Zung Selfrating Depression Scale

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Read each statement and decide how much of the time the statement describes how you have been feeling during the past several days.

Make check mark (V) in appropriate column.

little of the time

Some of the time

Good part of the time

Most of the time

1. I feel down-hearted and blue

2. Morning is when I feel the best*

3. I have crying spells or feel like it

4. I have trouble sleeping at night

5. I eat as much as I used to*

6. I still enjoy sex*

7. I notice that I am losing weight

8. I have trouble with constipation

9. My heart beats faster than usual

10. I get tired for no reason

11. My mind is as clear as it used to be*

12, I find it easy to do the things I used to*

13. I am restless and can't keep still

14. I feel hopeful about the Future*

15. I am more irritable than usual

16. I find it easy to make decisions*

17. I feel that I am useful and needed*

18. My life is pretty full*

19. I feel that others would be better off if I were dead

20. I still enjoy the things I used to do*

Now, total up your score, which should range from 20 to 80. The starred items (2, 5, 6, 11,12, 14, 16, 17, 18, and 20) are reverse-scored (a little of the time = 4 and most of the time = 1). The remaining items are scored from 1 (a little of the time) to 4 (most of the time).

Adapted by permission from Zung (1965). Copyright by the American Psychiatric Association. I also wish to acknowledge GlaxoSmith Kline for reprinting this scale on their website, www.wellbutrin-sr.com/hcp/ depression/zung. html, July, 2001.

In the first type, which I call the classic recurrent type, a full-bore depression or mixed disorder develops either following a period of time in which you've been functioning at your baseline {or what, for you, is your typical mood state) or just after a manic episode, with little or no break in between. The onset of this depressive episode is usually not as sudden as the onset of a new episode of mania or hypomania. instead, it usually involves a gradual winding down of your mood state over a period of days, weeks, or even months, until you reach a state of full clinical depression or mixed disorder. For some people the onset can be tied to specific life events (see Chapter 5).

In the other type, called double depression, you have an ongoing state of sadness (dysthymia) that may have been present for years and is quite unpleasant but still allows you to function. Then, a major depressive episode develops on top of this state of dysthymia. This new episode of bipolar depression is kind of a "slow burn": It develops gradually and perniciously, almost imperceptibly from day to day. When this severe depression remits, you may return to a milder state of depression or dysthymia rather than to a depression-free state. This cycle can be quite frustrating and demoralizing.

Notice that in describing these course patterns, I don't refer to depression as a change from normal mood. In my experience, people with bipolar disorder do not ever feel like they get to a state of normal mood. In fact, they feel that their moods are always fluctuating. Many say that they are always somewhat depressed. Of course, it's not entirely clear what normal mood means for the typical person—some people seem to feel fine most of the time, whereas others are always somewhat anxious, angry, bored, disappointed, or sad.

Whether you have classic recurrent or double depression, it is important to learn to recognize your prodromal signs of a new episode. As I talk about in Chapter 9, prodromal signs are those early indicators that your mood state is changing, if you live in an ongoing state of dysthymia, the prodromal signs of a new depressive episode will probably be more subtle than those experienced by people with classic recurrent depressions, and will mainly reflect changes in the degree to which you experience depressive symptoms (for example, the seriousness of your suicidal thoughts). Nonetheless, knowing how to intervene when these signs appear can be central to your mood stability and well-being. You may be able to implement the self-care strategies in this chapter to keep the depression from becoming as bad as it otherwise might become, or to make your "rebound" dysthymia more tolerable. It is important to keep these targets in mind—the fact that your depression doesn't disappear entirely is not a sign that you have failed in your attempts to cope with it (see the earlier example of Alexis).

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