Mood

DEPRESSION FAQ

 

What is depression?

Officially, psychiatry classifies depression as a mood disorder characterized by a range of symptoms (such as loss of pleasure) that significantly interferes with one's ability to function. Unofficially, I would describe it as a state of psychic distress that renders us incapable of coping with whatever life may throw our way. It's as if our brains have quit on us.

What are the symptoms of depression?

The American Psychiatric Association's Diagnostic and Statistical Manual, Fifth Edition (DSM-5) lists nine symptoms for major depression, five or more which must be present over the same two-week period, including one of the first two: 1) Feeling depressed most of the day, nearly every day, or 2) Markedly diminished pleasure.

The other seven symptoms include: 3) Significant weight gain or loss, 4) Insomnia or hypersomnia, 5) psychomotor agitation or retardation, 6) Fatigue or loss of energy, 7) Feelings of worthlessness or inappropriate guilt, 8) Diminished ability to think or concentrate, 9) Recurrent thoughts of death, suicidal thinking, suicide attempts.

What if I have only four symptoms?

Symptom-counting can be a very dangerous and misleading exercise, especially when the DSM symptoms give us very little insight into how we think and feel and behave. I would suggest if you are "feeling" depressed and if life is too much to handle right now, a doctor will most likely confirm that you have depression.

Tell me more.

Take a look at the first DSM symptom - "Feeling depressed most of the day." What is that supposed to mean? Are you sad? Unmotivated? Grieving? Going through a spiritual crisis? In psychic pain? Wanting to shut down? Overwhelmed? Underwhelmed? Over-thinking? Can't think?

This is critical, as we've assigned just one name to cover a lot of potential stuff going on. It's as if we were to call every infectious disease something like "runny nose disease" with only one type of medicine to treat it.

So depression is more than depression, then.

Exactly. Depression, in fact, is a very inapt word. Depression incorporates a wide range of emotions and behaviors, from feeling sad to loss of pleasure to being anxious to being angry to acting aggressively. Throw in out of whack sleeping and eating, loss of energy, not being able to think straight, and unexplained pain, and we are talking about a mental and physical perfect storm.

 

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Tell me more.

Take a look at the first DSM symptom - "Feeling depressed most of the day." What is that supposed to mean? Are you sad? Unmotivated? Grieving? Going through a spiritual crisis? In psychic pain? Wanting to shut down? Overwhelmed? Underwhelmed? Over-thinking? Can't think?

This is critical, as we've assigned just one name to cover a lot of potential stuff going on. It's as if we were to call every infectious disease something like "runny nose disease" with only one type of medicine to treat it.

So depression is more than depression, then.

Exactly. Depression, in fact, is a very inapt word. Depression incorporates a wide range of emotions and behaviors, from feeling sad to loss of pleasure to being anxious to being angry to acting aggressively. Throw in out of whack sleeping and eating, loss of energy, not being able to think straight, and unexplained pain, and we are talking about a mental and physical perfect storm.

I have been told to snap out of it. Depression must be my fault, right?

Wrong. Depression is a medical illness (more likely a number of illnesses) which affects a physical organ, the brain, which in turn affects the rest of the body. One can no more snap out of depression than one can snap out of diabetes or heart disease. It would help to have a positive outlook, but the very nature of depression is a lack of positive outlook. Unfortunately, having depression still carries a stigma, though not nearly as bad as in the past. If there is any consolation, you are in good company: Winston Churchill, Abraham Lincoln, Peter Illych Tchaikovsky, Frederic Chopin, and Mike Wallace, just to name a few, all had crushing depressions.

Are there specific types of depression?

Yes. The DSM officially breaks down depression into a number of different subtypes, but it is probably more useful to look at what is really going on.

Do tell.

Chances are your symptoms relating to emotion, mental activity, physical activity, and behavior will resolve into vegetative or agitated states.

Describe a vegetative state.

A vegetative depression is like you're dead but breathing. You have no energy, no motivation, you can barely move or string two thoughts together.

Describe an agitated state.

An agitated depression feels more like you're in neutral, but with the motor running out of control. You almost want to grab the world by the neck and shake it.

Is there more?

Yes. Ask me about situational depression.

Okay, then, what is situational depression?

Often, our depressions can be tied to the events around us, such as toxic work environments or new stresses in our lives. Yes, depression is a biological illness, but there are environment factors that we can often connect to specific events. This applies across the rest of medicine, as well - just ask anyone with an STD.

How does stress and trauma fit into this?

Our brains weren't built to handle stress overloads. Biologically vulnerable brains tend to break down in response to life's crushing burdens. One result may be depression. Even resilient brains are at risk. Trauma makes even normal life seem stressful.

Are there times when depression is normal?

Yes, such as when we have lost a loved one. Indeed, depression is often a healthy response to adversity. But when it persists, we need to pay close attention.

Is depression different from bipolar disorder?

Yes and no. Yes, in the sense that we are talking about two different illnesses with different treatments. We use the term "unipolar" to distinguish clinical depression from bipolar depression. No, in the sense there is considerable overlap. We find the overlap occurring with recurrent depressions and mixed depressions.

What is recurrent depression?

As opposed to chronic depression, which may persist over years, recurrent depressions tend to come and go in a pattern not unlike bipolar, only without the pronounced ups into mania and hypomania (mania lite). Closely spaced depressions (highly recurrent) may be a sign that the depression should be treated as if it were a bipolar depression, with mood stabilizers.

What is mixed depression?

These are depressions with some elements of mania (such as racing thoughts). These depressions tend to be agitated, with intense feelings of psychic unease, as if wanting to crawl out of your skin.

How does anxiety fit into depression?

In a number of ways. Anxiety tends to be part of the stress response that leads to depression. Most individuals with depression tend to have full-blown anxiety, and nearly all have some elements of anxiety. In general, where there is depression, look for anxiety.

How does psychosis fit into depression?

Psychosis involves delusional thinking. Depression involves distorted thinking (such as seeing life as hopeless). Psychosis may be related to this distorted thinking (what is called "mood congruent") or unrelated ("mood incongruent").

Is there any connection between depression and personality?

Glad you asked. Yes, though you won't find this spelled out in the DSM. On one hand, we can have a depressive temperament without being depressed. On the other, the interaction between a depressive episode and various personality traits can result in endless complications.

Is there any such thing as a pure depression?

In theory. The reality is there are likely to be other things going on (such as anxiety) which complicate its course and treatment. Knowing this will help you figure out your best options.

What is dysthymia?

Dysthymia is chronic mild to moderate chronic depression. But don't be fooled by the "mild to moderate." Dysthymia can wear you down.

What is atypical depression?

Atypical depression is psychiatry's way of distinguishing vegetative from agitated depression. We are basically talking about vegetative depression with "mood reactivity" (with improved mood when something good happens) and "sensitivity to personal rejection" thrown in for good measure.

What is seasonal affective disorder?

Seasonal affective disorder is major depression that appears in the fall or winter and goes away in spring, thought to be caused by lack of sunlight.

What is postpartum depression?

Postpartum depression occurs within four weeks of a women giving childbirth. Most new mothers suffer from some form of the "baby blues." Postpartum depression, by contrast, is major depression, thought to be triggered by changes in hormonal flows associated with childbirth.

Are women especially vulnerable to depression?

Yes. Besides postpartum depression, some women also experience depression as part of their hormonal cycle, referred to as premenstrual dysphoric disorder, or PMDD. Across all nations and cultures, it was found that twice as many women experience depression as men.

So men get off lightly, right?

Wrong. A strong body of opinion posits that the DSM is biased toward women. Men tend to express their inner hurt in ways besides teary behavior, such as anger, irritability, and aggression.

Is physical illness tied into depression?

Yes. Mind and body are very much connected. Depression has been linked to heart disease, diabetes, bone loss, stroke, irritable bowel syndrome, and possibly cancer. In addition, people with depression have much higher rates of alcohol and substance use than the general population.

Just how serious a problem is depression?

According to the National Institute of Mental Health, approximately 18.8 million American adults, or about 9.5 percent of the US population age 18 and older in a given year, have a depressive disorder. According to the World Health Organization, depression is presently on track to becoming the world's second-most disabling disease (after heart disease). Additionally, one million people worldwide die by their own hand, most as a result of a mood disorder. Finally, the linkage between depression and a host of physical illnesses makes it arguably the world's greatest killer.

Can kids get depression?

Yes. Some 3.4 million Americans under age 18 are depressed, one in 33 children and one in eight teens. Kids respond to the same treatments and therapies as adults, but a good deal of opposition to kids taking meds designed for adults is valid.

What about the elderly?

Depression is not a normal part of aging. Older people may have more to be depressed about, but this is generally offset by the range of coping skills they have picked up over their lifetimes. There is the additional complication of depression tied into physical deterioration in brain

Who should I go to for my depression?

By default, your primary care physician is your first stop. But keep in mind, your doctor is not likely to pick up depression during the course of a typical physical exam, nor is he or she likely to pick up its subtleties.

Should I seek out a psychiatrist?

It may take weeks to get an appointment, so a PCP is likely to be your first stop. But a psychiatrist is in a much better position to pick up the subtleties.

What about seeking out a talking therapist?

A psychologist is also qualified to give you an examination and give you a diagnosis, but is not licensed to prescribe medications. The advantage is that a psychologist or other talking therapist has much more time to spend with you, and so may be in a much better position to help you out.

Isn't there a simple test to determine if a person has depression?

Unfortunately not. As we have seen, depression is at best an arbitrary designation for a host of symptoms. There is no depression bacteria or virus we can identify, nor do we have any kind of blood or lab test to determine if a person has depression.

How is depression caused?

The short answer is we don't know. It is convenient to say it is caused by a chemical imbalance in the brain, but this is not at all accurate. The expert consensus is that depression is the result of genes, biology, and the environment interacting with one another.

Any closing remarks?

Yes. Depression may be one of the most devastating illnesses on the planet, but the mere fact that you are reading this means you are fighting back. Our brains may have quit on us, but our brains are also wired for recovery and healing. Your brain may be tricking you right now into believing you have no options. I know, I've been there. But here I am right now, talking to you.

See also: Depression Treatment FAQ, Recovery FAQ

Reviewed June 18, 2016

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