So many folks toss around the word depression without really thinking about what it means. Saying things like, “the coffee place was out of my fav coffee, I’m so depressed!” “It’s MONDAY I’m so depressed!” We are using this word so MUCH that it seems like it is…losing its original meaning. MOST of the time the word they probably “mean” is SAD, or bummed or upset. Still…I get it…that is the evolution of words…what used to mean X and now means Y. But here is the rub:
Depression is a DIAGNOSIS, sadness is a feeling.
I know…the word “depression” is a “feeling word” that we use interchangeably with sadness. BUT Depression is a Diagnosis, not JUST a feeling. It is a compilation of symptoms that have a significant negative impact on your life…Depression is not JUST “sad” or “upset” or “bummed” those things are typical, and we can pull ourselves out of those, so sad goes away…sad is usually in response to some THING and what we feel is commensurate with that THING. It makes sense. Upset…same thing. These things are smaller and don’t have the weight of depression. Say, your pet dies…SAD is the natural response…of course you are sad. If your mom dies…yes you are SAD, of course you are sad….it makes sense. Now, if that “sad” continues…if it grows and gets out of control, or if it has a significant negative impact on your ability to function…then it may turn into Depression.
So, maybe you are thinking;
Kelly who cares? It’s JUST a word!
Well, first of all words matter, they are descriptors that we all agree MEAN some THING. So, if we SAY depressed when we MEAN “sad” we have agreed that depressed and sad are the SAME.
BUT here is MORE of the rub:
If you have DEPRESSION and someone equates it with SAD it leads to all sorts of issues.
The fist one is that folks tend to minimize what you are experiencing and put simply…that sucks. When someone is equating a sad MOMENT with DEPRESSION…it’s like equating the common cold with cancer…both are “sick” but WOW they are very different sorts of “sick”
Folks also give advice like, “when I was depressed I pulled myself out of it by….” fill in the blank…pulling myself up by the bootstraps, going to a movie, thinking positive, etc OR the old standby “time heals all wounds!” Folks are FILLED with WELL INTENDED advice on how to “deal” with depression…the problem is not the advice itself, it’s probably good advice…the problem is, this sort of advice that works well for SADNESS but doesn’t always work well for Depression.
SO, if you are sad and do those things…you will likely feel less sad…if not right away, then at least it does still help. Thinking more positive CAN help with sad, being more proactive, exercising, distractions, looking down the road to a happier time, finding hopefulness…it all helps with sadness. Depression though…is more…stubborn than sadness, it’s more INVASIVE it takes over MORE of your brain, more of your energy more of your LIFE than sadness.
So, if folks give you advice (that works for THEM) and it doesn’t work for YOU…then two things happen:
- It can lead to MORE depression, because now you feel like YOU are the problem…YOU are just not trying hard enough…whey could “they” snap out of it and YOU can’t?!!? It an make you feel like you are just not DOING IT RIGHT.
- It makes you LESS likely to get help. If “they” could snap out of it without help you SHOULD be able to also!!
- Folks (yes well meaning, loving folks) will often get frustrated that you can’t just SNAP OUT OF IT….they will get frustrated with you as though you are not trying hard enough, or not listening to their wonderful advice. This means you turn to them less, and goes back to YOU feeling ilke YOU are just doing it wrong!
So what do we DO about this? How do we deal with the notion that sadness and depression are synonymous? We challenge this belief…and…we create a new words or new ways of talking about it…that are hopefully more descriptive and therefore MORE helpful.
So, let’s define Depression more concretely, as sort of a gradient.
First level is: Depressed Mood: Aka SAD. This comes with feelings of sadness or emptiness…often associated with a lack of energy and a negative thought process. This is most often a temporary response to an unpleasant or stressful event. On a scale of 1 to 10, it may feel like a 10 at first, but it tends to drop down fairly quickly in the scheme of things. It can also come and go. Folks are still able to find some joy…some peace and it is typically not 24/7 especially after the trauma passes. This is often seen as the “normal” response to trauma…again if your dog dies, you are SAD…of course you are sad, it’s terrible and your sadness or “depressed mood” makes sense. You’d look at the situation and think: “most folks would be sad if this happened to them” THIS is what most folks mean when they say, “I’m depressed”
Second level: Dysthymia: Not really an official diagnosis anymore…but I always thought this diagnosis had some merit…and it’s a good sort of…middle spot between Depressed Mood and Major Depression. So, this is sort of a Chronic low-grade depressed mood. At this level the Depressed mood is present MOST of the time and lasts for a LONG time (often YEARS). It is more likely accompanied by lack of energy, changes in appetite (eating too much or too little), changes in sleep (sleeping too much or not enough or just not getting restful sleep) as well as low self-esteem and feelings of hopelessness. These issues cause some distress and difficulty in functioning, but are less severe than in major depression. There may be periods where the mood shifts…and can get better…but the SAD is there MORE often than NOT. If it is long standing, it could be accompanied by passive suicidal thoughts (It would be fine if I didn’t wake up tomorrow). Most folks with Dysthymia get by, they do their job, life their life…though perhaps not as effectively as they could. Folks around them often see them as just “Debbie downers.” It is hard for someone with Dysthymia to feel GOOD. The kicker here is that sometimes they do feel good…making this diagnosis difficult to make. This is also likely why so FEW folks with Dysthymia get treatment….folks just think it’s “who they are” their “personality” and so don’t even consider treatment. So, while Dysthymia is often seen as “depression light” it can be awful to live with…in part because of its chronic nature. Think of it this way, it’s like low grade ongoing day to day headache…it’s miserable and exhausting, even if it isn’t debilitating. This is still a DIAGNOSIS, it’s MORE than JUST sad…remember, sad is a feeling, this is a CONDITION. Typically, when folks DO come in for treatment, we treat it much the same way we do Major Depression.
Third Level: Clinical/Major depression. This does have a component of a “depressed mood” but it is MORE than in the previous categories. There is ALSO a significant loss of interest or pleasure in things you used to enjoy, usually there is significantly decreased energy, significant changes in sleep and appetite and often feelings of guilt and/or hopelessness. There is often significant difficulty concentrating/focusing, some restlessness, agitation/irritation and anxiety are common. For these many of these folks even the most mundane things can be difficult to do…getting out of bed and taking a shower can feel like climbing a mountain, they may still do it…but it is EXHAUSTING. And for some folks, if it gets severe enough…they literally cannot do even the most minimal things. As a baseline, these issues must be present for at least two weeks AND cause significant distress, and significant impairment to normal levels of functioning. See how it is MORE than just sadness or depressed mood?
Here is a MYTH I am HAPPY to dispel:
People with Major Depression do NOT always have suicidal thoughts. Yes, some folks (usually with Severe Depression) do have suicidal thoughts or actions. But in my experience, MOST of the clients I treat who have Major Depression as a Diagnosis are NOT actively suicidal. They may have had the passive thoughts, such as “it would be ok to not wake up tomorrow” (which are still SCARY) but they most often haven’t reached a level where they are currently thinking of suicide.
I say this because MANY folks think that Major Depression is NOT the diagnosis UNLESS there are suicidal thoughts/actions. So, they think that they are NOT depressed…and, as mentioned above, feel bad for NOT being able to just GET OVER IT. You do not have to be SUICIDAL to have Major Depressed…and you have to be more than JUST sad…to be diagnosed with Major Depression.
Now…to complicate things even MORE….
Major Depression is considered a “spectrum” disorder…meaning it goes from Mild to Moderate to Severe. And maybe this is part of the confusion…because folks with MILD depression might think they ARE “just” sad (and so will not get treatment). BUT, even MILD depression is MORE than JUST depressed mood, more than just SAD. As a clinician I tend to think of the “degree of impact” on a person’s life when I am deciding between Mild, Moderate or Severe. But regardless of the “level” of Depression it is MORE than JUST sad.
Ok, so how do you KNOW if you are “sad” or have Major Depression?
There are a LOT of resources and self-assessment tools online that can help you see if YOU or someone you care about is “sad” or truly has “Major Depression.” Just be sure to use a reputable source that isn’t trying to SELL you something. However, I believe the only way to get an accurate diagnosis is to go to a professional. Your medical Doctor can be a good place to start. Or a Psychologist, Therapist, Counselor…we can all help you figure this out…help you know if it’s sadness (a feeling) or Depression (a diagnosis). Why does it matter? Well, really ti’s about how you talk to yourself, what you DO next and how your life will look going forward.
Additional complications around this issue include:
If you say it’s “sadness” you will likely not get treatment (though counseling can help with this too). You will likely beat yourself up for not “getting better” or feel like you are just doing things WRONG. It will be hard to turn to your support system and actually be supported in a way that helps….because folks (including you) might minimize what you are experiencing.
Some folks will stick with “I’m just feeling sad, it is NOT Major Depression“ because NOBODY wants to have Major Depression! If it’s “just sad” we CAN get over it, it does have some sort of end date. Whereas folks sometimes feel like “MAJOR Depression” is SO…well MAJOR that it’s not something they’ll get OVER. There is still some stigma associated with a diagnosis like this…where folks can feel broken, or somehow feel guilt or shame.
HOPEFULLESS
1 out of 5 folks in the US have some sort of Mental Health issue….YOU ARE NOT ALONE.
If you have Major Depression, there IS treatment that WORKS. You are not doomed to be depressed forever.
Keep in mind, sadness can turn IN to Major Depression. Treatment can help, even if it IS just SAD…so getting in to see someone is a good way to prevent Major Depression as well as treat it if it is already present.
So, now you know…Depression is a diagnosis…sad is a feeling. You have some info on what the diagnosis means. More to the point…there is something you are experiencing, thinking or feeling that made you choose to read this. I would argue, sadness or Depression differences aside…whatever made you read this, whatever you are going through…there IS help. YOU do not have to KNOW if you have Major Depression or are SAD…you just have to know you want…different, you want change, the old phrase
You are sick and tired of being SICK and TIRED.
There is help. Self-help books, or sites like this are a great place to start. Especially for sadness, dysthymia or even mild depression….but these sources are more…generic. Whereas Therapy is a GREAT place to get help that is specific to YOU and YOUR situation and is where you can get the sort of help that…well…HELPS.
Now, since I believe knowledge is power, (and with power you can create change) Lets look a bit more at Major Depression.
Depression Factoids:
I call these “factoids” because the statistics vary so greatly depending on where you get them. So, the “facts” don’t always match up. Mental Health research is also VERY hard research to DO. Most of it is based on “self-report” and if we learned anything in the last post…it is that LOTS of folks confuse SAD with DEPRESSED…so the stats are a guesstimate at best. Some say they are drastically UNDER reported and other says overly so. I took the most commonly held suppositions and went with those 🙂
Major Depression factoids:
- Depression is the MOST common mental health disorder (I see a LOT of coexisting anxiety too)
- If you have been depressed once before, you are ~50% more likely to be depressed again. IF you have been depressed twice before you are ~80% more likely to become depression again. (I KNOW we HATE this one, but again knowledge is power, and this knowledge means you want to pay attention so that you can get treatment EARLY.
- If you have a family history of depression, you are more likely to become depressed at some point in your life.
- If you have past “trauma” (and who doesn’t??) you are more likely to become depressed.
- It is estimated that about one of out ten adults in the US will experience some form of depression.
- OF the folks that are diagnosed with Severe Depression approx 1 in 10 will attempt suicide.
- Of the folks with Major Depression only 40% receive treatment, (hmm, maybe because they THINK it’s just SAD!) even less for Dysthymia.
- Some depression is chronic (fairly steady over long periods) or recurrent (comes back again and again with breaks between), some is situational (due to a trauma).
- Major Depression can be debilitating, exhausting and miserable.
- Most folks who have never experienced Major Depression…will not “get it” will equate it to “sad” and often discount the impact it has on the depressed person’s life.
There are many more stats…things that are tracked…like which state has the most depressed folks, or what sort of person (male/female, job types, ethnicity etc) it’s easy to get lost in looking at all the stats we keep on this diagnosis! But, for the sake of this blog…I reined in my curiosity 🙂
First thing to note:
If you fall into one or more of the above categories you are still not LIKELY to experience depression in your lifetime….just MORE likely than folks who don’t fall into the above categories.
THAT is the funny thing about statistics…while you may be “more” likely…it’s still not a FOR SURE. So, maybe instead of 1 out of 10 it’s 1. 5 out of 10 for folks that fall into the above criteria…following that logic the more things that fit you from that list…the more likely you are to have depression…but it’s STILL NOT FOR SURE. So, don’t read those and think, “Oh NO! Depression is for sure in my future!!!” While 1 in 10 is not good…that means 9 in 10 will NOT experience depression…so it is still MORE Likely you will NOT have a bout with depression.
Now, how can we use these stats? First, just take a look around…think of the folks you know…ONE in TEN have struggled with some form of depression….not just sadness, but Depression. And NO it’s not just folks YOU don’t know…it’s someone you know…since you are HERE it may even be you.
The good news about this…is you are NOT ALONE…LOTS of folks have been right where you are…even folks you KNOW (though they may not have told you). One of the reasons I include stats is because then we don’t feel so ALONE. If you know OTHER folks have been right where you are, have felt just what you are feeling…that makes things a little easier to go through. As professionals these sorts of stats help us in coming up with effective treatment plans…helps us know the best ways to help folks get OUT of depression.
I have read that depression is not “curable” I don’t now folks…I’ve SEEN folks come OUT of it…I’ve seen folks move PAST it…sure, it may be lurking somewhere in the background…but in my practice I’ve seen folks GET BETTER. There is hope…in fact here are some more HOPEFUL factoids from WebMd:
- 70-80% of the folks Diagnosed with Major depression report it mostly goes away
- 80% of the folks who get treatment report it helps.
- YOU can make a difference in YOUR life…you do have some control
- Depression CAN and DOES lift…there IS help and lots of it
- Medications can really help…with minimal side effects for most folks. 6 out of 10 patients see improvement with the first medication they try.
- This Depressed state doesn’t NOT have to become YOUR LIFE
- You can learn to head another bout off “at the pass”
- Folks who recover often know themselves better, feel better even than before the diagnosis.
- You can end up being better prepared for any future trauma
- Depression can be a path to healing old wounds…the symptoms can make us miserable enough to go back and clean out those wounds, so they no longer can cause infections.
Hopefully you were able to get through the first set of factoids without getting MORE depressed! Pat yourself on the back for making it to this point…I did the hopeful things SECOND so you would end this post on a good note. YOU CAN GET BETTER…there IS HELP…I hope this blog is just a starting point…a way for you to get the ball rolling so that YOU can recover and live a happy healthy life. For many folks with Major Depression, that is can seem like a TALL order…but keep in mind…change only happens when you decide to DO something DIFFERENT. So, GO YOU for doing THIS, for having enough hopefulness to even READ about depression. Keep going…I will be writing more on how you can recover from Major Depression.
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