Every mental health clinician knows the symptoms and signs that are found in patients who are depressed. These are often taught and remembered using the mnemonic SIG E CAPS. But clinicians very commonly fail to ask themselves: What is this person depressed about? In my opinion, it is one of the Most Important Things (MITs) that we need to do with regard to depressive disorders.
Quick review of SIG E CAPS
S = Sleep (increased or decreased)
I = Interest/pleasure in activities (decreased)
G = Guilt (excessive or inappropriate) or feelings of worthlessness
E = Energy (decreased)/fatigue
C = Concentration/ability to think/decisiveness (decreased)
A = Appetite/weight (increased or decreased)
P = Psychomotor activity (agitation or retardation)
S = Suicidal ideation or attempt
But wait! These are only eight items, while the DSM-5-TR diagnostic criteria for major depressive disorder list nine items (American Psychiatric Association, 2022). What is the ninth item (symptom) that is not included in the SIG E CAPS mnemonic? Depressed mood. So, the nine clinical manifestations that may be found in people who are depressed include depressed mood plus SIG E CAPS.
This is basic, introductory stuff. Yet, I feel very strongly that there is one more question that we should ask all people who are depressed. If we start doing this routinely, it will make a big difference.