Depression is the common cold of mental disorders — most people will be affected by depression in their lives either directly or indirectly, through a friend or family member. Confusion about depression is commonplace, e.g., with regard to what depression exactly is and what makes it different from just feeling down.
There is also confusion surrounding the many types of depression that people experience — unipolar depression, biological depression, manic depression, seasonal affective disorder, dysthymia, etc. There have been so many terms used to describe this set of feelings we’ve all felt at one time or another in our lives, it may be difficult to understand the difference between just being blue and having clinical depression.
Depression is characterized by a number of common symptoms. These include a persistent sad, anxious, or “empty” mood, and feelings of hopelessness or pessimism that lasts nearly every day, for weeks on end. A person who is depressed also often has feelings of guilt, worthlessness, and helplessness. They no longer take interest or pleasure in hobbies and activities that were once enjoyed; this may include things like going out with friends or even sex. Insomnia, early-morning awakening, and oversleeping are all common.
Appetite and/or weight loss or overeating and weight gain may be symptoms of depression in some people. Many others experience decreased energy, fatigue, and a constant feeling of being “slowed down.” Thoughts of death or suicide are not uncommon in those suffering from severe depression. Restlessness and irritability among those who have depression is common. A person who is depressed also has difficulty concentrating, remembering, and trouble making decisions. And sometimes, persistent physical symptoms that do not respond to traditional treatments — such as headaches, digestive disorders, and chronic pain — may be signs of a depressive illness.
Do I Have Just The Blues… Or Something More?
Feeling down or feeling like you’ve got the blues is pretty common in today’s fast-paced society. People are more stressed than ever, working longer hours than ever, for less pay than ever. It is therefore natural to not feel 100% some days. That’s completely normal.
Depression can be a gradual withdrawal from your active life.
What differentiates occasionally feeling down for a few days from depression is the severity of the symptoms listed above, and how long you’ve had the symptoms. Typically, for most depressive disorders, you need to have felt some of those symptoms for longer than two weeks. They also need to cause you a fair amount of distress in your life, and interfere with your ability to carry on your normal daily routine.
Depression is a severe disorder, and one that can often go undetected in some people’s lives because it can creep up on you. Depression doesn’t need to strike all at once; it can be a gradual and nearly unnoticeable withdrawal from your active life and enjoyment of living. Or it can be caused by a clear event, such as the breakup of a long-term relationship, a divorce, family problems, etc. Finding and understanding the causes of depression isn’t nearly as important as getting appropriate and effective treatment for it.
Grief after the death or loss of a loved one is common and not considered depression in the usual sense. Teenagers going through the usual mood swings common to that age usually don’t experience clinical depression either. Depression usually strikes adults, and twice as many women as men. It is theorized that men express their depressive feelings in more external ways that often don’t get diagnosed as depression. For example, men may spend more time or energy focused on an activity to the exclusion of all other activities, or may have difficulty controlling outbursts of rage or anger. These types of reactions can be symptoms of depression.
John Folk-Williams has lived with major depressive disorder since boyhood and finally achieved full recovery just a few years ago. As a survivor of...Read More
A recovery story is a messy thing. It has dozens of beginnings and no final ending. Most of the conflict and drama is internal, and there’s a lot more inaction than action. The lead character hides in the shadows much of the time, so you can’t even see what’s going on.
I joined up with depression around the age of 8. There are snapshots of me in the shabby brown jacket I liked to wear. My mom took beautiful photographs, and there are lots of me in moody shadows, looking as down as could be.
She had her own depression to worry about. My typical memory of her from that time brings back a couch-bound, often napping, mother. She explained her sleep problem as a condition she called knockophasia – a term I’ve never been able to find in any dictionary. A few minutes after lying down, snap! Sound asleep. No one mentioned strange emotional problems or mental illness in those days. My parents occasionally talked about someone having a nervous breakdown as if they had died. There was no hint of a need to get help for my mother, much less for me. No one worried about me since I was a star in school, self-contained and impressive to teachers for being so mature, so adult.
Migraine headaches started then, and increasingly intense anxiety about school. I missed many days, felt shame as if I were faking, and obsessed over every one of my failings. I spent long hours alone in my room.
Through my teenage years, depression went underground. Feelings were dangerous. There were too many angry and violent ones shaking the house for me to add to them. So I kept emotion under wraps, even more so than in childhood. Nothing phased me outside the house and even at home I showed almost no sign of reaction to anything, even while churning with fear and anguish.
It was in my 20s that I broke open, and streams of depression, fear, panic, obsessive love and anger flowed out. In response to a panic attack that lasted for a week, I saw a psychiatrist. In one marathon session of 3 hours he helped me put the panic together with frightening episodes from my family life. I was cured on the spot but never went back to him. It was too soon to do any more.
It took another crisis a few years later to get me back to a psychiatrist and my first experience with medication – Elavil. But I had no idea what it was. I took something in the morning to get me going and something at night to help me sleep. I took it short term, got through the crisis but continued in therapy. From there I was steadily seeing psychiatrists in various cities for the next 8 years. But no one mentioned depression.
I first saw the word applied to my condition in a letter one psychiatrist wrote to the draft board during the Vietnam era. But I wasn’t treated for that problem. Therapy in those days was still in the Freudian tradition, and it was all about family life and conflict. Depression was a springboard for going deeper. Digging up the past to understand present problems was a tremendous help, and it changed me in many ways. But depression was still there in various forms, reappearing regularly for the next couple of decades. There were wonderfully happy and successful times as well, but I had these ups and downs through marriage, children and a couple of careers.
Gradually, depression became so disruptive that my wife couldn’t take it anymore and demanded I get help. So I finally did. This was the 1990s. Prozac had arrived, and I started a tour of medication over the next dozen years that didn’t do much at all. Nor did therapy, though two psychiatrists helped me to understand the more destructive patterns in my way of living.
Depression pushed into every corner of my existence, and both work and family life became more and more difficult. The medications only seemed to deaden my feelings and make me feel detached from everyone and immune to every pressure. It was like having pain signals turned off. There was no longer any sign coming from my body or brain that something might be wrong. I felt “fine” but relationships and work still went to hell.
The strange thing was that after all these years of living with it, I didn’t know very much about depression. I thought it was entirely a problem of depressed mood and loss of the energy and motivation. As things got worse, I finally started to read about it in great depth.
I was amazed to learn the full scope of depression and how pervasive it could be throughout the mind and body. I finally had a coherent, comprehensive picture of what depression was.
That was a big step because I could at last imagine the possibility of getting better. I could see that I wasn’t worthless by nature, that there were reasons my mind had trouble focusing and that the frequent slowdown in my speech and thinking was also rooted in this illness. Perhaps the right treatment could bring about fundamental changes after all.
There were still traps ahead, though. I became obsessed with the idea of depression as a brain disease. I studied all the forms of depression, the neurobiology and endless research studies. That was a good thing to do, but after awhile I was looking more at “Depression” than the details of my own version of the illness.
I wondered how many diagnostic categories I fitted into. For sure I had one or more of the anxiety disorders. Perhaps I fit into bipolar II instead of major depressive disorder. What about dissociation? I read the research study findings as if they were announcing my fate.
It was comforting to know I had a “real” disease. Not only could I answer any naysayers about the reality of depression. I also had a weapon to fight my internalized stigma, the lingering doubt that anything was wrong with me. I used to think that maybe I really was using the illness as a way to avoid life and cover up my own weakness. Here was proof that depression wasn’t all in my imagination but in my brain chemistry.
Neurobiology was far beyond my control. I couldn’t recover by myself. Doctors had to cure me through medication or other treatments, like ECT. However, that meant my hopes were pinned on them, not on my own role in getting better.
When the treatments failed to work, I got desperate that there would never be an end to depression. Hope in the future fell apart. My life would continue to run down. Could it even lead to suicide, as it had for friends of mine?
Fortunately, as I learned more, I listened to the experts who had a much broader view of the causes of the illness. Peter Kramer’s overview of research in Against Depression made it clear to me that contributors to the illness could include genetic inheritance, family history, traumatic events and stress as well as the misfiring of multiple body systems. No one could point to a single cause or boil it down to a few neurotransmitters.
So I went back to basics and looked much more closely at the particular symptoms I faced. I tracked the details in everyday living and saw that I needed to take the lead in recovery. Medication – when it had any effect at all – played a modest role in taking the edge off the worst symptoms. That bit of relief gave me the energy and presence of mind to work on the emotional and relationship impacts, to try to straighten out the parts of my life I had some control over.
I was determined to stop the waste of life in depression. I got back into psychotherapy and tried many types of self-help as well. Many didn’t work at all, but something inside pushed me to keep trying, despite setbacks.
One of the most important efforts was writing about my experience with depression. Writing is one way I discover things, but a deep fear had blocked me from doing it for years. I can see now that the real reason I got stuck was that I had been trying to write about everything but depression. When I could finally take that on directly, writing came naturally.
Blogging turned out to be the right medium. It was manageable even when I was down. The online community of people who lived with depression gave me a form of support that I had never had before. Another decisive step was getting out of high-stress work that I had been less and less able to do effectively. Taking that constant burden away restored a deep sense of vitality.
After all this, recovery finally started to happen. It took me by surprise, and for a long time I didn’t trust that it would last. But something had changed deep down. I believed in myself again, and the inner conviction of worthlessness disappeared.
I had found a deeply satisfying purpose in writing, as well as the energy and humor to do what I wanted to do. I regained the awareness and emotional presence to be a part of my family again, instead of the hidden husband and dad.
As anyone dealing with life-long depression will tell you, setbacks happen. There’s no simple happy ending. But if you’re lucky, an inner shift occurs, and the new normal is a decent life rather than depression.
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