Life is hard. As such, it is normal and expected to feel down and dejected periodically. Our culture can imply that we should be “having fun” and “enjoying our life” all the time. In a life fully lived, with its unpredictability and range of experiences, it is unrealistic to be “happy” day in and day out, and it can be harmful to hold on to that constant appearance of “happiness” as an ideal. But clinical depression is different than the usual ups and downs of life. It is a deep sense of despair, hopelessness and lack of meaning that can cause enormous suffering and contribute to poor decisions, up to and including suicide.
Depression is common and anyone who experiences it should know that it affects men, women, teenagers and even children. Each year depression affects about 16 million adults, or about seven percent of the U.S. population over age 18, according to the National Institute of Mental Health. Over the course of a lifetime, approximately 20 percent of people in the U.S. will experience an episode of diagnosable depression, according to research published in the journal Psychological Medicine by experts in the field Evelyn Bromet at Stony Brook University School of Medicine and Ronald Kessler at Harvard Medical School.
Depression is Common Worldwide
The World Health Organization ranks depression as the fourth leading cause of disability worldwide and projects that by 2020, it will be the second leading cause, according to Evelyn Bromet in research published in BioMed Central that analyzed data from 89,000 people in 18 countries.
Depression can be understood in many ways, but generally it is a severe muting of the colors and nuance of life. It leaves the world feeling grey and cold and diminishes to the point of vanishing hope for a different tomorrow. It can have a relentless and bullying quality to it and in its more pronounced forms can feel as though it is declaring “this is your life and it is worthless and you are also worthless.”
Depression can lead to feeling overwhelmed and despairing, making it difficult or impossible to manage common responsibilities like work, school, relationships and maintaining good health. Depression can make it feel impossible to take any satisfaction in those common pursuits and tasks.
It’s when we are overwhelmed by feelings of sadness, emptiness or irritability for more than a couple of weeks – and those feelings interfere with functioning – that it’s important to reach out to a trusted friend or family member or psychotherapist. Acknowledging potential depression sooner rather than later is desirable and helpful.
It is important to understand that depression can afflict anyone and is not a sign of weakness or poor character. It is evident in all cultures and nations. Globally, more than 300 million people suffer from depression, according to a 2017 report from the World Health Organization. Left untreated, it can cause great harm and unrelenting pain and isolation.
Recognizing and Treating Depression Can Save a Life
Depression is in many ways one of the most dangerous mental health disorders and potentially as dangerous and destructive as the most severe medical diseases due to its statistically high occurrence, debilitating effect and relatively high mortality rate.
At its worst, depression can lead to suicide. More than 50 percent of all people who die by suicide suffer from major depression, according to the American Foundation for Suicide Prevention.
Depression is Treatable
The good news is that depression is generally highly treatable and responsive to a range of therapeutic interventions. Many therapy approaches can be profoundly helpful when administered skillfully and when the therapy relationship is solid and trustful.
Finding professional assistance to help you with depression may help you regain, or find for the first time, your sense of meaning, purpose and clarity. The lifting of depression and the opening to life with some degree of connectedness and hopefulness can be a powerfully life affirming experience and an enormous relief.
Reasons People Ignore Signs of Depression
One of the most common reasons people ignore the warning signs of depression is that friends and family members often suggest that the person will “snap out of it.” Other common and sincerely offered, but potentially harmful, suggestions include “it will pass” and “just keep busy.” Those suggestions may be accurate for times of feeling “down,” but clinical depression tends to keep a person from just “getting over it.”
There is with depression a continuing, although decreasing, stigma surrounding mental health disorders, and a person who may be suffering from depression may fear losing a job or being shunned by their social network.
Most people think first of an extended period of sadness as the major sign of depression and that is one part of this complex and varied psychological and physical condition. Some people with depression may not feel sadness at all. Different people have different symptoms, so it’s important to be alert to signs of change in sleep, eating, energy levels or interest in activities you previously enjoyed.
Signs of Depression
- Persistent sad, anxious or “empty” mood
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness or helplessness
- Loss of interest or pleasure in hobbies or activities
- Decreased energy, fatigue, or being “slowed down”
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping, early-morning awakening, or oversleeping
- Appetite or weight changes
- Thoughts of death or suicide or suicide attempts
- Restlessness or irritability
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause that do not ease even with treatment
Types of Depressive Disorders
Depressive disorders vary according to the cause and the duration of time it affects a person. These are some of the most common ones and their characteristics:
Major Depressive Disorder, Single Episode: The person is in a depressed mood most of the day, nearly every day, for two weeks or more; loss of interest in most or all activities, significant weight loss or weight gain or change in appetite, insomnia or sleeping more than usual, fatigue, feelings of worthlessness, difficulty concentrating, or thoughts of death.
Major Depression Recurrent: Repeated episodes of depression with no times of extreme mood elevation or “mania.”
Dysthymia: Also called Persistent Depressive Disorder, a continuous long-term form of depression. It is not as severe as major depression, but the person may still lose interest in normal daily activities, feel hopeless, lack productivity, have low self-esteem and an overall feeling of inadequacy. These feelings can last for years and may significantly interfere with relationships, school, work and daily activities. A person with dysthymia is sometimes described as having a gloomy personality, constantly complaining or incapable of having fun.
Bipolar Disorder: Formerly called manic depression, bipolar disorder is characterized by extreme mood swings, with emotional highs called mania or hypomania, and lows that are episodes of depression. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.
Anxious Depression (co-occurring): Anxiety and depression frequently coexist. At least 85 percent of people with major depression also have significant anxiety symptoms. Antidepressants can treat both depression and anxiety, and it’s critical to have a mental health professional determine which type of medication may be suitable for the individual.
Options for Treating Depression
The first step in getting the right treatment for depression is to visit a health care provider. You can talk first to your primary care doctor, who may suggest some lab tests to see if there are any physical conditions that may have symptoms similar to depression. Your primary care physician can, if necessary, refer you to a mental health counselor, such as a psychologist or psychiatrist. You can also go to a community mental health agency or contact a private counseling group.
Once diagnosed, depression can be treated with medication, psychotherapy or a combination of the two. Physical exercise, mindfulness based exercises, meditation and reaching out to friends are also very helpful, but often made a major challenge to pursue by the power of depression.
Psychotherapy, or talk therapy, can help by teaching new ways of thinking and behaving, and changing habits that may be contributing to depression. One well-established and highly effective treatment for depression is cognitive behavioral therapy, or CBT. It focuses on identifying, understanding, and changing thinking and behavior patterns.
Antidepressant medications can stabilize mood and help a person more calmly evaluate stresses that may cause depression and allow time to work through issues. It takes some time, but once you take the first step, then another step, and you feel the darkness begin to lift, you’ll be more inclined to continue with the positive practices that help you create a more satisfying and peaceful life.
New Research and Promising Findings on Depression
For people struggling with depression, it’s important to remember that extensive research is being done on medications and non-medicinal treatments and promising new discoveries are being made.
One promising path of research is “mindfulness,” which is learning to focus on the moment, releasing worry about the past or future, and not judging thoughts or emotions that may arise.
“A growing body of research is pointing to an intervention that appears to help prevent relapse by altering thought patterns without side effects – mindfulness-based cognitive therapy, or MBCT,” according to an article in Monitor on Psychology, published by the American Psychological Association.
As these new therapies are researched and proven helpful, the hope for lightening the shadow of depression grows brighter. Confronting depression is a courageous and hopeful act. It is a noble effort worth being proud of.
National Institute of Mental Health, “Depression,” October 2016
Anxiety and Depression Association of America, “Depression,” 2016
World Health Organization, “Depression,” February 2017
Kessler, Ronald; Birnbaum, Howard; and Bromet, Evelyn, “Age Differences in Major Depression: Results from the National Comorbidity Survey Replication,” Psychological Medicine, Feb. 2010
Bromet, Evelyn, “Cross-National Epidemiology of DSM-IV Major Depressive Episode,” BioMed Central, July 26, 2011
Diagnostic and Statistical Manual of Mental Disorders, DSM-5, 2013
Mayo Clinic, “Persistent Depressive Disorder,” 2017
Mayo Clinic, “Bipolar Disorder,” 2017
Clayton, Paula J., M.D., “Co-Existing Disorders,” Depression and Bipolar Support Alliance, 2016
Lu, Stacy, “Mindfulness Holds Promise for Treating Depression,” Monitor on Psychology, American Psychological Association, March 2015.