“Depression affects your functioning – It’s not just sadness”
I think it’s important to talk about what we do with depression in society. How we move it around loosely in our language to a point where it can mean so many things. It’s a mental illness, a word, a vague expression, a public misunderstanding. This is problematic because it often delegitimizes what individuals truly experience. I’m hoping to tackle a few of these issues that are commonly riddled with misinformation. This is not an exhaustive discussion of depression but rather I’ll be looking at what depression is (clinically), different ways of conceptualising it and some challenges related to depression in society.
Defining Depression, what to look out for?
For a diagnosis of clinical depression, or Major Depressive Disorder (MDD), at least 5 of the following symptoms must be present for a two week period (DSM, 2013):
- Depressed mood (can also appear as irritable)
- Diminished interest or pleasure (often described as a feeling of emptiness, not caring, can cause social withdrawal, also called anhedonia).
- Weight or appetite changes
- Sleep disturbances
- Fatigue/loss of energy (e.g.: getting out of bed or getting dressed seems difficult and tiring)
- Feelings of worthlessness or excessive or inappropriate guilt (e.g.: unrealistic negative evaluation of self worth, feeling like a failure)
- Poor concentration or indecisiveness
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation with or without out specific plan.
If you start to scan your eye over these symptoms, I think it’s important to remember that these symptoms could be fairly familiar to many of us. Before we start self-diagnosing or diagnosing others, these symptoms are fairly common if seen in isolation. Some of us may now look back and see that perhaps we were depressed at a point in our lives. We could even go further and identify coping skills or support structures we’ve used to helped us through those time – which is all fairly normal. The difference it that perhaps it passed over a few days, or passed once a stressor had passed. Depression is somewhat different to this.
Depression affects your functioning: It’s not just sadness
Of the symptoms mentioned above, it would be important to look at whether this is having an impact on your functioning. For example, if your ability to maintain a job, to maintain functioning relationships and to maintain emotional stability in order to undertake daily tasks is affected; this starts to better capture the picture of depression. It is usually at this point where individuals seek help or where others start to signal noticeable changes in them. At this stage, you’re not your usual self.
This is far deeper than sadness for a few days. This is not laziness and it’s different to not sleeping for one or two nights. As mentioned it’s a cluster of symptoms, present at the same time for at least two weeks, and it affects your functioning to the point where it is not only noticeable by the individual but by those around them as well. However, many individuals “function” with depression, and hide it very well – which makes it challenging to detect. This clinical picture can be given the diagnosis of MDD, but this is only a name of the cluster of symptoms describing the experiences. This does not mean that Major depressive disorder is forever. Not in my clinical experience anyway.
The way I like to explain it is that, with appropriate treatment, (whichever that appropriate fit is for the individual) – they can build up resilience, coping skills, and self awareness to either reduce the harsh impact of depression or seek support to be proactive in preventing full blown episodes. We can also learn to adapt our lifestyles to recognize risk factors and stressors. So in my view, MDD need not be forever. Labels and diagnoses can be very validating for many in capturing and acknowledging the difficulty they authentically experience. But for others, it can feel like a damning target on their back where the stigma becomes too overwhelming. The picture below captures what a number of people living with MDD can feel.
The main feature for me may not be the main feature for you. For some it can be more crippling to not sleep and to feel fatigued. For others, it may be the emptiness and the struggle with a sense of meaningless of their lives and general human existence. Others may struggle more with an overwhelming sense of guilt and feelings of failure that impact on self worth. A main feature for others can be ruminating negative thoughts and thoughts of suicide. This is why topics such as this are so incredibly complex. Depression does not have a face, it is not always visible in the same way.
Depression is complex.
Just as we are complex human beings, our experiences of depression can be too. We are complex beings with webs of interacting factors, traumas, histories, upbringings, emotional states, work environments, family dynamics, health levels, activity levels, values etc. So my depression may not be exactly like your depression. I may not become depressed after the same type of situation. I may be depressed for longer than you. I may be depressed again – or not.
Although there are common features categorized as symptoms mentioned in the beginning of this article –our own subjective experience of them can be fairly different. Perhaps this is why we find people saying to others that they must “snap out of it”, “cheer up”, “be positive” because they cannot fully understand or empathize with the subjective experience of depression. These approaches by our loved ones are typically not helpful.
I wonder if part of why we misunderstand depression is due to how loosely we use the word. We say ridiculous things like, “I wanted to go to the beach today and it’s raining, I’m so depressed”, or “They didn’t have my favourite prawn chips at Woolies, I’m so depressed.” Although these are very silly examples, be mindful the next time you use depression as a menial expression. I believe it slowly chips away at legitimacy of those symptoms I mentioned earlier. This is also not to say that smaller things don’t get us down, but I believe these types of expressions make “depression” appear overly colloquial or simplistic – which of course it isn’t.
How can we bring depression into our conversations to raise awareness but without erasing lived experience of it?
Remember that depression is more common that we may be aware of.
- Depression is leading cause of disability worldwide.
- Every 20th person you come across in one day suffers from depression.
- The proportion of the global population with depression in 2015 is estimated to be 4.4%.
- The total number of people living with depression globally is 322 million.
- In South Africa, 2 402 230 cases of depressive disorders were prevalent in 2015 which was 4.6% of the population
(According to the World Health organisation, Global Estimates, 2017)
Treatment Options for Depression
We cannot ascribe one cause to this disorder nor do I believe there is one solution or treatment option. Consulting professional services can be a safe space to explore possible causes of depression for an individual. This is usually a combination of multiple factors from biological, psychological and social roots. There may not be a clearly identifiable a cause. Seeking professional support can be the starting point of your receiving the appropriate support and treatment. Briefly, the most common treatment options for depression are:
- Psychotherapy –“talking therapy”
Different therapeutic modalities are used by psychologists to treat depression. Some examples are psychodynamic therapy, cognitive behavioural therapy, dialectical behavioural therapy. (This will be explored further in a later blog).
- Psychopharmacology – medication
This can be prescribed by a GP or a psychiatrist. There are multiple anti-depressants (most commonly SSRI’s) that treat depression that can be very effective. As it is medication, there are possible side effects and it will require close working with your practitioner to be aware of those and adjust medication as necessary.
Depression can also occur at the same time as other co-occurring disorders such as Post traumatic Stress disorder (PTSD), Substance use, personality disorders, and can also occur in the context of abuse. These circumstances could also be assisted by the treatment options above and can work in conjunction with one another. Either way there is treatment available to address all of this.
Let’s Talk Q&A : I received a few anonymous questions on social media related to depression that I have addressed here.
Disclaimer: This is an especially difficult topic to cover because it is so broad and there is so much out there about it. I just chose to go over a few basics and this certainly doesn’t cover it all. Feel free to interact in the comments if there’s something you would like to see more of around this topic that I can cover in a future post.
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Next topic: Part II of the Let’s talk series: Anxiety