Depression is more than just feeling unhappy or sad; it is a constant state of indescribable heaviness that is difficult to quantify. Dysthymia, or a “low-level” state of feeling blue, is different than a major depressive disorder. Those who are dysthymic may be sluggish and not appear very joyful, but they are able to interact with others, go to work, and are generally able to function and take care of their needs, albeit not at a high level. These folks can remain in this state for some time, and even though they believe they could be happier, many do not seek help and merely trudge through life one day at a time.
Depression is a much more serious illness. Someone who is depressed is in a constant state of anxiety and dread. They cannot feel joy and begin to withdraw from others who are happy because it hurts too much to be around them. Someone who is clinically depressed or having a major depressive episode feels like they are in a “bubble” and are “different” from everyone else. They believe they are insignificant, valueless, hopeless, and not worth the trouble to fix. Depression is painful on so many levels.
The criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition for a major depressive episode are as follows:
- Depressed mood for most of the day, nearly every day, as indicated by subjective reporting (e.g. feels sad or empty) or observations made by others (e.g. appears tearful). In children and adolescents can be an irritable mood.
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by subjective or observational reporting)
- Significant weight loss when not dieting or weight gain or decrease in appetite nearly every day.
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day (observational data).
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day
- Diminished ability to think or concentrate, or indecisiveness, nearly every day
- Recurrent thoughts of death, recurrent suicidal ideation with or without a specific plan.
According to the DSM-V, if a person has five or more of the preceding symptoms during a two-week period, which is a variation from previous functioning, the person may be suffering from depression. As noted above, these symptoms can be reported either subjectively (by the person themselves) or observationally (from others) to meet the criteria. Exclusionary criteria may be a medical condition, substance abuse, or bereavement after the loss of a loved one. Some who are depressed try to “self-medicate” with alcohol or drugs as a way to feel better.
Those who are depressed may not get much sleep and wake up in the morning feeling exhausted. Others get too much sleep yet may still not feel refreshed. It is an ever-constant state of being fatigued from which there is no escape. Imagine having twenty-pound sandbags attached to each leg and arm and trying to have a normal day. It feels like a nightmare to exist in a fatigued state and have the weight of the world on you as well.
Someone who is depressed not only feels different from everyone else but will act differently from others, too. Those who are not depressed exude an air of lightness and confidence, knowing that if they make a mistake it’s not the end of the world. Depressed individuals have zero confidence and constantly worry about making mistakes, which puts their anxiety level into overdrive. They constantly worry about what they will do if something doesn’t go exactly right. The combination of being exhausted and having to work so hard to get everything right is a recipe for serious trouble and, unfortunately, may lead to thoughts of suicide.
Being clinically depressed is like being in a state of paralysis. Not only is the body depleted of any energy, the mind is exhausted as well. Thinking hurts, and the prospect of ever feeling better seems a million miles away. Imagine having a toothache of the mind; the pain is constant, and tears are just a millimeter below the surface. It is a psychological, cognitive, physical, social, and spiritual illness that unless experienced is hard to imagine.
Too many depressed individuals do not seek help, believing that their depression cannot be treated. And many others do not want to see a psychiatrist for fear they will be labeled as “crazy.” Too often, those battling depression avoid medications that may be helpful. “I am not a pill person” they say. Others believe medication will change them in such a way that they may not know themselves anymore. Still others believe that if they have to take medicine it solidifies the fact that something must be wrong with them; therefore, if they don’t take medication, it proves nothing is wrong with them.
There is so much erroneous information out there, including on the internet, that in order to help some people, trust and education are required that fact may be distinguished from fiction. Trust is a major factor when one goes to see a therapist or a psychiatrist. It’s difficult to trust even a professional with many years of training and experience when someone has embedded beliefs against therapy and doctors (i.e., “My father didn’t believe in going to doctors, so why should I?”) Again, education is key for people who are resistant to treatment, with the hope that the depressed individual will begin to challenge their old belief systems and try something different in hopes of feeling better. Depression can alter positive thinking, which is why it is so difficult to help the depressed to help themselves. However treatment is nearby. With the guidance of a qualified doctor and experienced therapist, symptoms of depression can be mitigated. Depressed individuals can feel better by reaching out for help. As difficult as that first step can be, it will be the first of many steps to wellness. Call a therapist today!
*The above essay is from the book, When to Call a Therapist, Chapter 5, Depression – Not What Everyone Thinks It Is by Robert C. Ciampi, LCSW