The Experience of Depression

Everyone knows what depression feels like. Everyone feels the blues at times. Sadness, disappointment, and fatigue are normal parts of life. There is a connection between the blues and clinical depression, but the difference is like the difference between the sniffles and pneumonia.

Depressive disorders are "whole person" illnesses; they affect the body, feelings, thoughts, and behavior. The depression itself can make us feel as if it's useless to seek help. The good news is that 80 to 90 percent of people with depression can be treated effectively, but the bad news is that only one sufferer in three seeks treatment. More bad news is that almost half the American public views depression as a character defect, rather than an illness or emotional disorder. In addition, only half of all cases of depression are accurately diagnosed, and only half of those receive adequate treatment.

We tend to confuse depression, sadness, and grief. But the opposite of depression is not happiness, but vitality-the ability to experience a full range of emotion, including happiness, excitement, sadness, and grief. Depression is not an emotion itself. It's not sadness or grief, it's an illness. When we feel at our worst, sad, self-absorbed, and helpless, we are experiencing what people with depression experience, but they don't recover from those moods without help.

The trademark of depression is a persistent sad or "empty" mood, sometimes experienced as tension or anxiety. Life lacks pleasure. People with mild depressions may go through the motions of eating, sex, work, or play, but the activities seem hollow; people with more severe depression withdraw from these activities, feeling too tired, tense, or bitter to participate. There is often a nagging fatigue, a sense of being unable to focus, a feeling of being unproductive.

People with depression usually experience a lowered self-esteem. In a depression, you may feel that you are a helpless victim of fate, but also feel that you don't deserve any better. Feelings of guilt, shame, and hopelessness are common.

There are often a host of physical symptoms, of which sleep disturbances are key. People may have difficulty falling asleep or may awaken early without feeling refreshed. Others may sleep excessively, again without feeling rested. Appetite may increase or decrease. There may be difficulty in sexual functioning. There may be nagging aches and pains that don't respond to medical treatment. But there are physical illnesses that cause symptoms like depression-Lyme depression, diabetes, thyroid conditions, anemia-and depressions can cause physical symptoms like other diseases.

If you are feeling depressed, it is important to be sure that an underlying health problem does not exist, and you should see your physician for a checkup. At the same time, if you know you have a health problem and are feeling depressed, don't assume you will feel better once the health problem is under control.

Suicidal thoughts and impulses are often present, and suicide may be a real risk. Some people are repeatedly tormented by these impulses, which they experience as frightening and painful, while others have symptoms appear as if out of the blue, detached from emotions. The impulse to spin the wheel and drive suddenly into oncoming traffic is horribly common.

Alcohol and other drugs may be used to give relief from depression. But the relief is only temporary, at best, and usually the person just hates himself more for giving in to temptation. Alcohol itself is a depressant, and long-term alcohol abuse may lead to chronic depression-it certainly doesn't help you make the right decisions in life, and that is enough to be depressed about.

Recognizing Depression

From all these symptoms, it might seem that a depressed person is easy to recognize. It is often easy when the person recognized it himself-when it's a change from a more normal state of mind, the depression is experienced as something foreign to the self, something to overcome. But very often, depression has become part of the self: the person has felt this way for as long as he or she can remember, and can't imagine anything else. These people come to the attention of health professionals through some other crisis, not seeking help with depression, but the depression emerges as a big emptiness in the background.

There is a sequential process in the recognition of depression. First is a stage of confused pain in which the sufferer knows he suffers, but doesn't know why. People often blame circumstances. Adolescents blame their home lives, married people blame their spouses, and employees blame their bosses. But there is recognition that the pain is not normal.

The second stage is recognition that something is wrong with me. It may be that external circumstances have changed but the pain continues, or it may be a gradual recognition that the suffering is so extreme that circumstances can't be blamed. This is a painful recognition that often takes years. It is an acceptance of a damaged self. But because of the nature of depression, the self-blame and guilt that are manifestations of the disease, this acceptance does not always lead to seeking help.

People then may move to the third stage, a crisis that usually leads to professional intervention and diagnosis. It is often a suicide attempt or psychiatric hospitalization. The diagnosis often provides hope, that treatment or a cure is possible, and explanation, a way to understand what has only been confusion before. The fact is that this is a diagnosis of a mental illness, with all the shame and stigma that that entails.

The fourth stage involves acceptance of an illness identity. Depression comes to be seen as an outside agent invading the self, rather than as a manifestation of the self.

It is essential that anyone suffering from depression get good help from a competent, qualified professional. These are warning signals: if you or someone you love experiences four or more of the following symptoms for more than two weeks, you should seek competent help as soon as possible:

1)  Sad, depressed, or "empty" mood
2)  Loss of interest or pleasure in ordinary activities
3)  Eating disturbances (appetite and/or weight loss or gain)
4)  Sleep disturbances (insomnia, early-morning waking, oversleeping)
5)  Activity level slows down or increases
6)  Decreased energy, fatigue
7)  Feelings of pessimism, guilt, worthlessness, helplessness, hopelessness
8)  Diminished ability to think, concentrate, or make decisions
9)  Thoughts of death or suicide, suicide attempts

On the next page we will talk about Diagnosing Depression.