What is SIG-E-CAPS?
SIG-E-CAPS (it sounds like and is written as “SIGECAPS” or “SIG E CAPS”) is an acronym of the diagnostic criteria used by psychiatrists to diagnose depression.
It is estimated that over 16 million adults over the age of 20 suffer from a major depressive episode in the United States. (NIMH) Also, approximately 60 percent of adults who commit suicide had a mental illness such as major depression, bipolar disorder, dysthymia. (HHS.gov)
Therefore, it is critical to diagnose depression as soon as possible and the SIG-E-CAPS mnemonic has been used for this purpose for over a century.
But, you probably didn’t know that you can also use it to overcome depression.
Your doctor probably doesn’t know that either.
This is not because your doctor doesn’t want to help you, but because she or he is medically conditioned to treat depression with – antidepressant medication.
Antidepressants are not the Only Solution
Certainly, in some cases, antidepressants can save the life of someone in severe distress.
And, also, this article is not intended to diagnose depression or to suggest that you needn’t consult a psychiatrist.
This article is written to help those who are suffering from mild to moderate depression, in some ways to augment medication, and in some ways to rethink medication.
For instance, many people have “treatment-resistant depression” – the medication is not helping.
Many feel depressed who have not yet sought out a psychiatrist but they feel “depressed.”
In either case, you may see dramatic improvement by following some of the suggestions in this article.
Finally, some, antidepressants can actually trigger (catastrophic) mental and physical side effects, including suicidal ideation, and worse, suicide itself.
So says the actual warning labels on many antidepressants.
If you could find a roadmap to help your depression after using unhelpful medication or without resorting to antidepressants, why wouldn’t you try it out? Don’t you risk more by not trying?
In fact, as I did, you may even be able to wean yourself off antidepressants–especially if you don’t feel they are helping.
I am going to give you a roadmap that can help alleviate depression based on the very same tool used to diagnose depression – SIG-E-CAPS.
What Does SIG-E-CAPS Stand for?
Each letter of “SIG-E-CAPS” represents one of eight diagnostic criteria prescribed in the DSM-5: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition ( American Psychiatric Association – APP ) to identify Depression.
You may not have them all, but doctors look at the following significant areas:
- Sleep changes,
- Interest decline,
- Guilt and/or feelings of uselessness,
- Energy levels,
- Concentration difficulties,
- Appetite/weight fluctuations,
- Psychomotor Retardation / Psychomotor agitation, and
- Suicidal ideation
8 Depressive Symptoms
“S” stands for Sleep disturbance
Sleep changes are a classic symptom of major depressive disorder.
Are you having sleep difficulties? Are you sleeping more in the day or less at night?
Insufficient restful nighttime sleep or excessive daytime sleep are important indicators—and, as I describe below, can be one of the causes—of depression.
“I” is a loss of Interest in activities
Have you experienced a loss of interest in activities that you once found enjoyable?
Do you believe that nothing is worth doing?
“G” stands for Guilt
Do you have feelings of low self-esteem? Do you feel guilty or have feelings of worthlessness?
Guilt and worthlessness are such powerful and overwhelming feelings that can destroy a person.
“E” stands for Energy levels
Do you often feel fatigued, have a general lack of energy, or experience “burnout” regularly?
Burnout or exhaustion that persists over days can indicate that you suffer from depression.
“C” is for Concentration problems
Do you often have difficulty concentrating or focusing on things that are important?
Reduced concentration is a hallmark of depression.
“A” refers to Appetite or weight fluctuations
Have you had a dramatic change in appetite, lost your appetite and enjoyment of food, or are you binge eating?
“P” stands for Psychomotor agitation or retardation
What is psychomotor retardation?
Have you become more sluggish and slow-minded or in your movements?
Do you feel so anxious you cannot sit still?—or cannot move?
Psychomotor retardation or agitation impairs your ability to function properly at work or at home and is a major cause of disability.
The Final “S” stands for Suicidal Ideation
This is a dangerous area.
Are you preoccupied with, or commonly think about death or have you even devised a plan to commit suicide?
Suicidal thinking is one of the most significant indicators of severe depression and requires immediate treatment. Please seek the assistance of a trained specialist or go to your nearest Emergency room if this thinking is severe.
Some risk factors for suicide include (Centers for Disease Control- CDC):
- Mental illness such as Depression or Bipolar disorder
- Social isolation, elderly patients
- Male (University of Nebraska Medical Center)
- Financial problems
- Impulsive or aggressive tendencies
- Job problems or loss
- Legal problems
- Serious illness
- Substance use disorder such as drugs or alcoholism (UNMC)
- Unsafe media portrayals of suicide
The History of SIG-E-CAPS
You may not know but physicians use the abbreviation “sig” on the directions prescriptions. “Sig” is an abbreviation for the Latin, signetur, or “let it be marked.” (VeryWellHealth)
And one of the first names for antidepressants was “Energy capsules” or “E” caps. (University of Nebraska Medical Center).
During an evaluation for mood disorders such as major depressive or anxiety disorders, SIGECAPS is the most widely used screening test.
Only a qualified physician can determine if your answers to the SIG-E-CAPS depression questions I have described are clinically significant or not.
Based on your symptoms, your physician can make a differential diagnosis to identify what condition might be the cause of your symptoms.
This SIG E CAPS mnemonic is just one screening tool for psychiatric disorders.
Other diagnostic criteria for depression, obsessive-compulsive disorder, and bipolar disorder are:
- the self-scoring Beck Depression Inventory and the online PHQ-9 Questionnaire.
- as well as “DIG FAST” for bipolar disorders.
- Clark-Beck Obsessive-Compulsive Inventory (APA PychNet)
But, as I describe below, and as I discovered myself, these SIG-E-CAPS categories of depressive disorder can be helpful by identifying those most important areas of a person’s life to focus on to get better.
Though I already discussed the areas of a person’s life that can lead to a diagnosis, let’s start by understanding: What is Depression?
Here is one excellent explanation I found:
Who Needs the SIG-E-CAPS Roadmap?
You can use SIG-E-CAPS as a roadmap to lift your depressed mood naturally — even possibly without medications—and sometimes even lift it forever!
My Roadmap can be a salvation if you take antidepressants that are not helping, which is a very common experience.
This SIG-E-CAPS roadmap is also something you should try if you experience some of the indicators of depression but you are not being treated.
Worse, this Roadmap can help you if you are suffering from adverse side-effects of antidepressants:
- insomnia, night sweats, nightmares
- loss of feeling in lower extremities
- hallucinations
- suicidal thoughts
I speak from my own experience about these problems since I suffered both antidepressant side-effects and a profound disappointment with medication that just didn’t work for me.
I needed to find new solutions and, after studying this problem for years, I found the solution by using SIG-E-CAPS – which helps to identify depression – as my way to help overcome depression.
Just as this Roadmap has helped me, I hope it can work for you or someone you care about.
As always, if you are on medication now or have some of the important signs of depression I described, you should consult a doctor to understand your options.
This is my new approach: What do you have to lose?
Step 1: “S” is for (improving your) Sleep
All doctors recognize that one of the most powerful weapons against depression is to improve your sleep.
In fact, a double-blind study of those depressed patients who were taking antidepressants and those on a placebo found that 87 percent of the participants had “significant improvements” to their mental state by establishing better sleep habits, and even found that their symptoms were disappearing after only eight weeks.
The study’s lead author told the New York Times:¹
“The way this story is unfolding, I think we need to start augmenting standard depression treatment with therapy focused on insomnia.”
So, how does this work?
Try any or all of the following and see what helps.
- Keep your bed just for sleeping.
- Many health-care professionals have recognized that doing things that cause anxiety while you are in bed can cause a psychological connection between your anxiety and your sleep. So, try to sever this connection by keeping your bed just for sleeping.
- Make a sleep “schedule” for yourself such as
- committing to a regular bedtime (around 10 or 11) in the evening.
- Make sure your room is as dark as possible. (Keeping it cool also can help.)
- When you lie down, try the following:
- Pay attention to your breathing and try to tune out everything else.
- Listen to yourself inhale and exhale.
- Allow your mind to think about things you are grateful for, things you have–instead of those you do not have. You might even visualize things that could make you happy.
- Plan to sleep seven to eight hours.
Then continue to work on improving your sleep–it is that important!
If you want to focus on this all-important area, Shawn Stevenson’s excellent book may help.
- Sleep Smarter 21 Essential Strategies to Sleep Your Way to a Better...
- Hardcover Book
- Stevenson, Shawn (Author)
The importance of sleep and how it affects your brain: Getting enough regular sleep is believed to “reset” your mind after the experiences of the day.
Step 2: “I” is for (finding a new) Interest
Getting interested in something, especially something that is productive, is the second step to fight depression.
But, if you are reading this you are probably disinterested in many or even most activities. So, how do you reconnect?—The answer is: Just begin. Don’t think.
Take up something that you imagine could interest you or do something that you used to like.
Try something that gets you out of your house and out of your head.
The new interest that is most important, however, starts with remembering those times that you felt interested in and trying to recover them by starting with something you used to believe: you are interesting. Invest in yourself!
Take note: A new interest does not mean trying all the flavors of Ben & Jerry ice creams!
To find a new interest can be as simple as thinking about:
- music,
- language,
- photography,
- or, my favorite depression killers, learn how to do:
- the deadlift,
- squats,
- bench press, and
- pushups
Step 3: “G” stands for (let go of your) Guilt
Non-stop guilt is a destructive force.
Guilt impedes action.
When you are guilty, you are not helping anyone, including yourself.
Excessive guilt eats up your insides.
There is no end in sight when you lock yourself in the prison of guilt.
The experience of guilt is punishing yourself for something you did to another, or to yourself. But, is it? Sometimes, when you ask yourself why you feel guilt, you don’t know why you may feel it.
But if you can recognize a distinct cause, a violation of your moral code, and you already committed the bad behavior, the guilt can’t rectify what you did.
The only remedy is sincere remorse, a vow never to do it again, and to start over.
If you need to apologize to someone, then do it.
When restitution of money is necessary, do it.
If someone refuses to accept your apology or forgive you, the matter is really out of your hands.
Start Over
Let yourself out of jail.
You can ask for help. You can admit to a friend, family member, or mentor that you feel guilty and they will likely tell you that they approve of you.
What if none of this works? This third step of the SIG-E-CAPS Roadmap demands that you “let go” of your guilt.
Though it may not be easy, you can start by forgiving others—start with parents, children, best friends. You may find that this allows your guilt to vanish.
But, most importantly, this step asks you to forgive, love, and approve of yourself first.
Powerful Affirmations Can Also Dissolve Guilt:
- I release the need to blame anyone, including myself.
- We are all doing the best we can with the understanding, knowledge, and awareness we have.
- Even though I struggle with guilt, I choose to love and accept myself anyway.
- I am OK, and it is safe for me to forgive myself.
- Today, I choose to accept myself as I am, and I decide to compliment myself and give myself credit for the good things I do.
- I am learning and improving every day.
- Today, I am patient with myself.
- I love and approve of myself.
- The best path is to release any self-blame or guilt, I don’t need those feelings anymore and let them go.
- I release and let go of all self-criticism.
- I forgive myself for being so hard on myself.
- You deserve the best always.
- Abundance and joy are my right. I am good enough, always been good enough, and I do my best.
- I completely love and approve of myself as I am.
Source Credit: Based on the teachings of Louise Hay
- Self-Help
- Hay, Louise (Author)
- English (Publication Language)
Step 4: “E” is for (eat quality food for) Energy
It will come as no surprise that people who take antidepressants often suffer from lethargy—either as a pre-condition or from the antidepressants themselves.
The best courses of action to increase your energy are to improve your nutrition and to get exercise–even a little. Your diet, second only to sleep, is the most important thing to address.
- Feed yourself high-quality food, the best of the best.
- Try to eat vegetables with most meals, at least twice a day.
Processed food is junk food.
Junk food is not entertainment and will never help you relieve depression. More junk food means more misery, often as you watch the scale numbers climb.
What are you getting out of the processed food “horror show” except fatter? And the fatter you get, the less energy you have and the more depressed you will be.
Stop investing in the stocks of Nabisco and Doritos, and start investing in yourself.
A fuel-oriented nutrition plan will give you a store-house of energy and even qualifies as a new interest.
High-quality nutrients will not only energize your body but also your mind.
Carbohydrates are a central aspect of all diets. But, most junk-food is pure sugar which is stored as fat and saps your energy.
Complex Carbohydrates
Instead, go for “complex carbohydrates” which your body can turn into energy:
- Quinoa
- Brown rice,
- Sweet potato,
- Potatoes,
- Buckwheat aka kasha,
- Sprouted grain bread like Ezekiel muffins, and
- Old fashioned oatmeal, instead of processed foods like wheat bread.
It is important to recognize how important diet is. Many foods can cause listlessness or other adverse reactions.
So, identify your potential food sensitivities.—They are generally wheat, eggs, peanuts, and even dairy that can substantially affect you.
For example, wheat consumption can actually cause symptoms of depression in some individuals.
You must first remove all the toxic foods from your life. Once you have done this, you can think of taking medication if you are still suffering from depression.
Taking charge of your diet can be the first step to removing toxic thoughts and habits.
An excellent diet—will increase your energy and attitude—and may help more than antidepressants.
Avoiding junk foods can boost your energy levels and attitude towards life more than any antidepressant.
Processed foods are killers:
See how ultra-processed junk food can affect people.
Obesity is no help for any person who wants to increase their energy levels.
If you need to lose weight, if your weight saps energy or you want to have more you can use this easy plan to lose 20 pounds in 3 months without suffering.
Here is an excellent start to improving the nourishment of your body and mind:
A Simple SIGECAPS Depression-Solution Meal Plan
- Drink a tall glass of water with a real lemon wedge when you wake up.
- Have half a grapefruit with breakfast.
- Eat oatmeal, hot or cold, with water, 1% organic milk, almond milk, or cashew milk.
- Add berries (and some peanut or almond butter) to the oatmeal.
- Boil a couple of eggs or sautee a vegetable omelet.
- For lunch, eat some brown rice, black beans, veggies, and turkey or chicken (optional).
- Eat fruit between breakfast and lunch, or lunch and dinner, when you get hungry instead of processed snacks.
- For dinner, try sweet potato, salmon, and a vegetable, like spinach, bok choy, cauliflower, broccolini, or broccoli.
- If you are still hungry after all this food, eat an apple.
- Establish regular meal times to train your body when to expect fuel every day.
If you take these steps you can lose weight, get more energy and prevent body-distress that may lead to a depressed mood.
Step 5: “C” is for (improving your) Concentration
What can you do to improve your concentration?
- Focus only on the next right thing.
- Try to limit distractions in which you zone out, avoid exercise, and avoid taking any positive steps in your life – like radio or TV.
- Work in a quiet atmosphere.
- Break up your task into manageable pieces.
- Establish a routine and write it down – stick to your calendar.
- Start a cardio program to burn your fat and depression.
Step 6: “A” is for Appetite (for foods with tryptophan)
Follow the simple meal and workout plans I described above.
They will give you energy and help regulate your appetite.
Try to think about food differently: “food is fuel for your body” – if food is fuel, you will start to only eat when you are hungry.
Do not punish your body for the anxieties of your mind. They are connected! An improper diet also can create a depressed person!
Reduce junk food and focus on high-quality food.
My strength- training plan will keep you moving, give you energy, and often conditions you to eat well.
Building muscle and exercise is going to help your appetite, and you will begin to eat well because your body will crave quality food.
Proper Nutrition and Depression
Most psychiatrists completely ignore your diet! Yet it can be the most important single thing you can do to overcome depression.
How important is good nutrition for depression?
Let’s examine the function of antidepressants:
- The most prescribed antidepressants increase serotonin levels in your brain.
- Why?—because studies showed that “happier” “more productive” people had higher serotonin levels in their brain.
- But how do they do this?
- They block specific receptors—think of them as “vacuum” cells—from re-absorbing serotonin.
- By preventing the reabsorption of serotonin, they increase the amount of serotonin for your brain cells.
This is why antidepressants are often called “SSRIs”—because, they are “selective” serotonin reuptake inhibitors.
The most common SSRIs include:
- Prozac – learn the 10 reasons why deadlifts are the best natural alternative treatment to Prozac.
- Celexa
- Luvox
- Paxil
- Lexapro
- Cymbalta
- Zoloft – See why weaning off of Zoloft is one of the best decisions you will ever make.
Doctors also prescribe tricyclic antidepressants such as Pamelor to help keep more serotonin and norepinephrine available to your brain and elevate your mood. ( TheRecoveryVillage)
How to Increase Serotonin Naturally
But antidepressants aren’t the only way to increase serotonin in your body—you can increase serotonin in your body naturally and it can work as it is meant to do.
And, this is the most important reason why diet can affect your mood.
Ask yourself: “Could I have been eating foods that reduced the serotonin in my body? Is that how the depression started to begin with?”
The best way of getting more serotonin into your system is naturally: through food—particularly food that contains tryptophan. (You can find this supplement in almost any drug store.)
For your body to manufacture serotonin, it needs a sufficient supply of the natural amino acid, tryptophan.
Tryptophan naturally helps normalize levels of serotonin and other neurotransmitters.
This can help with both depression, aggressive behavior or reduced motivation. ²
Foods high in tryptophan: ³
- Eggs
- According to recent research, the protein in eggs can significantly boost your blood plasma levels of tryptophan,
- Cheese
- Cheese is another excellent source of tryptophan.
- Cheddar processed cheese, cottage cheese, tofu, gruyere cheese
- Pineapples
- Tofu
- Salmon
- Have you ever noticed being in a better mood after good quality salmon? Now you know why!
- Halibut, cod, flounder, tilapia, and tuna
- Nuts and Seeds
- Turkey
- Traditional milk products, yogurt, and alternative milk products such as soy milk
- Calf’s liver, chicken breast, turkey breast
- Apples, bananas, blueberries, strawberries, avocados, pineapple, peaches
- Spinach, mustard greens, asparagus, eggplant, winter squash, and green peas
- Kelp, broccoli, onions, tomatoes, and cabbage
- Cauliflower, mushrooms, cucumbers, potatoes
- Walnuts, peanuts, cashews, pistachios, chestnuts, almonds
- Ground flax, sesame, pumpkin, fenugreek, sunflower seeds (roasted)
- Mung bean, soybeans, kidney beans, lima beans, chickpeas
- Brown rice, red rice, barley, corn, oats
Step 7: “P” stands for (improve your) Psychomotor skills with exercise/sports
Do you often feel full of anxiety and cannot sit still? Does your mind race or fail to function?
Are you more sluggish and very slow in your movements?
When I helped pull myself out of dependency on antidepressants, I created a 12-week beginner deadlift program (you can also use the 3×5 workout plan) to get stronger and build muscle and confidence.
Increased muscle burns fat and unneeded carbs. Your body becomes more efficient!
On top of that, “when you exercise, your body releases endorphins that trigger a positive feeling in the body, similar to that of morphine” (WebMD).
As a result, you may feel better than ever.
And further research advises that this outcome is very much dependent on training intensity. (MedicalNewsToday)
Is it no wonder then that full-body compound weightlifting like squats and deadlifts would help relieve depression?
For more details on how weightlifting helped my depression, see How Deadlifts Saved My Life
Of course, you can use any physical movement or sport that works for you.
Step 8: “S” is for (Strength training instead of) Suicidal Ideation
Instead of thoughts about destroying your body, focus on building your body!
The subject of suicidal ideation due to antidepressants is somewhat complex, but very often the medications prescribed by psychiatrists themselves may cause suicidal ideation (ideas/thoughts).
In fact, the FDA requires that antidepressants carry a warning label that their use might lead to suicidal thinking:
And the only “side-effect” of my program is your improved health, fitness, energy, and focus. Strength training was one of the most important things that helped me clear my mind of suicidal thoughts and end my reliance on antidepressants.
Besides my personal experience that lifting weights can lift your mood, “a meta-analysis of 33 clinical trials including 1877 participants found that resistance exercise training was associated with a significant reduction in depressive symptoms. The available empirical evidence supports resistance exercise training as an alternative and/or adjuvant therapy for depressive symptoms.” (
The Gift of Clinical Depression – Fight to Save Your Life
Resistance training may help you too, give it a try, what do you have to lose?
Strength Train to Fight Depression
Here is a sample week’s program:
- Walk every day for 30 minutes.
- Start a beginner deadlift workout routine for strength and fitness on Monday.
- Do a pushup or bench press workout on Wednesday.
- And a beginner squat workout routine on Friday.
- Rest on Tuesday, Thursday, and the weekend.
Begin the classic 3×5 workout that Mark Rippetoe popularized in Starting Strength – the bible of basic barbell training.
- Mark Rippetoe (Author)
- English (Publication Language)
- 347 Pages - 11/11/2011 (Publication Date) - The Aasgaard Company...
Learn more about the power of deadlifting to lift your depression and transform your body and life in the following articles:
- These 7 Mighty Deadlift Muscle Groups Worked is WHY Deadlifts are So Good For You
- 37 Remarkable Benefits of Deadlifts to Unleash Your Fitness Fast
- 27 Sensational Ways How Deadlifts Change Your Body and Mind
- How to Deadlift for Beginners – A Step by Step Guide
- The Simplest DIY Deadlift Platform for Beginners
Remember: improving the fitness of your body is going to help improve the fitness of your body and mind.
Good luck! Has the SIG-E-CAPS Ultimate Guide helped you get fitter and manage depression? Let me hear your stories and questions: Contact Me.
Crossing the Bridge from Depression to Life
I published a book that more fully describes the Plan that helped me Cross the Bridge from Depression to Life:
ZEHHU: Crossing the Bridge from Depression to Life
What’s Next
The next step on your journey to a stronger mind and body is to understand why deadlifting has such a massive impact on your mental and physical fitness.
It is because deadlifts work the major muscle groups of your body.
To manage depression, try this beginner deadlift workout routine as part of this 12-week deadlift program.
For obesity, use these free guides to lose 20 pounds in 3 months and 75 pounds in 6 months to reach your ideal weight.
As mentioned, be sure to consult with your primary care doctor about using the mnemonic SIGECAPS for depression.
Related Posts:
- Weaning Off Zoloft is the Best Decision You Ever Made
- Fat and Depressed; How to Escape the Nightmare
- 5 Depression and Obesity Links You Need To Know
- The Holstee Manifesto – It Can Change Your Life
- How Deadlifts Saved My Life – The Best Exercise for Depression
- Set Up Your Deadlift Studio – Deadlift Equipment for Beginners
Footnotes
¹ Sleep therapy as an aid to treat depression
² https://www.lifeextension.com/magazine/2013/5/better-brain-chemistry-with-tryptophan/page-01 – Life Extension Magazine: Tryptophan improves brain chemistry
Infographic SIG-E-CAPS Roadmap
Please take a moment to share SIG-E-CAPS: The Ultimate Guide for Screening and Managing Depression with your friends, family, or physician:
Rich is a NASM-CPT (Certified Personal Trainer), an