There’s been a wave of mental health awareness, for which I am incredibly grateful for. But between the media attention, the revelation of celebrities who struggle with mental health, and maybe even the realization that our friends/families are struggling…we can feel kinda awkward asking for clarification. So let’s go back to basics for a bit. What is depression?
How is it Diagnosed?
The DSM (Diagnostic and Statistical Manual of Mental Disorders) is published by the American Psychiatric Association. It is currently in its 5th edition. With every edition, they combine years of research to come up with a standard definition and classification for mental disorders. It helps Mental Health Practitioners diagnose their clients and the use of these diagnoses helps the rest of the practitioners out there have a basic understanding of what the client is dealing with (if there is a transfer of care or a team of practitioners working together; we’ll talk about confidentiality in another post).
What Does Depression Look Like?
The DSM-5 gives us a list of symptoms to look for before we can diagnose depression. (Note: At least one of the reported symptoms have to be either depressed mood or loss of interest or pleasure.) Symptoms include:
- Feeling “down” or extreme sadness most of the day, almost every day.
- Decrease interest or enjoyment in day to day activities; especially in hobbies or once-loved activities (like being with friends or family).
- Significant weight loss or gain.
- Being sluggish or restless; this has to be observable by those around you.
- Impaired concentration (difficulty thinking or concentrating).
- Sleeping too much or sleeping too little.
- Feelings of worthlessness and/or guilt.
- Feeling fatigued and/or without energy, almost every day.
- Recurrent thoughts of death; wanting to commit suicide; having a plan for committing suicide; or attempting suicide.
For those of you who have never experienced depression, I want you take a moment and go over this list again. Stop at each one and imagine yourself in those shoes. Imagine that you feel sad all the time. Sad for no particular reason and its such a deep-reaching sadness that you can’t snap out of it. A sadness that makes your heart break and your soul ache. And that’s just symptom #1.
Now imagine that the little things in life that make you happy are gone. That coffee you enjoy every morning tastes like dirty water. Food is bland. Netflix is just a thing that plays in the background. Family is just people who are there but who you can’t really connect with. Imagine feeling like your mind is foggy. Its like there’s always something on the tip of your tongue but you can’t ever reach it. Imagine wanting to sleep all the time because getting out of bed simply requires more energy than what you have. Or maybe laying in bed all night wishing sleep would come. You’ve counted the sheep a thousand times, you’ve banned electronics from your bedroom. You’ve memorized every indentation on your ceiling. Yet sleep never comes. Imagine feeling so utterly worthless that you think the world would be better off without you.
For those of you who have never felt that way, it’s hard to imagine it. But you can try. You can try to understand the depth of their pain. The difference is that you are purposefully thinking through this. For them, it comes from within.
The DSM-5 requires five (or more) symptoms from the above list to diagnose depression. But there’s a few other things we look for. Such things include irritability, body aches and pain (not attributed to any medical problem), low motivation, feeling anxious or worried.
Sadness vs Depression?
I hope by this point its clear that there is a drastic difference between sadness and depression. Sadness is short term and doesn’t last all day, almost every day. Sadness doesn’t stop you from living your life for long periods of time. It doesn’t drain you of all happiness and/or enjoyment.
A good way to think about it is that sadness is often triggered by something. Whether it be a death in the family, the end of a relationship (romantic or not), a failure in school or the work place, there is something to point to for the sadness. That isn’t often the case with depression. Sadness and grief definitely has its place in the mental health world and its something we all experience sometimes. Depression goes to a deeper level and has a longer stay in our lives. It generally does not go away by itself.
With all this talk about Mental Health Awareness, I worry that depression is getting normalized. So many people talk about their depression so nonchalantly that I wonder if it’s depression or if it’s cynicism with the world, apathy, or sadness. That said, I am definitely not advocating accusing people of not actually being depressed. I do push for more talk about treatment, not just the illness. I don’t want to see ‘being depressed’ as the new normal.
If you are sad more often than not (3 days or more out of the week). If you are thinking about death, especially when those thoughts are intrusive (unwanted, and causing you distress). If you are experiencing the symptoms listed above, please seek help. Find a therapist, psychologist, or psychiatrist. If you are unable to find a mental health practitioner, at least go talk to your Primary Care Physician and they’ll help you find one.
You will not be judged. You will not be laughed at. There is nothing wrong with you as a person, you are just unwell. The same way you would go to the doctor if you were experiencing drops in your blood sugar, you have every right to see someone regarding your mental health.
If you think you will hurt yourself, call 911 or go to your nearest emergency room.
There is help available and you deserve to get better.