“Can I Get Disability for Depression?”

Depression is the leading cause of disability worldwide. If you are wondering if you can get social security disability for depression, the answer is yes. Major depressive disorder is a disability for which you can receive social security disability benefits if your symptoms keep you doing any work for at least 12 months.

Although we have all experienced sadness at some point, not all of us have been depressed. Depression is a mental illness that affects the normal functioning of the brain. It does not happen because the person is weak and the improvement does not depend in the first instance on their willpower.

Mental health professionals categorize depression into three levels according to how powerful the symptoms are. Severe depression is defined as when a person does not recover with the correct treatment.

Receiving a diagnosis of depression alone does not qualify someone for disability. A full psychiatric history, which details the intensity of symptoms and the impact on the person’s ability to work and provide for themselves, is also necessary.

How to recognize depression in yourself and others

According to the WHO, depression affects approximately 5% of adults worldwide, being twice as prevalent in women as in men.

Depression is a psychological disorder that manifests in persistent feelings of sadness or bad temper for extended periods over the course of two or more weeks. Additionally, the following symptoms may be present to a greater or lesser extent:

• Loss of interest or inability to enjoy things that were once pleasurable
• Insomnia or excessive sleep
• Decrease or increase (when anxiety is present) in appetite or changes in body weight
• Inattention and lack of concentration that difficult decision making
• Lack of energy or will to perform any activity
• Psychomotor agitation or retardation
• Feelings of guilt and worthlessness
• Thoughts of death or suicide
• Decreased sexual desire
• Social isolation
• Difficulty in self-care (bathing, grooming)
• Hopelessness

These symptoms compromise the functioning of the person to a variable degree including the ability to work. The changes are evidenced both by those who suffer from depression and by their relatives and co-workers.  Persons with severe depression who cannot work and should file a claim for social security disability often need the encouragement of family and friends because of their low energy, and discouragement.  Sadly severely depressed Texans often feel guilty and ashamed for needing disability benefits  – even though they paid for this benefit through their years of working.

What does it Take to Win Disability Benefits for Depression in Texas?

Social security disability law is federal.  That is, the legal standard of disability for both Social Security Disability Insurance (SSDI) or Social Security Income (SSI) is the same in all states.  But the initial and reconsideration decisions in a disability claim are made at the state level.  That is, state Disability Determination Services make the disability decision for the social security administration.

So regional differences can come into play in social security disability cases.  Unfortunately, Texas is one or the hardest states to get disability in.

Persons with disabling depression, however, win disability benefits every day in Texas.

Depression as a “Medically Determinable Impairment” under Social Security Law

A winning depression-based disability case in Texas starts with a legitimate diagnosis made by a mental health care professional.  there must be medical evidence (diagnosis and medical treatment) of mental illness in the form of severe depression.  The diagnosis of depression is made based on the criteria of the Diagnostic Statistical Manual of mental disorders, fifth edition (DSM-V).  It is preferable that the diagnosis comes from a mental health care professional such as a psychiatrist, psychologist or other mental health care specialist.

Here are the diagnostic criteria for depression under the DSM-V:

Depressed mood

Most of the day, nearly every day; may be subjective (e.g. feels sad, empty, hopeless) or observed by others (e.g. appears tearful); in children and adolescents, can be irritable mood

Loss of interest/pleasure

Markedly diminished interest/pleasure in all (or almost all) activities most of the day, nearly every day; may be subjective or observed by others

Weight loss or gain

Significant weight loss (without dieting) or gain (change of >5% body weight in a month), or decrease or increase in appetite nearly every day; in children, may be failure to gain weight as expected

Insomnia or hypersomnia

• Nearly every day

Psychomotor agitation or retardation

• Nearly every day and observable by others (not merely subjectively restless or slow)

Fatigue

• Or loss of energy, nearly every day

Feeling worthless or excessive/inappropriate guilt

• Nearly every day; guilt may be delusional; not merely self reproach or guilt about being sick

Decreased concentration

• Nearly every day; may be indecisiveness; may be subjective or observed by others

Thoughts of death/suicide

• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without specific plan, or suicide attempt, or a specific plan for suicide

Further DSM-V diagnosis criteria

1. The individual must be experiencing five or more the above symptoms during the same 2-week period

2. At least one of the symptoms identified (i.e., the 5 symptoms needed for the depressiondiagnosis) should be either (1) depressed mood or (2) loss of interest or pleasure.

3. Must have all 4 of the following findings:

• Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
• Episode not attributable to physiological effects of a substance or another medical condition
• Episode not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders
• No history of manic or hypomanic episode

While the diagnosis of depression is made based on the criteria of the Diagnostic Statistical Manual of mental disorders, fifth edition (DSM-V), to qualify for your medical history of depression must meet the criteria on the Social Security Administration (SSA) list for depression.

By the end of this article we will have covered key information about clinical depression and the main issues that you should know to qualify for disability benefits.

Types of depression according to the DSM-V

The DSM-V specifies several types of depression. There are two types of special interest when applying for disability for depression: major depression and persistent depressive disorder (also called dysthymia).

Major depression was previously described. This mental illness carries a high risk of suicide mortality and is highly disabling.

Dysthymia, on the other hand, is characterized by the presence of a sad mood for most of the day, almost every day for at least two years. During this time there should not be periods longer than two months without symptoms.

DSM-V-specified symptoms of dysthymia do not include thoughts of death and suicidal ideation, psychomotor agitation/retardation, or lack of interest in activities. A person with dysthymia may develop episodes of major depression when meets all criteria for this diagnosis.

Both diagnoses are ruled out if there is a history of manic episodes (elevated mood, increased speed of speech, decreased need for sleep, increased energy, risky and reckless behavior). In which case depressive symptoms are part of bipolar I disorder.

Medical Treatment: Vital for winning a Texas Depression Disability Case

Ongoing medical treatment is required to win a social security disability for any medical or mental impairment – perhaps especially so with major or clinical depression.   The advice I provided in another blog post regarding metnal illness disability claims in general applies to depression, and is worth reading.  The medical treatment for clinical depression is varied, includes psychotherapy, drugs and hospitalization. Your doctor may recommend lifestyle changes and other therapeutic interventions as part of the treatment.

1. Psychotherapy for depression

Psychotherapeutic treatment is necessary to bring about changes in how a person copes with the challenges of daily life.

The goal is for the patient to strengthen their coping skills and gain useful tools to deal with daily stressful situations.

Medical evidence supports that Cognitive Behavioral Therapy (CBT) is the most efficient therapeutic approach to depression. When combined with pharmacological treatment improvement is achieved in around 80% of cases.

2. Pharmacological treatment for depression

Pharmacological treatment complements CBT for depression.

There are several FDA-approved drugs for the treatment of clinical depression; the most widely used are selective serotonin reuptake inhibitors (SSRIs).

An antidepressant begins to work after two or three weeks of treatment. Sometimes the treatment does not produce the expected effect and the doctor may decide to change it. In other cases your doctor may consider to try an augmentation strategy.

Keeping a record of the pharmacological treatment you have received and whether or not your symptoms improved will help you get your disability claim approved.

3. Hospitalization

Psychiatric hospitalization is necessary where the patient:

• Represents a risk to himself or others (suicidal or homicidal risk)
• Has difficulty adhering to pharmacological treatment
• Does not have adequate family support
• Has severe symptoms and require ongoing assistance for basic tasks such as eating or getting a shower.

4. Electro-convulsive therapy (ECT)

ECT is a very effective therapeutic alternative that consists of the application of electrical current to the brain. It is reserved for cases of depression with psychotic symptoms, pregnant women and severe depression.

Although it is within the therapeutic options, not all patients with depression meet criteria for ECT.

Winning a Texas Social Security Disability Claim based upon Depression

As mentioned above, social security rules and regulations in determining disability for dpression in Texas are the same as in all ohter states.  Social security follows a sequence of questions referred to as the 5-step sequential evaluation.   One early and important step in a depression disability case is the consideration of whether the depression meets or equals a listing.  In another blog article I have discussed the listings in detail, and the fact that many have the wrong idea that if the conditions for meeting or equalling a listing are not present, the disability case will be denied.  This confuse seems particularly truth with mental illness-based claims and depression.

Meeting the listing for Depression

The listing for Depression reflects criteria that mental health profession have agreed would qualify for disability benefits. The listing for depression is particularly important because most depression disability claims – if approved – are approved based upon meeting a listing.

Ths listing for Depression include two parts: Part A deals with symptoms, and Part B deals with the functional results of those symptoms.  Many of the symptoms in Part A are the same as those symptoms documented in reaching the depression diagnosis under the DSM-V, but not all.

Part B is particularly important: many depression disability cases meet the “”A criteria of the listing, but fail under Part “B”.  These are the functional criteria found in Part B:

• Understand, remember, or apply information
• Interact with others.
• Concentrate, persist, or maintain pace
• Adapt or manage oneself

Winning a Texas Disability Case for Depression without Meeting the Listing

If your depression does not meet a listing the decision-maker or administrative law judge must determine your residual functional capacity after your depression symptoms are taken into account.   Simply put, what can you do despite your depression?  Administrative Law Judges typically focus on these critical functional abilitues:

• carry out simple instructions
• make simple work-related decisions
• respond appropriately to supervision and to co-workers, and
• handle changes in routine.

Clinical Depression vs. Situational Depression

The term clinical depression is used to refer to mental illness that meets the diagnostic criteria of the DSM-V. On the other hand, situational depression is a term used by judges when they reject a depression based disability case. In those cases, judges consider that the symptoms are explained by a particular “situation” instead by the illness itself.

Talking about situational depression can lead to confusion. The onset of most episodes of clinical depression relates to a “trigger”; that is, a situation significant enough in the person’s life to generate changes in their mental health.

Some examples of triggers are a break up; a divorce; the loss of a loved one; losing a job or retiring; or significant material losses. In some people, these situations can trigger depressive symptoms as part of other mental health conditions such as adjustment disorder. In this case, all the depressive symptoms are explained by the stressful situation and improve within 6 months after the resolution of the trigger.

The best way to prove to the judge that it is a case of clinical depression is to have a complete medical record. It should include:

• The diagnostic impression of a specialist psychologist or psychiatrist
• Detailed description of previous psychiatric hospitalizations and depressive episodes if any
• Detailed pharmacological and psychotherapeutic treatment received for the last two years.
• Your commitment to treatment and follow-up appointments

If your disability claim is denied but you still believe you qualify for social security disability benefits you and your disability attorney can appeal.

Do most cases of depression qualify for disability?

Although we have all experienced sadness at some point, not all of us have been depressed. Depression is a mental illness that affects the normal functioning of the brain. It does not happen because the person is weak and the improvement does not depend in the first instance on their willpower.

Depression is classified as mild, moderate or severe depending on the intensity of the symptoms. Severe cases are those in which, despite receiving adequate treatment the patient does not improve.

In these cases, your doctor may fill out a residual functional capacity (RFC) form. A RFC form basically details what you can and cannot do based on your current medical conditions. This will support your depression disability case as it specifies your ability to focus and concentrate, working memory, interpersonal relationships, and ability to work under stress.

Having the diagnosis is not enough to obtain disability for depression. It is necessary to have a complete psychiatric medical history that supports the severity of your symptoms and how they interfere with your ability to keep your job and support yourself.