When is sadness a medical problem?

When is sadness a medical problem?


Our prior post discussed when anxiety should be considered a medical problem. Much like anxiety, everyone has occasional feelings of sadness. The goal of this post is to identify features of sadness that might be suggestive of a medical problem.


Any number of life events can leave people feeling sad or unhappy. Normal sadness is usually triggered by an unpleasant, hurtful, or disappointing event or experience. Key features of normal sadness include the following:

  1. Venting or crying often can improve mood.
  2. There usually is not a loss of self-esteem with normal sadness.
  3. And, although terrible events such as the loss of a loved one can lead to prolonged sadness, mood generally tends to improve over time.


Sometimes people with normal sadness refer to their mood as depression. But medical depression differs from sadness in several ways.

Depression is a serious medical illness. Based on DSM (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) criteria,1 a diagnosis of major depressive disorder (a common form of depression) includes feelings of sadness or loss of interest in activities that were once enjoyed for at least 2 weeks. There are several additional key features that must be present for the major depressive disorder diagnosis (incompletely summarized from DSM criteria):

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is (1) depressed mood or (2) loss of interest or pleasure:

  1. Depressed mood most of the day, nearly every day
  2. Decreased interest or pleasure in all, or almost all, activities most of the day, nearly every day
  3. Significant weight loss when not dieting or weight gain
  4. Insomnia or Hypersomnia nearly every day
  5. Agitation or feeling slowed down nearly every day
  6. Fatigue or loss of energy nearly every day
  7. Feelings of worthlessness or excessive or inappropriate guilt
  8. Inability to think or concentrate, or indecisiveness, nearly every day
  9. Recurrent thoughts of death (not just fear of dying) or suicidal thoughts, plans, or attempts

B. The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.

C. The symptoms are not caused by a substance (for example, a medicine or a drug of abuse) or another medical condition (for example, hyperthyroidism).

D. The symptoms are not better accounted for by bereavement, after the loss of a loved one, or a different psychiatric disorder.


Clinical depression can severely impair daily function, social interactions, and family cohesion. Sometimes normal sadness can become depression. It is important that you discuss prolonged and severe feelings of sadness with your healthcare provider. If you have thoughts of hurting yourself, tell a loved one, speak with your physician, call the National Suicide Prevention Lifeline (1-800-273-8255), or go to your local Emergency Room.


1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, D.C.: American Psychiatric Association; 2013