What is depression?

Depression is a mental and behavioral disorder affecting a person’s thoughts, behavior, motivation, feelings, and sense of well-being. The core symptom is anhedonia, a loss of interest or a loss of feeling pleasure in certain activities that usually bring joy to people. The most common symptoms are low mood, aversion to activity, loss of interest, and a loss of feeling pleasure.

Do you feel…

… unreasonably bad disproportionately often? That’ll include sadness, emptiness, apathy, hopelessness, anger, irritability and frustration, worthlessness, and guilt.

… more negative than usual where thoughts and judgment of things are more prone to getting a negative tone?

… less interest and amusement in most of what you used to appreciate, like sex, hobbies, and work?

… as if you do those things less, regardless of if you feel better or worse by doing them?

… less interest in yourself and how things work out?

… a decline in self-respect and self-esteem?

… as if you don’t care about taking care of yourself, your stuff, your home, or your responsibilities?

… as if past mistakes bother you more now than they have done earlier?

… anxious, or more anxious than usual – perhaps with the addition of restlessness?

… unmotivated and having a hard time taking the initiative?

… as if small things become big problems?

… tired and as if you lack energy?

… as if you’re having trouble sleeping?

… more or less interested in food, so your weight has changed?

… generally slower in thought and perhaps even physically?

… as if your brain won’t cooperate, so thinking, memorizing, and concentrating is harder?

… more morbid than before, drawn to death and thoughts about it? Perhaps even suicide?

… as if you’re more sensitive to pain or painful things have suddenly appeared?

If you do, that would be typical symptoms of depression, I’d say. It doesn’t always come with all of the symptoms, and sometimes they’re unreasonably tricky with just a few barely characteristic traits, but this is often it. Doom and gloom. Darkness and despair. A lack of everything joyful and lovely. Instead, there’s just hopelessness, meaninglessness, and anxiety.

Ruminations and brooding go around and around:

Why can’t things be as they should be?

Why can’t things be as they used to?

Why did it, or I end up like this?

Why am I feeling like this?

Why am I not like everyone else?

How does depression begin?

Depression could creep up on you gradually or come on as a full-frontal assault. The other of the two is more obvious and is commonly referred to as Major Depressive Disorder. If you get depressed by something acute, a trauma, or something happening, you and everyone around you will notice. If you’re in an accident or someone close to you dies, that is generally understandable. People will get that you’re down, and if you keep going in the same way for too long, someone will get you help. If someone’s around, that is.

The slower version where you’ve “always been like this” and depression feels more like how you are than something that is temporarily bothering you, makes things trickier. If you’ve always been the more or less gloomy, dark, sour, and depressed one, who didn’t get this the acute way, this could be everlasting since it’s far less obvious to look for help for something that is… you, in some sense. It’s easier to look for help when you want to get rid of a problem rather than getting rid of a part of you.

The more sneaky, persistent version of depression is dysthymia or persistent depressive disorder. It’s similar to the “Major Depressive Disorder” in symptoms and how you’re affected, but it’s less acute and longer-lasting. Worth underlining is that less acute doesn’t necessarily mean less severe. Today we use it as a term for what we earlier called “depressive personality”. That’s likely a good thing since it sounds slightly more empowering when it’s not a part of you in the same way. You’re not necessarily this way, and you’re not entirely a victim. You feel bad, but you can still do something about it. The difference between the two is that dysthymia is more outdrawn than Major Depressive Disorder.

In the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV, dysthymia is defined as chronic depression for at least two years or one year for children and adolescents. Per definition, those with the condition experience symptoms for years before being diagnosed. The debut is often in the teens, making it even sneaker since we develop a lot there. It might as well be a personality trait rather than something “pathological”, right? Diagnoses are likely less common if people believe that depression is a part of their character and avoid discussing the symptoms and suffering. They don’t seek medical attention, and it’s often seen as irrelevant to discuss with family and friends.

Then there’s the middle ground and compromise. Nothing acute happened, but this isn’t something they’ve been doing forever either. It’s sort of new but came gradually. Slowly enough to barely be noticed. This is where most of my clients are when they seek help with stress. I’m pointing to those with twenty-something points when doing the MADRS-test, where they don’t really wish they were dead – but they can’t find any joy in life right now either. In some cases, I hear them mention that they don’t want to die, but they don’t want to live either. Clinically, 20-34 points when doing the test is a “moderate depression” and definitely affects the quality of life. Right now, it’s noticeable – and it hurts – but it wasn’t when they were in the middle of everything and kept busy. Now, as they’ve crashed enough to stay put so they can feel it – and they desperately want to do something about it… If there’s that much fight left in them, that is.

What’s normal?

It’s reasonable to think that life has its ups and downs.

Sometimes you don’t love your workplace, and the kids are unreasonable or moody. You might be in a conflict with someone, sprained your ankle, the weather sucks, and can’t sleep because of the stupid neighbors. The economy might suck, and perhaps there’s a pandemic.

That’s often what we call life. Shit happens, and it’s up to you to solve it or accept it. That doesn’t have to result in what we call depression.

But depression IS COMMON, so said life obviously does result in depression from time to time. Some numbers say that one out of five or six is depressed right now. One of two women and one of four men get depressed at some point. Twenty percent get healthcare to treat it at some point.

Some are provocatively content. Some are fine. Some are bothered by life. Some get depressed. Some are bothered by life enough to seek medical attention, so there are different levels of how much life sucks. If life sucks enough for you to be drawn to thoughts of ending it, that’s usually a quite clear indicator that things are not alright.

To get a diagnosis

To “get a diagnosis”, if that’s necessary, there are a number of criteria to live up to. If you visit www.mbdolor.com/madrs, you’ve got enough criteria and resources to quantify it in a more or less objective way, or you could find just the DSM-5 criteria here.

Consequences.

Depression is often accompanied by anxiety, worries, and general dislikes. If it’s not high-level horror and misery, it’s just unpleasant. Disliking life, while you can’t sleep or enjoy anything is really stressful over time. Statistically, it increases the risk of drug or alcohol addiction, since they offer short-term relief from the suffering. It commonly ruins relationships, causes problems at work or even unemployment, and could make people completely unable to handle life.

The brain interprets mental suffering much as it would physical pain, which could increase sensitivity to pain, just like long-term pain does. That, alongside increasing the stress, could give the same troubles you get from stress over time, which takes us to why the three of them go hand in hand.

In the book found at www.mbdolor.com/book I go through some of my most powerful tools to combat depression.

Full series:
The Big Three: What Is Depression?
Why Do We Get Depression?
Treat Depression