Growing up, it did not take me long to realize that some people are very different from others. I’m not talking about skin color, or belief, or height and size. I’m talking about the way people deal with problems and events, they way they respond to joy, pain, excitement. Some people are naturally talented at living – it’s almost like they sway with the wind, and nothing knocks them down. They’re rare, but they’re out there. But most people struggle. Things get to them, and they have a hard time bouncing back. There are some who struggle more than others, though. And with time, I began to understand why. As I got older, I learned about depression and how it affects others – especially those I love. And like most people, I wanted to know more. Here’s what I learned.
Depression is a mental disorder that presents as unnaturally prolonged periods of severe sadness. Characterized by symptoms such as insomnia (inability to fall asleep) 1, dysphoria (dissatisfaction with life), suicidal thoughts and anhedonia (an inability to feel happiness), depression sets itself apart from usual moments of sadness by way of duration and severity. Depression is diagnosed if a patient experiences symptoms consistently for over two weeks, and unfortunately, depression can last years. Everybody gets sad, but only one third of US adults experience the symptoms of depression at one point or another, and roughly 7% of the US adult population is struggling with depression in any given year. 2
The Feeling vs. The Disorder
There are many synonyms for being depressed, including being sad, feeling blue, or feeling low. As far as feelings go, a depressed feeling is different from depression. Where a “press” is just applying force, to “depress” means specifically to push down, with no indication of how far or for how long. You can say you’re feeling depressed, or that something is depressing. It’s not a misuse of the word. But to be depressed typically means to struggle with a mood disorder, such as major depressive disorder or manic depression.
Depression has had many names throughout the years, including clinical depression, major depression, unipolar disorder, and even melancholia. As a diagnosis, depression is as old as the Hippocratic Oath itself. The Ancient Greeks already understood that some people experienced sadness more severely than others and were plagued by it.
Sometime around the mid-20th century, researchers theorized that depressive symptoms were often caused by chemical imbalance between the different neurotransmitters in the brain. This meant that the chemicals responsible for regulating moods and emotions were often out-of-whack in the brains of depressed people, although causes were not conclusively known. Today, we know that that’s not the only reason depression occurs, and that neurotransmitters are only part of the picture. 3 There are several common biological differences between the brains of depressed people and non-depressed people, with several being the key word. Not everyone exhibits depression in the same way, or for the same reasons.
More Than One Diagnosis
Psychology often runs into the problem that MDD is not a very specific disorder. For millions of Americans, depression is a day-to-day reality with severe consequences, including limited productivity and thoughts of suicide. For others, depression presents as an overwhelming sadness, albeit not enough to cause daily consequences. MDD refers to the former, where depression is debilitating. But it does not explore this further.
Every case is different with different causes and effective treatments, as well as different interacting disorders or medical conditions, and influential factors such as lifestyle. Cases also exhibit depression differently. People who are depressed by continue to function in their daily lives are still depressed, because depression refers not just to feeling sad, but to feeling sad for a very long time without an obvious cause. The loss of a loved one, for example, can kickstart a depression – while it’s normal to feel melancholy and mourn for a while, it is not normal to be stuck in sadness for weeks, months, and years, even if the symptoms allow one to continue working and functioning in society.
This is part of why depression has grown in frequency and as a topic of discussion in America. It’s topic worth discussing, because millions of Americans struggle with symptoms of depression, but there is no easy or quick answer for what they have, and why.
There are also concerns around how often people are diagnosed with depression, and the level of pharmacological treatment levied on patients with less than severe symptoms of depression. Some prominent figures in modern psychiatry have gone on to say that depression is a metaphorical disease, the phenomenon of medicalizing sadness, while one particularly prominent example considers depression – and many other examples of mental illness – incapable of matching the definition of a disease or disorder.
So Is It Real?
Here’s what you need to know. Depression, as a separate concept from sadness, exists. Extensive research has shown a marked difference in the way euthymic people (people with a normal or neutral baseline of emotions) and depressed people (those diagnosed with depression) react to antidepressants. 4 It has also shown that depression is significantly more common in families with previous diagnosis of depression, suggesting a biological basis due to genetics. 5 Finally, people with depression often exhibit other biological symptoms, including significantly shorter REM sleep, and various abnormal biological reactions in the brain.
Depression is treatable, but treatment is not universal. The kind of treatment a person needs depends entirely on their living condition as a whole – without a holistic approach, depression cannot be properly addressed. Some people are born with a genetic predisposition towards depression, caused expressly by a problem in the brain. Others experience depression because of another underlying condition, or because of certain circumstances, such as a traumatic event, frequent bullying, excess stress, and so on. It also depends on severity. However, regardless of what kind of depression someone struggles with, it is possible to live a fulfilling life if depressive symptoms are managed responsibly. That means prescribing the right treatment to the right person.
What Depression is Like
Everybody has their own visceral description of depression. Some feel it like an unseen shadow looming over them, except that this shadow has weight, and it presses down unlike anything physical. Quite literally, they feel depressed – their spirit deflated, their motivations crushed.
Another way to describe it might be as a black hole: a dark hole with a steep and slippery slope, constantly pulling at a person until they fall in. Some days the pull is stronger, some days it’s weaker, but not a day goes by where it’s completely gone.
Descriptions of every kind and color exist, but all of them have one thing in common: the ubiquitous darkness. Depression is not classically aggressive or painful, and it does not cause someone to see things that are not there. It doesn’t give or add. It takes. It tugs at a person’s motivations, hope, happiness, and strength. It can make pain more painful, sleep less invigorating, and it can make simple things – like getting out of bed to take a shower or brush one’s teeth – too challenging to consider accomplishing.
Some days are better, some days are worse. Some people experience depression without the severity that leaves them bedridden, while others have periods where entire days go by without anything getting done. Understanding that one case is just as valid as the other, but requires different treatment, can help give a better picture of how depression is not just a single diagnosis, but part of a larger list of disorders.
How Depression is Treated
Clinically, depression is treated in three ways: through psychotherapy, through medication, and through alternative therapies. Holistically – meaning as a whole – overcoming depression might also involve lifestyle changes and necessitates the inclusion of family and friends in combatting thoughts of sadness and suicide.
Psychotherapy is a broad term to encompass pretty much all known forms of valid therapy. This isn’t just the kind where you sit face-to-face with a therapist, but it involves group therapy, lesser known forms of art therapy and sports therapy, and specific types of “talk therapy” like cognitive behavioral therapy, where you work through a program with a professional to change the way you think and behave, sort of like a reeducation out of depressive thinking.
The medication for depression is an antidepressant. Antidepressants come in many shapes and forms, working in different ways. The most common kind is an SSRI, which inhibits the reuptake of serotonin in brain cells, thus letting serotonin stay in the brain for longer. Different antidepressants come with different side effects, so it is recommended to try them as per your therapist’s prescription until you find one that works.
Alternative therapies tackle depression in ways medication and psychotherapy cannot, usually by affecting the brain. These treatment methods are usually reserved for when the other two more common treatments do not work. An example of an emergent alternative treatment for depression is transcranial magnetic stimulation, where the application of magnetic fields to a patient’s brain positively affects their mood and thought process, causing a total remission of depressive symptoms in a third of patients. 6 Other non-Western approaches to depression include yoga, acupuncture, and herbal medicine.
Getting Help for Depression
If you or someone you love seems depressed, it’s important to see a professional. Spending time with a therapist or psychiatrist can give you a better understanding of whether it’s depression or something else, or if it’s a specific diagnosis tied to something biological, or in response to something environmental (like stress). It’s important to have a better understanding of what’s causing the sadness if you want it to go away.
If you have already been diagnosed with depression but don’t know what to do, get help. Find a friend, or a family member, or call a professional. Do not be alone. You never have to be alone – and often, just being with someone else can make things a little better.