Am I depressed?
Depression is a word that gets thrown around a lot. You may be wondering what it actually means and if it applies to you. In this article, I will review the following questions:
What is depression?
The Merriam-Webster dictionary defines depression as “low in spirits”, with the synonym of sad. This is how depression is often used in conversation: “I am depressed that I have to go to work today.”
Sometimes, people say that they are clinically depressed. What does it mean to be depressed, not as a feeling but as a medical condition?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-V-TR), is the most recent manual published by the American Psychiatric Association. This manual defines and classifies mental disorders. When mental health professionals make diagnoses, they are diagnosing based on criteria in the DSM-V-TR.
The DSM-V-TR has very specific written criteria that you can review here. In practice, clinical depression, or major depressive disorder, means that for at least two weeks, every day or most days, you’ve been feeling sad, down or low and/or you’ve no longer enjoyed things. On top of that, you must have experienced at least 5 of the following symptoms: changes in sleep; appetite; energy; concentration; feelings of guilt, hopelessness, helplessness, worthlessness; moving faster or slower than usual; thoughts of death, wishing to be dead or ending your life.
Moving beyond the words on the paper, you may wonder: What does this actually look and feel like?
I have observed and spoken with hundreds of patients with depression, both before, during and after an episode. In their words, this is what depression is like:
1.) Not wanting to do things anymore.
This is one of the most telltale signs of depression rather than run-of-the-mill sadness. You find that you’re just not interested in the things you usually like. You don’t want to get out, you don’t want to see people, you don’t want to do things. In fact, maybe what you’d like most of all is to just stay home in bed and do nothing. When people around you suggest that you get out, it may even be upsetting. You just don’t feel like it. And if you do ultimately do something, you just don’t enjoy it.
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2.) Low mood.
This one is more obvious. Another feature that differentiates depression from regular sadness is the pervasiveness of low mood. You don’t feel down and then up – you just feel down, all day, every day.
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3.) Low energy.
It’s not just your mind that down – it seems like your body is, too. Everything feels ten times more difficult. You may feel literally weighed down by something.
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4.) Changes in sleep and appetite.
You may not notice those changes, but if you think over your recent patterns in sleeping and eating, you may find changes from baseline – whether that’s eating or sleeping too much or too little.
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5.) More negative thoughts about yourself and others.
It’s like the nasty voice in your head which says that you’re not good enough suddenly got a little stronger and a lot more present. Suddenly, you’re acutely and painfully aware of everything that you’re doing wrong, and this makes it very difficult to interact with others. It’s like the difference between a bright, warm, sunny day when it feels like everything’s going your way and everybody’s smiling you – and a cold, rainy day when everything that can go wrong does go wrong.
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6.) Thinking that it would be easier to be dead, or the world would be better off without you; feeling trapped; thinking about ending your life.
Suicidal thoughts exist on a spectrum. If you are having any, it is important to seek help right away, including emergency care at the emergency room or via 911.
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7.) Moving faster or slower than usual.
This is usually difficult to identify on your own. You may notice that you move faster or slower. More commonly, you may find that it takes you longer to do things, or someone around you has pointed out a difference.
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As you can see, clinical depression is more than just feeling sad. It’s an experience in which you feel fundamentally different, and the world feels fundamentally different. It’s as though everything just feels bad, no matter what you do. And one of the worst parts of it is the isolation. Being alone feels terrible, and yet it also feels better than being with the people next to you.
What causes depresion?
First and foremost, it is important to clarify an important misconception: that depression is all in your head. Depression is not something “made-up”. Depression is a very real illness with multiple contributing factors.
1.) Genetics.
As with other mental illnesses, depression has a genetic basis. It is estimated that genes account for 30-50% of the cause of depression. In my experience, almost all my patients have a family history of mental illness, thought that illness is often not diagnosed, not perceived or it is very subtle.
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2.) Attachment style.
Attachment is a complex and important topic which will be covered in another article. In brief, attachment describes the way that an infant connects with its primary caregivers. This primary caregiver relationship, or attachment relationship, creates an attachment style which profoundly influences the way that a person experiences him/herself, others, and the world throughout life. An insecure attachment style contributes both directly and indirectly to mental illness. Unfortunately, people with caregivers who suffer mental illness are in for a double whammy because it is often difficult if not impossible for an infant to have a secure attachment with a caregiver experiencing mental illness. Thus, a genetic basis for depression is followed by an insecure attachment, which further increases the likelihood for depression.
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3.) Medical illness.
The mind and the body are not separate entities. Rather, they directly influence each other. Symptoms of depression may be due to an underlying medical condition such as anemia or hypothyroidism. It is important to have a medical work-up to rule out medical causes of depression.
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4.) Other biological factors.
On a more subtle note than depression due to an outright medical illness, depression may also be caused by biological factors such as nutrition, light exposure, seasonal changes and hormonal changes. While it is unlikely that addressing these factors will resolve an episode of depression, it is still important to correct them whenever possible.
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5.) Life events.
Major life events such as stressors and losses and even positive milestones can trigger an episode of depression, especially in those who are already predisposed to it due to the aforementioned factors. Most people experience an episode of depression in response to a precipitating event.
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How do I know if I have depression?
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Tempting as it may be to self-diagnose depression (especially with the aid of an article like this one!), depression is something that should be diagnosed by a clinician. The subjective experience of depression described above comes along with characteristic changes in speech, movement, behavior, cognition, and perception that an experienced provider can detect. In addition, the symptoms of depression often overlap with those of other mental illnesses. Again, the diagnosis of depression should only be made by an experienced provider.
If you are interested in having a psychiatric evaluation at BCIP, you can start by scheduling a free 15-minute consultation here.
Can depression be cured?
The answer to this question depends on what you want to know.
In the world of statistics, this question first needs to be defined: what are the criteria for a cure? In the world of evidence-based medicine, available statistics must be read in context: what exactly is being measured, how is it being measured, what are the limitations and shortfalls in these measurements in their attempt to reflect reality?
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In another blog post, I’ll discuss the process of making sense of statistics and evidence in terms of understanding what they really mean. In short, the conundrum of medical evidence and statistics is this: the better a statistic is, the less applicable it is to an individual person. This is because the most accurate statistics come from the best experiments, and the best experiments control for the most variables. The best experimental subject would be the most standard person you could find - male, five foot 10, 160 pounds, young, healthy, no other medical conditions – with the fewest confounding variables – if he lived in a laboratory, that would be the best of all! Obviously, as the experimental subject and conditions become more standard, they become less representative of real life – which might be your eighty-year-old Latina grandmother with a million medical conditions and the recent loss of her husband.
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Anyway, I am going to assume that you are not so interested in knowing whether depression can be cured as defined by statistics, but whether depression is something that will go away on its own or with treatment.
Approximately 50% of people in the general population who experience a first episode of depression never go on to have another. Among the clinical population (meaning, people who are seen in a medical context), 75% of people who have a first episode will go on to have another. Some of those people have many episodes over a lifetime, triggered by increasingly smaller stressors.
As a doctor, I can only empirically comment on my patients, who a clinical population by definition. Unfortunately, most patients whom I see have multiple episodes of depression over their lifetime. In practice, I do not see depression as something to be cured, but something that can be very effectively managed. The best outcomes come when people are willing to put in the work in therapy to truly understand and tolerate their feelings. It is possible to experience depression and go on to live an emotionally rich and fulfilling life, but it takes a lot of hard work, and sometimes medication is needed as well.
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Sometimes, I think of managing depression like eating healthy. It is always going to require some effort and awareness. Depending on where you start out, you might need to make a lot of effort and implement difficult changes. It’s a journey in which you feel yourself grow with each step you take. You get used to making the effort; the habit of making the effort makes you stronger and capable of ever greater challenges; and you reap the rewards as you go along. In other words, you get out what you put in.
This may sound daunting, but in my experience, the thing that is the hardest and which matters the most is to truly want to get better. People are capable of incredible things when they truly put their heart in it.
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What are you my treatment options?
The most common and effective options are therapy and medication. It is important to create a treatment plan that is tailored to your specific needs and wishes.
If you’d like to pursue treatment at BCIP, you can schedule a free 15-minute consultation here.
Office, Blossom Center for Integrative Psychiatry
Conclusion
Depression is a real medical illness with multiple causes. Depression profoundly changes the way in which you experience yourself, others, and the world. Common symptoms include low mood; lack of enjoyment; changes in sleep, appetite, energy, and concentration; feelings of guilt, worthlessness, hopelessness, and helplessness; moving faster or slower than usual; thoughts of death and/or wanting to be dead. Depression should be diagnosed by a medical professional. In many people, depression is a recurrent illness, but it can be effectively managed with treatment including therapy and medication.
Sources
1.) Kendall KM, Assche EV, Andlauer TFM, et al. The genetic basis of major depression. Psychological Medicine. 2021;51(13):2217-2230.
2.) Major depression and genetics. Genetics of Brain Function. https://med.stanford.edu/depressiongenetics/mddandgenes.html?tab=proxy
3.) The role of insecure attachment and psychological mechanisms in paranoid and depressive symptoms: An exploratory model. Schizophrenia Research. 2022;243:9-16.
4.) Wiegand-Grefe S, Bomba F, Tönnies S, Bullinger M, Plass A. [do attachment styles of mentally ill parents impact on the health-related quality of life of their children? ]. Prax Kinderpsychol Kinderpsychiatr. 2016;65(4):266-281.
5.) Monroe SM, Harkness KL. Major depression and its recurrences: life course matters. Annu Rev Clin Psychol. 2022;18:329-357.
