It’s Not Just Feeling Sad: What Is Depression?

Depression is a common illness and a leading cause of disability worldwide. Despite how widespread it is, there is still confusion around the illness. Many don’t understand that there are different types of depression. More are unaware that there is clinical depression, short-term or situational depression, and more manageable feelings of sadness.

John B. Roseman, MD, associate director of McLean Hospital’s Electroconvulsive Therapy (ECT) Service, said, “Depression is characterized by feelings of sadness and low mood, accompanied by physical and cognitive symptoms.” He said that these symptoms “help behavioral health specialists separate clinical depression from a mood state that may be a reaction to circumstances.”

What Depression Looks Like

Depression can affect all ages, genders, races, and socioeconomic backgrounds. To be clinically diagnosed with depression, a person must experience five or more of the following symptoms during the same two-week period. At least one of the symptoms must be either depressed mood or loss of interest or pleasure.

Other symptoms of depression include:

• Depressed mood most of the day, nearly every day
• Markedly diminished interest or pleasure in all—or almost all—activities most of the day, nearly every day
• Significant, unintentional weight loss or gain, or decrease or increase in appetite nearly every day
• An observable slowing down of thought and a reduction of physical movement
• 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 specific plans for suicide, or a suicide attempt

Symptoms must be distressing to the patient and/or impair functioning. These symptoms cannot be a result of substance misuse or another medical condition.

“This means that in addition to feeling down and sad, the individual typically has physical symptoms,” Roseman explained. “These may include disrupted sleep, low energy, poor concentration, and abnormal appetite.”

Can Depression Be Situational?

Specific, identifiable circumstances can cause situational depression. External triggers like death, job loss, illness, or an argument with a loved one may account for a drastic change in mood.

The phrase “situational depression” can be misleading, Roseman warned. “Regardless of whether the depression is the result of a life stressor or just arose out of the blue, the symptoms, severity, and course can be the same,” he said. “The improvement in external circumstances may not lead to symptoms resolving once the depression ball gets rolling, although one can never discount the importance of improved life circumstances in improving mood and outlook.”

Roseman stated that “when someone’s mood declines, either because of an identified event or for no clear reason, treatment may be needed, and the type of treatment may not differ.”

Am I Just Sad?

“If someone is sad or upset about an event or loss, that mood may last for a few days,” said Roseman. “But that sadness does not typically lead to thoughts that life is not worth living. If someone is saddened by an incident and they spend days engrossed in negative thoughts, not sleeping well, not feeling like eating, this sadness does not typically persist for days on end. They will still be able to get pleasure out of previously enjoyable activities.”

When to Seek Help

People with symptoms of depression often wonder when the right time is to seek help or whether they are “eligible” for treatment. “I always tell people, ‘If it’s a problem, then it’s a problem,’” Roseman said. “If low mood or other symptoms are starting to impact any aspect of functioning or relationships, you need to get evaluated.”

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DEPRESSION TREATMENT

Roseman said that “any time you experience new thoughts of suicide or self-harm, or feelings of wanting to hurt others, then you need immediate evaluation. If you are experiencing new and intense feelings of sadness, or you find that you cannot get negative thoughts out of your head, then you should get evaluated by a mental health professional.”

Patients with depression fare better when it is diagnosed and treated as early as possible. Roseman reported that evaluation for depression mainly consists of sitting and talking with a mental health professional. “They will be empathetic about your symptoms, nonjudgmental, and will make every effort to understand you and your problems,” he said.

Treatment for Depression

Treatments for depression vary. Many people benefit from talk therapy, antidepressant medication, or a combination of the two. “Talk therapy can be unstructured, with the patient meeting with a therapist to talk about whatever issues are troubling,” Roseman said. “Or it can be more structured, like cognitive behavior therapy (CBT) or dialectical behavior therapy (DBT). These are forms of therapy organized around teaching the patient new skills to better manage mood symptoms.”

In cases of severe depression, therapies like transcranial magnetic stimulation (TMS), ketamine treatment, or electroconvulsive therapy (ECT) may help someone feel like their best self.

“If you are experiencing any change in mood that lasts more than a few days and has accompanying physical symptoms and/or you have any thoughts of suicide or self-harm, you should seek evaluation,” Roseman said. “Regardless of how severe symptoms are, if they are causing you distress or affecting your functioning or relationships, you should get evaluated.”