes without leaving a significant impact on one’s well-being.