So, You’re Depressed
What Does That Mean, Exactly?
Depression. Everybody’s heard about it — and a lot of people have it, have had it or will have it at some point. In a given year, more than 300 million people around the world suffer from depression. With such a staggering statistic, it’s almost guaranteed that you know someone who has dealt with depression, assuming you haven’t suffered from it yourself.
Despite being by far one of the most common mental illnesses, dwarfed only perhaps by anxiety disorders, it also happens to be a source of great misunderstanding for the general public, including some media outlets.
Perhaps you’ve been told to just “snap out of it” or perhaps you’ve heard a certain YouTube “celebrity” say that depression is all in your head (hint: that’s why it’s a mental illness) and that positive thinking will magically solve all the world’s problems.
Either way, in my personal experience it has been made abundantly clear that many people simply don’t know what depression really is, or they try to put it in some arbitrary box without realizing it’s more complicated than that. Here’s the real scoop when it comes to depression.
What Is It?
First of all, there’s a bit of misconception when it comes to “depression” as a mental illness in and of itself. Technically, depression is not a mental illness. Let me explain what I mean by that.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) there is no mental disorder by the name of depression. Instead, there is a group of mental illnesses under the category of “Depressive Disorders.” This group is comprised of Disruptive Mood Dysregulation Disorder, Major Depressive Disorder, Persistent Depressive Disorder (Dysthymia), Premenstrual Dysphoric Disorder, Substance/Medication-Induced Depressive Disorder, Depressive Disorder Due to Another Medical Condition, Other Specified Depressive Disorder and Unspecified Depressive Disorder. That was a mouthful, I know.
As you can see, depression is really just a layman’s umbrella term for all of these different diagnoses we have in the world of mental health. Each of these specific disorders has diagnostic criteria that differentiate them from others in the group, but all have in common the “presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function.” In the DSM-5’s words, the major differences between Depressive Disorders are duration, timing or presumed etiology. With all that said, the most common Depressive Disorder, and the one most people think of when referring to depression is Major Depressive Disorder (MDD) and this is the disorder I will be referring to as “depression” for the rest of the article.
There’s More to It Than You Think
A common misconception I’ve heard regarding depression is that it’s just sadness, or prolonged sadness, or a deep sadness. And while sadness can certainly be a symptom, as we saw in the DSM-5’s definition of Depressive Disorders, a lot of the other symptoms that arise from depression can be overlooked because of the strong colloquial link between the terms “depression” and “sadness.”
According to the DSM-5, in order to be diagnosed with Major Depressive Disorder, a person must exhibit five of the following symptoms during a two-week period with at least one of the symptoms being depressed mood or loss of interest or pleasure:
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
As you can see, the symptomology of Major Depressive Disorder varies widely and despite being a single disorder, can present incredibly differently depending on the person. Let me use two hypothetical scenarios as examples of how differently MDD could present in two different people.
A 16-year old girl is brought in to the doctor by her mother. Her mother says she has been very irritable over the last two weeks. The mother notices that her daughter’s clothes, which used to be tight, now hang loose on her and she fears that her daughter has lost a significant amount of weight. The 16-year old claims to sleep only 2 or 3 hours per night and seems to fidget constantly. When being interviewed by the doctor, it is clear that the 16-year old is easily distracted and is unable to concentrate on the task at hand.
The 16-year old is diagnosed with Major Depressive Disorder as she meets 5 criteria, including “depressed mood.”
A 67-year old man goes to the doctor’s office complaining of being completely uninterested in hobbies he used to find great joy in. He says that he sleeps 16+ hours per day and still feels completely drained of all energy even with the excess sleep. He says he frequently thinks about dying, especially since his wife died last year and says that he blames himself completely for her death, despite her dying of natural causes.
This man is diagnosed with Major Depressive Disorder as he meets 5 criteria, including “loss of interest or pleasure.”
These two hypothetical scenarios paint completely different pictures of depression, and yet both are, in fact, examples of the exact same illness: Major Depressive Disorder.
So What Does Depression Mean, Exactly?
The reality is that depression depends almost entirely on the person. There will certainly be similarities between two people with depression, but depending on the symptoms, both parties are experiencing their depression may be very similar, very different or somewhere in between.
Depression is not sadness. Depression doesn’t even require a depressed mood to be diagnosed and a depressed mood could be sadness, emptiness, hopelessness, irritability or a mixture of all of those feelings combined into one.
Here’s what depression really is: a group of symptoms that, when combined, reduce someone’s ability to function properly for a period of two-weeks or longer. I know that’s vague, but the reality is that depression can be vague. The symptoms vary and no one’s depression is going to present exactly the same as the next person’s. I think the important thing to take away is that although depression will vary widely from person to person, all depression is valid. Don’t let anyone tell you that you aren’t depressed because you don’t fit their preconceived notion of what depression is. Depression isn’t a cookie-cutter disease, and I’ll let you in on a little insider secret: most mental illnesses aren’t.
So You’re Depressed… What Do You Do?
Luckily, depression isn’t usually something that lasts forever, although in 20% to 30% of people, symptoms never entirely go away. Although depression may seem like a death sentence for those people whose symptoms are never cured, 80% of people report that treatment does at least help and I would hazard a guess that the other 20% were helped at least a little, even if they didn’t realize it.
As for treatment, many people will tell you to sleep well, eat well and exercise and while those are things you can and should do that will indeed help with depression, your main goal should be to get professional help.
It can be scary, I know, but you’ll be thankful you took the leap.
As for the most effective form of professional help? It depends. It’s best to talk with your doctor or with another healthcare provider that knows your history well. Sometimes, depression can be overcome with therapy alone. Other times, depression needs a combination of medication and therapy to combat it. Like I said earlier, everyone’s situation is unique; your road to recovery will be equally unique.
So, you’re depressed. What does that mean? It means you’re human. It means that for a complex variety of reasons, your brain isn’t working properly. It means you need help to get back to where you were before you felt this way, and that’s okay.
If you or someone you know needs help, resources are available. In case of an emergency, please call 911 for immediate help.
In Canada: Call Crisis Services Canada at 1–833–456–4566, text them at 45645 or visit their website to chat with someone
In the USA: Call the National Suicide Prevention Lifeline at 1–800–273–8255 or visit their website for more information.
In Australia: Call Lifeline at 13 11 14.
In the UK: Call Samaritans at 116 123.
