This is Depression.
It’s ugly and confusing. It’s mental and physical. It’s real.
“It took me awhile to fully understand that sadness and depression are completely different things. Sadness is a feeling. Depression is an illness. And even though it’s called a “mental illness,” I watched depression completely destroy my boy’s body. It was like he was rotting from the inside out.
It was so hard for me to wrap my head around depression because even though something was clearly wrong, unlike other illnesses I couldn’t see what the root of the problem was. I just didn’t know what I was looking for.” — Mom
The Diagnostic Statistical Manual of Mental Disorders (DSM-V) is the official text that mental health professionals use to classify and diagnose mental disorders. It is a 947-page textbook, the medical field’s go-to-guide, published by the American Psychological Association.
According to the DSM-V, a person is depressed if they have five or more of the following symptoms:
Symptoms[i]
Depressed mood most of the day nearly every day
Anhedonia, the loss of interest or pleasure in all, or almost all, activities
Significant weight loss or weight gain
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or inappropriate guilt
Difficulties thinking, concentrating, or decision making
Recurrent thoughts of death, suicidal ideation, suicide attempt
Note that a person can have any combination of five or more of these symptoms. One person might gain weight and sleep all day while another might lose weight and struggle with insomnia. People with depression can and often do have different experiences from one another.
That said, the DSM-V specifies that at least one of their symptoms must be either depressed mood or anhedonia. Symptoms need to persist for at least two weeks and additionally, the following conditions must be met:
Conditions
Symptoms significantly impair social, occupational, or other important areas of functioning
Symptoms are not caused by substance abuse or other medical conditions
Symptoms are not better explained by a schizoaffective disorder or bipolar disorder
While the DSM-V provides the clinical, by-the-book diagnosis of depression, building empathy requires a deeper understanding of the illness and the experiences of those who suffer from it.
“If I had to define major depression in one sentence, I would say it’s a biochemical disorder with a genetic component and early experience influences where somebody can’t appreciate sunsets.”[ii] — Robert Sapolsky
Dr. Sapolsky is a famous professor in biology and neurology at Stanford University and one of the world’s leading experts on stress. In his description of depression, Dr. Sapolsky recognizes that depression is more than just a “mental” illness. This is an especially important distinction because when people hear mental illness, it’s easy for them to think, “Oh, it’s all in that person’s head. They should just snap out of it.” But as Dr. Sapolsky points out, “The bodies of depressed people work differently.”[iii]
- Sleep patterns are disrupted. The brain scans of people who are depressed show that their sleep patterns are broken compared to those who are not depressed. [iv, v,] Figure 1 shows that depressed people wake up more frequently throughout the night, rarely reach deep sleep, and wake up very early in the morning.[vi]
2. A flood of stress hormones. The hypothalamic pituitary adrenal (HPA) axis is the part of the brain responsible for regulating stress hormones.[vii] The HPA axis of a depressed person is hyperactive.[viii, ix] Your loved one might be tired and unresponsive but inside, their body is in a state of war with itself, constantly fighting a flood of stress hormones.[x, xi]
3. Brain damage. The brain scans of depressed people have shown that recurrent bouts of depression are correlated with hippocampal atrophy — the hippocampus shrinks by roughly 9%.[xii] The hippocampus is responsible for managing a person’s emotions, memory, and learning abilities. Damage to the hippocampus can impair these important cognitive functions.[xiii], [xiv], [xv]
Highlighting the physical parts of depression can make it easier for people to accept it as a real medical condition. Fatigue, weight loss, and insomnia are things that people can’t just “snap out of.” The physical symptoms alone are challenging, but when combined with the mental symptoms, depression becomes a different beast.
It can be difficult describing the cognitive symptoms of depression to someone who is not mentally ill. Imagine an obsessive barrage of thoughts that tell you you’re alone, that you’re not good enough, and that no one loves you. These thoughts teach you to hate yourself and can encourage you to take your own life.[xvi], [xvii]
For many people, depression can often make them feel numb to everything around them. They can be with people that they know they love or do things that they know they’re supposed to enjoy, and yet they feel nothing. [xiii]
Depression can make people feel trapped in their own head, a prisoner of an abusive mind.
Every person’s experience is different but this is depression. It’s something people just can’t snap out of. It’s ugly and confusing. It’s mental and physical. It’s real.
Therapists can take care of a loved one once a week but family takes care of them always. We’re building the tools that families and friends need to help their loved ones beat depression while also taking care of their own mental well-being. You can learn more about us and our project here.
References:
[i] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
[ii] Sapolsky, Robert. “Depression in the U.S.” 10 November, 2009. Stanford University, Palo Alto, CA. Lecture.
[iii] Ibid
[iv] Tsuno, N., Besset, A., & Ritchie, K. (2005). Sleep and depression. The Journal of clinical psychiatry.
[v] Nutt, D., Wilson, S., & Paterson, L. (2008). Sleep disorders as core symptoms of depression. Dialogues in clinical neuroscience, 10(3), 329.
[vi] Ibid
[vii] McEwen, B. S. (2004). Protection and damage from acute and chronic stress: allostasis and allostatic overload and relevance to the pathophysiology of psychiatric disorders. Annals of the New York Academy of Sciences, 1032(1), 1–7.
[viii] Arborelius, L., Owens, M. J., Plotsky, P. M., & Nemeroff, C. B. (1999). The role of corticotropin-releasing factor in depression and anxiety disorders. Journal of endocrinology, 160(1), 1–12.
[ix] Nestler, E. J., Barrot, M., DiLeone, R. J., Eisch, A. J., Gold, S. J., & Monteggia, L. M. (2002). Neurobiology of depression. Neuron, 34(1), 13–25.
[x] Hammen, C., Davila, J., Brown, G., Ellicott, A., & Gitlin, M. (1992). Psychiatric history and stress: predictors of severity of unipolar depression. Journal of Abnormal Psychology, 101(1), 45.
[xi] Kendler, K.S., Kessler, R.C., Neale, M.C., Heath, A.C., Eaves, L.J., 1993. The prediction of major depression in women: toward an integrated etiologic model. Am. J. Psychiatry 150, 1139–1148.
[xii] Sheline, Y. I., Sanghavi, M., Mintun, M. A., & Gado, M. H. (1999). Depression duration but not age predicts hippocampal volume loss in medically healthy women with recurrent major depression. Journal of Neuroscience, 19(12), 5034–5043.
[xiii] Sheline, Y. I., Wang, P. W., Gado, M. H., Csernansky, J. G., & Vannier, M. W. (1996). Hippocampal atrophy in recurrent major depression. Proceedings of the National Academy of Sciences, 93(9), 3908–3913.
[xiv] Videbech, P., & Ravnkilde, B. (2004). Hippocampal volume and depression: a meta-analysis of MRI studies. American Journal of Psychiatry, 161(11), 1957–1966.
[xv] MacQueen, G., & Frodl, T. (2011). The hippocampus in major depression: evidence for the convergence of the bench and bedside in psychiatric research?. Molecular psychiatry, 16(3), 252.
[xvi] Beck, A. T. (1963). Thinking and depression: I. Idiosyncratic content and cognitive distortions. Archives of general psychiatry, 9(4), 324–333.
[xvii] Joormann, J., & Arditte, K. (2009). Cognitive aspects of depression. Handbook of depression, 2, 298–321.
[xiii] Gotlib, I. H. (1992). Interpersonal and cognitive aspects of depression. Current Directions in Psychological Science, 1(5), 149–154.
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