The characteristics depression in mood is described differently by various clinically depressed patients. Whatever term the patients uses to describe her or his subjective feelings should be further explored by the examiner.
If the patient uses the word “depressed,” for instance, the examiner should not take the word at its face value but should try to determine its connotation for the patient.
Persons who are in no way clinically depressed may use this adjective to designate transient feelings of loneliness, boredom or discouragement.
Some time the feeling is expressed predominantly in somatic terms, such as “a lump in my throat,” or “I have an empty feeling in my stomach,” or “I have a sad, heavy feeling in my chest.”
On further investigation, these feelings generally are found to be similar to the feelings expressed by other patients in terms of adjectives such as sad, unhappy lonely or bored.
The intensity of the mood deviation must be gauged by the examiner. Some of the rough criteria of the degree of depression are the relative degree or morbidity implied by the adjective chosen, the qualification by adverbs such as “slightly” or “very,” and the degree of tolerance the patient expresses for the feeling.
Among the adjectives used by depressed patients in answer to the question “How do you feel?” are the following: miserable hopeless, blue, sad, lonely, unhappy, downhearted, humiliated, ashamed, worried useless, guilty.
Eighty percent of the severely depressed patients reported some degree of sadness or unhappiness as compared with 23 percent of the nondepressed patients.
Mild
The patient indicates feeling blue or sad. The unpleasant tends to fluctuate considerably during the day and at times may be absent, and the patient may even feel cheerful.
Also the dysphoric feeling can be relieved partially or completely by outside stimuli, such as compliment, a joke, or a favorable event. With little effort or ingenuity the examiner can usually evoke positive response. Patients at this level generally react with genuine amusement to jokes or humorous anecdotes.
Moderate
The dysphoria tends to be more pronounced and more persistent. The patient’s feeling is less likely to be influenced y other people’s attempts to cheer him or her up, and may relieve of this nature is temporary.
Also a diurnal variation is frequently present: The dysphoria is often worse in the morning and tends to be alleviated as the day progresses.
Severe
In cases of severe depression, patients are apt to state that they feel “hopeless” or “miserable.” Agitated patients frequently state that they are “worried.” About 70 percent of the severely depressed patients indicated that they were sad all the tine and “could not snap out of it”; that they were so sad that it was very painful or that they were so sad they could not stand it.
Dejected Mood
