Psychē Nashville
DBT and CBT in Nashville for Adults and Adolescents. Treating Depression, Anxiety, and Personality Disorders.



There is a big difference between a mood (or a bad week) and the diagnosis of  Major Depressive Disorder (MDD).  


Too often, the label “Depression” is tossed around in popular culture as a way to describe what is actually a feeling or mood state, i.e. “I’m depressed thinking about how much work I have to do this weekend” or, “After looking at my bank balance this morning, I’m completely depressed.” While these situations may trigger sadness, hopelessness, and/or other unpleasant emotions, they are not necessarily indicative of a Depressive Disorder. There is some evidence that MDD is over-diagnosed1 and failure to view a Major Depressive Episode in terms of level of severity can lead to problems at both ends of the spectrum--some may be medicated for a disorder they don’t actually have, while others who meet criteria for Severe MDD may be under-treated because they are approached in the same way as “anyone with Depression.”


Depression is not just a feeling.

The DSM-V criteria of “depressed mood most of the day, nearly every day” and feeling “...sad, empty, hopeless” is only 1 criteria out of a minimum of 5-9 that must be met to be diagnosed with MDD.

While almost everyone has had a few days, weeks, or even longer in which they felt down in the dumps, low, and/or unmotivated, the comparison between this and Major Depressive Disorder is similar to comparing a cold to bronchitis or pneumonia. A Major Depressive Disorder almost always needs to be treated or the patient runs the risk of serious complications, one of which includes the risk of death (via suicide).


When a person experiences the onset of a Major Depressive Episode, there is a change from their previous level of functioning--take the analogy of coming down with the flu. There is a definite difference, even if it creeps up. We often advise patients who have an onset of MDE to treat themselves kindly, as though they were physically ill. This may involve placing less demands on themselves and giving themselves props for any tasks they are able to accomplish during that time. This avoids adding to the already present feelings of worthlessness or guilt and also addresses the physical fatigue or loss of energy and disturbed sleep (sleeping too much or difficulty sleeping) they are likely experiencing. One big difference between the flu analogy and how we treat Depression is, with MDD we want to keep the patient moving, whereas with the flu, bedrest is essential!

Not all depressive symptoms are the same.

It is important that your provider asks the right questions. Before a skilled therapist diagnoses a Major Depressive Episode, they rule-out medical conditions which could be the underlying cause such as hypothyroidism, Vitamin D deficiency, and anemia. Therapy will not benefit a person who is exhausted, sad, and unmotivated because of an undetected kidney infection. Furthermore, a Major Depressive Episode would not be diagnosed if the symptoms were in response to a significant loss and they made sense in the context of that loss such as the death of a loved one, having experienced a natural disaster, or going through a major financial loss. Finally, another mood disorder might fit better, such as Persistent Depressive Disorder, Bipolar Disorder, or even the exhaustion stemming from Generalized Anxiety Disorder.

If you are diagnosed with Major Depressive Disorder, Cognitive Behavioral Therapy has been shown to be highly effective as a psychotherapeutic treatment. When it comes to severe cases of MDD, getting an appointment with a medication provider can’t hurt. PSYCHē works collaboratively with Nashville’s best psychiatrists to make sure our patients are well taken care of. A combined approach of medication and therapy is often the key to recovering from what we refer to as, the “pneumonia of mental health,” Major Depressive Episodes.

1 Mojtabai, R., Clinician-Identified Depression in Community Settings: Concordance with Structured-Interview Diagnoses. Psychotherapy and Psychosomatics, 82, 161-169