Depression: It’s More than Just Being Sad
“That’s the thing about depression: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end. The fog is like a cage without a key.” — Elizabeth Wurtzel.
When we talk about depression, we refer to more than just sadness or feeling low. While it is normal to feel sad or “down” at times, depression goes beyond the normal ups and downs of everyday life and lasts for weeks, months, or even years.
Unfortunately, the stigma surrounding depression and other mental health problems is still very much present in today’s society. It’s often uncomfortable for people to talk about it with others. Moreover, it’s easy to overlook the symptoms of depression — it may be hard for people to know what’s wrong or how to find help.
It’s important to remember that depression is not a character flaw or a sign of weakness, laziness, or failure. If you or someone you know is experiencing symptoms of depression, seek help. You’re not alone, and there are ways to get support and overcome it.
If you’re in crisis, call 1-800-273-8255. The toll-free National Suicide Prevention Lifeline is available 24/7.
What is depression?
Depression is a common and serious mental health disorder that can affect anyone at any time.
Some symptoms include:
- Persistent low mood
- Loss of interest and pleasure in life
- Ongoing feelings of sadness
If these symptoms last 2 weeks or longer and cause significant disturbance in cognition, emotion regulation, or behavior and distress or disability in social, occupational, or other important activities, impairment, a person may be experiencing depression.
While depression is not the same for everyone, it’s a mood disorder that affects people of all ages, genders, ethnicities, and walks of life.
How common is depression? According to the WHO, about 280 million people have depression worldwide. It’s projected that untreated mental health problems — particularly depressive disorders — will be the leading cause of mortality and disability by 2030.
Sadly, there’s a lot of misinformation and some myths about depression that prevent people from getting the help they need. However, there’s a way out!
It’s easy to overlook the signs and symptoms of depression as a result of the stigma surrounding this mood disorder. Some people exhibit no signs at all.
How to tell if you have depression? While you can’t diagnose yourself or someone else without medical supervision, there are some key symptoms and signs that healthcare professionals look out for:
- Low, depressed mood
- Feelings of hopelessness, worthlessness, and/or helplessness
- A sense of failure
- Inability to feel pleasure and loss of interest in activities that usually bring joy (anhedonia)
- Feelings of inappropriate guilt
- Sleeping too much or too little
- Changes in appetite
- Social withdrawal
- Negative outlook on life
- Increased tiredness, fatigue, and loss of energy nearly every day
- Difficulty concentrating
- Changes in personal hygiene
- Unexplained aches and pains
- Low sex drive
- Significant weight gain or loss
- Increased irritability
- Feeling slowed down in movements and speech
- Recurrent thoughts of death
- Suicide ideation or attempt
The symptoms of depression have a significant impact on a person’s life. It’s also important to remember that they are not the same for everyone. For example, they range within the severity of the disorder — the impact of symptoms of mild depression on a person’s life differs from those of moderate and severe depression. Still, mild depression is not just a low mood that can improve after a short time itself.
Also, some depression symptoms in men can differ in some ways from depression symptoms in women. For example, aggressiveness, anger, violent or reckless behavior, and substance misuse are present and experienced in men more often.
In fact, depression in men is more insidious since men are less likely to talk about it and seek treatment. This can be one of the reasons why men die from suicide 3-5 times more frequently than women.
Depression can be hard to recognize and diagnose since it can be caused by a number of mental illnesses and also trigger other mental health problems. It can lead to anxiety disorders, eating disorders, substance misuse, and schizophrenia. Also, it has a link to bipolar disorder, PTSD, and grief.
So if you experience some of the above symptoms for over 2 weeks, talk to your healthcare provider. Only trained healthcare professionals can provide a diagnosis — a doctor, a therapist, or a psychiatrist. They may also ask a person to fill out a questionnaire.
Here’s the online copy of the Patient Health Questionnaire-9. Note: scores on a questionnaire cannot diagnose depression but can only indicate the range and severity of symptoms.
Depression and bipolar disorder
Bipolar disorder is previously known as manic depression. Bipolar disorder and depression have some similarities in symptoms and both include the risk of suicide. But also, there are some key differences. Knowing them is important for getting the right treatment.
What is bipolar disorder? Bipolar disorder is a lifelong condition. While depression is unipolar (persistent low mood), bipolar disorder is characterized by extreme mood swings:
- from severe depressive episodes — lows — extreme sadness, feeling hopeless, and loss of joy or interest
- to periods of mania — highs — extreme happiness, excitement, increase in goal-directed activity, inflated sense of self-esteem, increase in high-risk behaviors, decreased need for sleep, or irritability
A person with bipolar disorder can be severely depressed for hours, days, weeks, or months before entering a manic period that can range from several days to longer than 2 months.
It’s also possible to experience manic and depressive symptoms at the same time — a person can feel sad and hopeless while being very agitated.
Both bipolar disorder and depression are able to be effectively managed with the right and timely treatment.
Depression and anxiety
Although depression and anxiety are different conditions, they commonly occur together because one can trigger another and both may be caused by the same or similar factors. So here’s the link: anxiety can make us depressed and being depressed can make us anxious.
It’s common to have depression triggered by an anxiety disorder and have anxiety as a symptom of depression. It’s estimated that 60% of people with an anxiety disorder also will have depression. And almost the same numbers are of people with depression who will have an anxiety disorder.
Also, in many cases, depression and anxiety share similar symptoms and have similar treatment approaches.
Depression and grief
While grieving, the overwhelming feelings of sadness, anxiety, and despair can feel like depression. Grief and depression both have many similarities. However, there are some key differences between the two — particularly in their causes and how they impact you over time:
- While grief is a normal part of the healing process, depression is a clinical condition that can be life-threatening if left untreated.
- Grief about losing a loved one will never go away completely, but most people can move forward with time. Depression feels like there’s no way out.
- Grief is mostly caused by the death of a loved one or loss, whereas depression can appear without a clear cause.
- Grief and depression often co-occur, and grief can trigger depression.
- Although it is common to feel intense sadness while grieving (which is normal and expected during grief), you can also experience many other emotions during your grief stages — you can even sometimes feel uplifted, happy, and comforted. That is not the case with depression.
- Some key distinctive symptoms of depression are the inability to enjoy activities that used to bring great joy, persistent isolation, prolonged functional impairment, feelings of being stuck, and thoughts of suicide related to feelings of being worthless or undeserving of life.
If you notice that your grief symptoms persist or that your depression symptoms begin to appear and intensify, it’s important that you seek treatment right away.
Causes of depression and risk factors
Depression is a complex mood disorder. It can be caused by a variety of risk factors or a combination of genetic, psychological, biological, and environmental factors.
Here’s a non-exhaustive list of what causes depression:
- Genetic predisposition
- Brain chemistry
- Trauma or traumatic experiences
- Co-occurring mental health problems
- Disaster, war, and conflict
- Side effects from medications
- Drug use
- Grief and loss (of a loved one, job, dream, home, property, etc.)
- Breakup or divorce
- An illness or injury
- Chronic stress
- Experiencing a major life change
Also, it’s essential to recognize the diverse experiences of people of all identities and cultural dimensions. People from different racial/ethnic groups, religious groups, the LGBTQIA+ community, various socioeconomic backgrounds, and people with disabilities or chronic medical conditions may face unique risk factors for depression:
- Exposure to racial trauma
- Persistent social inequities and discrimination
- Prejudice and isolation
- Poor level of self-awareness and mental health education
- Traditional cultural norms that affect mental health
- Denial of civil and human rights
- An even more influential stigma within the communities
- Chronic physical pain
- Lack of culturally-sensitive health care or barriers to getting treatment
These and many more factors can cause new or worsen existing symptoms of depression, particularly in people with intersecting cultural, gender, or socioeconomic identities. For example, a 2020 study revealed that, on average, Black, Hispanic, and Asian American women experienced more depressive symptoms than any other population group.
And although depression rates are the same or lower in Black people and Hispanics than those of whites, research finds that depression is likely to be more persistent in blacks and Hispanics.
Some depression facts and additional statistics:
- Women are diagnosed with depression more often than men: 1 in 4 women will require treatment at some time, compared with 1 in 10 men. The reasons for this are yet to be clear.
- Depression is diagnosed in 1 in 5 older people.
- This medical illness tends to relapse in more than 50% of people. A further recurring risk in those who have a second episode increases up to 70%.
Children with at least one depressed parent are at an increased risk (about 50%) of developing the disorder themselves.
Most common types of depression
There are many risk factors for depression development and how the disorder manifests, ranging from person to person, and some of them are yet to be fully researched. Although some of the causes and symptoms associated with depressive disorders may overlap, there are some differences.
Thus, depression is an umbrella term for a variety of types of depressive disorders, each one being unique in its own way.
To get the right treatment, it’s important to determine which type of depression a person may have. Knowing your type is the first step in learning how to manage your symptoms and developing the right treatment plan with healthcare professionals.
Here are some of the most common types of depression:
Major depressive disorder (MDD)
What is major depressive disorder? Major depressive disorder is also known as clinical depression or unipolar depression — it is a severe and the most common type of depression and mental health disorder in the US.
People with MDD experience most of the earlier mentioned depression symptoms every day. Regardless of how long they last — for more than 2 weeks or for months — major depressive disorder symptoms can cause serious problems in a person’s daily life.
Even if the clinical depression causes are not clear, it doesn’t mean the disorder and what you’re going through aren’t real. It’s worth speaking to a professional — MDD can be treated and managed with the help of trained healthcare providers.
Persistent depressive disorder (PDD)
Persistent depressive disorder is also called chronic depression or dysthymia. It’s an ongoing type of depression that lasts for more than 2 years in adults and at least a year in children and teens. More than 3% of the U.S. population experiences PDD at some point in their lives.
If you have persistent depressive disorder, others can describe you as a constantly gloomy or dull person who finds it hard to enjoy and smile even on happy occasions.
Although chronic depression is not as severe as major depression, it’s a serious illness that can affect how you feel, think, and behave. Many people with PDD also experience at least one episode of major depression, thus having a “double depression.”
Postpartum depression (PPD)
Postpartum depression is a mood disorder occurring soon after childbirth. It’s one of the most common complications of pregnancy, affecting about 1 in 7 women in the year after giving birth. PPD is usually associated with new mothers but it can also occur in new fathers.
The symptoms of postpartum depression are similar to those of other types of depression, including feelings of sadness, irritability, anhedonia, and hopelessness, but also include those specific to new parenthood:
- A feeling of a disconnect from a baby
- A sense of despair about the future role as a parent
- The feelings of guilt or regret about the parenthood
- Thoughts of harming a baby
The symptoms can be very intense and are different from “baby blues.” They make it difficult for a parent to take care of themselves and their baby.
Nevertheless, if you’re experiencing postpartum depression, it’s not your fault. There are things you can do to help yourself feel better and recover.
Seasonal affective disorder (SAD)
Seasonal affective disorder is a real mood disorder, also often called “winter depression” or “winter blues.” People who suffer from seasonal affective disorder experience similar symptoms as those with major depressive disorder. But they are usually triggered by the seasonal changes that affect our body.
For example, the drop in incoming sunlight during the fall and winter months. Less often, the symptoms can be triggered during spring-summer.
It’s estimated that about 5% of adult Americans are affected by SAD every year, and women are more likely than men to develop it.
Besides, in some people the disorder goes undetected — they can hide the signs behind the smile for different reasons and keep the problems in secret (known as “smiling depression”). But whether you suffer from any type of depressive disorder or suspect your loved one can suffer from it, seek professional help.
While it’s treatable, it can take months, years, or even decades to fully recover. Nevertheless, there is the right support you need and ways to diagnose and treat depression to regain a better quality of life.
According to the NIMH report of 2017, about 35% of US adults with major depressive episodes didn’t receive treatment. Depression can be life-threatening if left untreated. However, it’s one of the most treatable mental health disorders. You don’t have to suffer in silence.
Depression treatment usually involves a combination of talk therapy, medication, and self-help. The key to successful treatment is to find healthcare professionals you’re comfortable with and who’ll come up with a treatment plan that works for you.
Seeking help doesn’t mean you’re a weak person or that your emotions are wrong — instead, it means you’re taking control of your situation and doing what’s in your best interest.
The most common type of depression medication is antidepressants. Although antidepressants can’t cure the disorder, they can reduce depressive symptoms, lower the risk of relapses, and help restore a person’s ability to live a more fulfilling life.
How do antidepressants work? They balance brain chemicals called neurotransmitters. These are serotonin, noradrenaline, and dopamine, and they pass signals along the nerves and affect mood and emotions.
Antidepressants are prescribed only by a healthcare professional, usually for moderate, severe, or chronic depression, considering your symptoms and individual needs. If the medication causes side effects that interfere with your daily life or you feel no benefit after taking drugs for 4 weeks, or you think about stopping it, speak to your doctor first.
There are many different antidepressants for treating depression. Some of them are:
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
- Tricyclic antidepressants (TCAs)
- Tetracyclic antidepressant
- Dopamine reuptake blocker
- Monoamine oxidase inhibitors (MAOIs)
- Noradrenergic antagonist
Antidepressants don’t always address the causes of depressive symptoms. That’s why the treatment involves a combination of medication, psychotherapy, and self-care practices.
Therapy is the first-line treatment for depression. Starting it, you receive help and support from a compassionate professional in a secure space where you can talk about your thoughts and feelings without judgment.
A mental health professional on Calmerry can help you:
- Validate your feelings and emotions
- Explore symptoms and daily experiences
- Understand how and why to be self-compassionate
- Understand why you’re feeling this way
- Develop healthy habits
- Learn coping skills
- Create a safe, non-bias space to share anything you want
- Develop a treatment plan to fight the disorder together
There are several types of psychotherapy for depression:
Cognitive behavioral therapy (CBT)
CBT attempts to break vicious cycles of thoughts, emotions, and behaviors by focusing on changing the thoughts and the resulting behaviors. Thus, it can positively impact a person’s well-being.
Interpersonal therapy (IPT)
IPT is a short-term form of therapy for depression. It focuses on one of four areas: interpersonal deficits, unresolved grief, life transitions, and interpersonal disputes. It emphasizes how much support you have from others and how your current relationships influence your mental well-being. It identifies how they may be affecting your symptoms and helps you develop a positive support system, self-esteem, and a strong sense of connectedness to fight depression.
Psychodynamic therapy is designed to help people understand how past experiences affect their current lives. Through free talking about them and self-reflection and self-examination, it may help you identify the root of emotional pain and develop long-term coping strategies.
How to deal with depression: Self-help tips
Even if you can’t see a way out of your situation just yet, there are some things you can try to alleviate the disorder. One of the best ways to deal with depression is to do self-care practices — something that makes you feel better every day.
Acknowledge what you experience
The first step to overcoming depression is to recognize that what you experience now is different from your usual “normal.” You should be open to yourself about your problems, feelings, and emotions and accept them. Look out for the symptoms you experience.
Meet yourself where you are with self-compassion and remember — there’s no need to judge yourself negatively for what’s going on inside you. It’s not all your fault, and it’s not a sign of weak willpower. Take your mental health seriously and take care of yourself.
Try to be compassionate about what you’re experiencing and going through. You may think, “I am a mess. I’m such a failure! I can’t believe this is happening to me. I am just so bad at dealing with this.” These kinds of negative thoughts can spiral into rumination and deeper depression.
Instead, consider things like, “I’m hurting and having a tough time right now. I’m sad that this is happening, but I’m not alone in my pain. I’ll do my best to get through this.”
Practice self-love and acceptance
Self-love is the cornerstone of emotional well-being and of course, a prerequisite for unconditional self-acceptance and validation. It takes many forms.
Self-love goes hand-in-hand with self-compassion, which means being kind, forgiving, and understanding with yourself when you are not at the best point you’d like to be, you can’t feel well, happy, or energized as used to be, or seem to fail to meet your own expectations.
Although it may seem impossible to do while being depressed, it’s important to accept your current experiences and focus on what you can do to care for yourself rather than what you can’t do to change the situation.
Try to do things that make you feel good. Use positive self-talk and reward your efforts for comforting yourself and trying to make your life better.
Talk it out
One of the major contributors to depression is keeping hard experiences within ourselves. And one of the most important aspects of fighting off the disorder is a good support network.
Talk to a friend or a loved one about your feelings. Or you can join a support group or community for people fighting depression and share your experiences with them.
Also, seek help from your healthcare provider. If you need someone to talk to and don’t want to leave the comforts of your home, engage a licensed therapist online, on Calmerry.
Keep a mood diary to vent frustrations, record how you feel, what you think, and what worked and what didn’t work in dealing with the symptoms. Thus you’ll be able to track your emotions and feelings, notice changes in your mood, and recognize triggers and warning signs of your depressive episodes.
Mindfulness helps you stop focusing on negative depressive thoughts. Leaning into these thoughts often leads to negative thought spirals. This can become a vicious cycle where you keep replaying the same depressive thoughts in your head and sinking into rumination even more.
However, learning to distance yourself from them through mindfulness can help you gain control over them, focus on the present, and learn to react more healthily next time.
Get outside in nature
Spending time in nature can be very healing for the mind and body. Some people find being in nature helpful because they can busy their minds. The colors, sounds, textures, and smells can all help you feel less anxious and more relaxed.
Look after your physical health, too
The state of physical health impacts mental health and vice versa. One of the most effective ways to alleviate the symptoms is to increase your physical activity. Exercising or just getting outdoors is a great way to relieve stress, shift your focus, and boost your mood. It’s also important to reduce any factors that increase your vulnerability to stress and depressive symptoms, get plenty of sleep, eat healthily, stay hydrated, and limit alcohol consumption.
Engage in opposite action
Depressive symptoms often come with urges to withdraw, isolate, and neglect self-care and social contact. Being mindful of these urges and intentionally seeking behaviors to elicit the opposite action can be key to breaking harmful patterns that fuel these negative thoughts and feelings.
Pushing to get out of bed and take a shower, call a friend, or put on uplifting music or movies are some good examples. Identify at least one activity, with a reasonable expectation, that helps build your sense of confidence and mastery is a great goal to start with.
Acknowledging or rewarding your accomplishments can also support new healthy habits.
Seek professional help
If you feel like you can’t cope with depression on your own, or it has gotten worse and you find it hard to do your daily activities, contact a healthcare provider — a GP, a therapist, or a psychiatrist. They will develop a personalized treatment plan.
Getting the right treatment is the first step toward learning how to ease symptoms and feel better.
If you have suicidal ideation or know someone is in crisis, get immediate appropriate help. Call 911, text the Crisis Text Line (text HELLO to 741741), or go to www.suicidepreventionlifeline.org
How to help someone with depression
Your attention, support, and care can make a difference for a person with depression.
Don’t rush into giving pieces of advice or trying to “fix” a person but be there as a compassionate listener. Many people with depression feel isolated and withdrawn, but it is important to remember that you can enormously help with the simple act of face-to-face talk and listening.
Encourage them to talk about how they feel, what they go through, and what they experience, and provide them with non-judgmental space. Show that you do care, stay in touch, and be gentle and compassionate. You can also offer help with daily tasks.
Take it seriously
Belittling the experiences and pain of a person with depression can make things worse. Take it seriously and avoid making inappropriate comments.
Take care of yourself
Being someone who is trying to care for and help someone who is depressed and not responding to your efforts can be a frustrating and anxiety-provoking experience. It’s important to take care of yourself and get the support you need, too.
Otherwise, it’ll be impossible to stay on track with your life and provide the same-level help a person needs. Set boundaries, speak up for your feelings, and make your own well-being a priority.
Engage professional help
You can try to remind a person that professional help and treatment are available, and there are many ways that can help relieve the symptoms and live a fulfilling life. You may say, “I am here to support you, but let’s look up where to get more professional advice.”
Also, pay close attention to some remarks that may indicate suicidal thoughts to help a person seek appropriate support. People in crisis often do not know they need help or may be unable to seek it on their own.
If a person is in a life-threatening situation, call 911 or seek emergency resources.
Depression can prevent you from getting through your day. It is the despair that prevents you from seeing any point in the future. It is the fear that makes you believe the rest of the world would be better off without you, and it is a disorder that can rob people of their lives, when it goes unrecognized or untreated.
When you’re depressed, it feels like it’s impossible to move forward. You might feel like a failure, or hopeless about your future. It may feel like no matter what you do, you will never be able to improve upon your situation.
Dealing with depression is a battle, but it doesn’t have to be fought alone. Help for depression is always available and accessible. With the right support you can regain control of your life and start leading the best life you want.
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Kate has an MD in Health and Medical Psychology. She has worked in the healthcare industry since 2017, helping people with depression, anxiety, trauma, and grief as well as identity, relationship, and adjustment issues. Kate tries to make the world a better place by fighting stigma and discrimination and advocating for equality and equity for all people. And what she loves most about her work at Calmerry is the possibility to make quality mental health care even more accessible to everyone – one step at a time.Read more