From fatigue to anger: the hidden ‘faces’ of depression


Depression is often associated with a sad looking person sitting in the corner dressed in black, but Dr Renata Schoeman, a psychiatrist from Cape Town, says this is a general misconception about the disease.

“Depression is a constellation of symptoms present during a defined period and people can present differently as a result of gender, age and other defining characteristics,” Dr Schoeman explains. In a child, it might be through a failure to thrive, in a teenager through the onset of behavioural problems, while an adult may become very sensitive and irritable.

How is depression diagnosed?

There are currently two widely established systems for classifying mental disorders namely the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD).

Based on the DSM 5, the diagnosis of depression requires any five of the following symptoms (of which at least one of the first two) to be present for the same two week period in a patient’s life:

  • Depressed mood
  • Loss of interest or pleasure
  • Changes in appetite/weight
  • Changes in sleeping patterns
  • Psychomotor agitation or retardation (e.g. restlessness or sluggishness)
  • Fatigue or loss of energy
  • Feelings of worthlessness or guilt
  • Impaired concentration or indecisiveness
  • Death wishes or suicidality

These symptoms should additionally also cause significant impairment in interpersonal, social or occupational functioning and must not be attributed to medical conditions, substances or medication.

The five types of depression according to the DSM-5

  1. Disruptive mood dysregulation disorder
  2. Major depressive disorder
  3. Persistent depressive disorder (dysthymia)
  4. Premenstrual Dysphoric disorder
  5. Substance/medication-induced depressive disorder

Dr Schoeman says that depression can also be distinguished through three levels of severity: mild, moderate or severe. For depression to be severe, symptoms of psychosis or suicidality should be present.

 “We also distinguish between unipolar and bipolar depression where the latter is part of another mood disorder, i.e. where episodes of hypomanic or manic symptoms are present. Treatment requires mood stabilizers and not necessarily antidepressants,” she explains.

Preventing and managing depression

Although depression is a clinical condition, there are ways to prevent and manage it to a certain extent. According to Dr Schoeman, you can lower your risk for depression through good self-care:

  • Enough sleep
  • Exercising at least five times per week for at least 30 min
  • Following a healthy diet
  • Avoiding substances (especially alcohol and codeine containing painkillers)
  • Healthy social interactions with good friends
  • Creating “me-time” for creativity, mindfulness etc. 
  • Managing your stress levels

If your symptoms still persist despite your efforts to manage them, it is better to get help either through support programmes or visiting a psychologist or doctor for a referral to a psychiatrist. 

Read More:

SEE: This movie scene is so sad it’s used in depression studies

‘My depression went undiagnosed for almost 20 years’

How to support someone with depression

We live in a world where facts and fiction get blurred
In times of uncertainty you need journalism you can trust. For 14 free days, you can have access to a world of in-depth analyses, investigative journalism, top opinions and a range of features. Journalism strengthens democracy. Invest in the future today. Thereafter you will be billed R75 per month. You can cancel anytime and if you cancel within 14 days you won't be billed. 
Subscribe to News24
Editorial feedback and complaints

Contact the public editor with feedback for our journalists, complaints, queries or suggestions about articles on News24.