“I didn’t want to talk to anybody in my family. I didn’t want to be there. I found myself walking to the woods and just sitting out there, and that was the first time in my life that I’d ever actually thought to myself, ‘Well, if I’m going to feel this way, I don’t want to feel anything at all.’ “ —Kenny C.
If you’re searching for information about depression then you likely think you’re experiencing something beyond simple sadness. We all experience sadness and emotional ups and downs. Depression is different.
It includes a depressed mood that is sustained over a period of time, causing a significant impact on daily life and normal functioning.
If you do have depression: you’re not alone. Depression is very common. One in five people will experience depression at some point in their lives. It happens at every age and in every culture.
But what is depression?
The word depression is thrown around a lot in casual conversation. It’s common to hear someone say, “I’m so depressed” about one thing or another. However, feeling down or unmotivated is different from clinical depression, which is also called major depressive disorder or MDD.
The American Psychiatric Association defines depression as “a common and serious medical illness that negatively affects how you feel, the way you think and how you act”. Depression is not a flaw and it’s not a weakness. It’s a powerful, but treatable, condition.
Clinical depression is not only more sustained than normal ups and downs – it can last years for some people – it also has a substantial impact on daily life. People with depression have difficulty being productive at work or school, connecting with others, and even doing simple, everyday tasks like shopping or laundry.
Depression also includes changes to your body and brain. Parts of the limbic system, the brain’s center of basic emotions, actually shrink in size and have reduced function with depression. And an area called the Dorsolateral Prefrontal Cortex (DLPFC), in the front part of our brain responsible for motivation, judgment, and sophisticated emotions, shows lower amounts of activity with depression.
People with depression also tend to have reduced immune function, constricted blood vessels, lower energy, sleep disturbances, weight changes, and increased risk of heart attack.
What are the signs and symptoms of clinical depression?
Everyone experiences depression differently, with different symptoms and patterns. According to Brightside Advisor Julia E. Hoffman, Psy.D. “Because people tend to use the term depression more generally, figuring out if you’ve actually got a clinical condition can be a little tricky, especially if what you’re experiencing doesn’t seem to fit with the common understanding.”
There are nine generally accepted symptoms of depression that are used to determine a diagnosis:
- Having little interest or pleasure in doing things
- Feeling down, depressed, or hopeless
- Having trouble falling or staying asleep, or sleeping too much
- Feeling tired or having little energy
- Poor appetite or overeating
- Feeling bad about yourself/failure
- Trouble concentrating on things
- Moving or speaking so slowly that other people could have noticed. Or being fidgety/restless.
- Thoughts that you would be better of dead, or thoughts of hurting yourself
These symptoms are often measured using the widely accepted Patient Health Questionnaire, or PHQ-9, to determine whether someone may be experiencing depression.
But these aren’t the only symptoms associated with depression. People who are depressed commonly say they feel overwhelmed, burnt out, inadequate, and ashamed. Many say they feel nothing at all, empty and flat.
Depression can include a sense of pain, not unlike physical pain, that makes people give up on their interest in the outside world.
You don’t have to have all of these symptoms to be depressed – everyone has their own pattern and symptoms can come and go. “Most people expect that depression means feeling sad or down during the episode but you could also feel irritable or disinterested in things that you usually enjoy and skip sadness altogether,” Hoffman explains.
Beyond the presence of symptoms, depression also needs to be persistent, lasting continuously for at least two weeks. Depression can appear in episodes, which may come and go over time, or may settle in and stay.
Many people have things in their life that can trigger or exacerbate depression – the death of a loved one, loss of a job, excessive stress, etc., but many people feel depressed for no apparent reason at all.
Depressed people can feel chronically negative—often regardless of what else is going on. “Although some kinds of depression allow people to have bright spots when they go through happy things, you generally expect that these bad moods are happening most of the time for the whole episode,” Hoffman says.
The impact of symptoms on your daily life, such as work and relationships, also helps identify depression.
So is this depression? Am I depressed?
The guidelines of the American Psychiatric Association (The DSM-5) state that to be clinically depressed:
- A patient must be experiencing at least five of the nine core symptoms and that this must include feeling down, depressed, or hopeless, or having little interest or pleasure in doing things.
- The symptoms need to be persistent for at least two weeks
- The symptoms need to be causing difficulty in a patient’s life
This formula is a guideline that is only part of the picture. A doctor also takes symptoms, history, and context into consideration when diagnosing depression.
There are some scenarios when symptoms may look like depression but be caused by other things – a doctor will want to rule these out as potential causes for what someone is experiencing. Some health conditions like hypothyroidism or sleep apnea can have symptoms that look like depression and some medications for other health conditions can have depressive side effects.
What can be done about depression?
Depression is very treatable. It is estimated that 80-90% of people get better with treatment. There are three primary treatment approaches for depression:
- Therapy, especially Cognitive Behavioral Therapy (CBT) and Interpersonal therapy (IPT), have been shown to be effective at reducing the symptoms of depression. Through education, introspection, and skill development, you can process emotions and modify thought and behavior patterns that are keeping you from feeling your best.
- Medication is effective at reducing the symptoms of depression and the impact it is having on your life. It works by affecting the availability of certain neurotransmitters – the brain’s chemical messengers – and stimulating the parts of your brain associated with depression.
- Self care includes making healthy changes to diet, sleep, exercise, stress management, and relationships to reduce depression. Small steps and habits can have a major impact.
Depression has multiple causes – biological, psychological, and social or environmental. Because of this, comprehensive treatment approaches that combine therapy, medication, and self care to address the multiple facets of depression are the most effective.
What should I do?
Despite the millions of people suffering from it, depression can be an incredibly lonely condition. When you’re feeling depressed, it can sometimes seem easier to live with it than to get help. Feelings of depression can start to seem normal. But, there are consequences to waiting. Depression can get worse and more difficult to treat the longer it goes on.
Depression is common. It’s not a flaw and it’s not a weakness. The first step to getting better is to get evaluated, determine where you stand, and figure out the right treatment plan for you.