What Is Depression?

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Lately the things I used to enjoy, even loved, have come to seem boring or not worth the effort. Watching the animals and birds, listening to people, playing games, writing about diabetes — even sex seems like too much work. Am I depressed?

Could be, but how can I tell? It’s a significant question, because according to the National Institute of Mental Health, about 7% of American adults have major depression. In people with diabetes, it’s closer to 20%. So it is worth knowing if you are becoming depressed or not.

It’s complicated, because people don’t agree on what “depression” means. Part of it is feeling sad. Psychiatrist Paula Trief wrote here, “A person who is depressed typically feels deep sadness, feels very little pleasure in life, and may even contemplate suicide.”

But there’s more to it than sadness. People can be sad without being depressed or depressed without being noticeably sad. According to psychiatrist Aaron Beck, a founder of cognitive therapy, symptoms of depression can be emotional (“affective”) and/or physical (“somatic”). Affective symptoms include pessimism about the future, feelings of failure in the past, feelings of guilt, self-dislike, self-criticalness, suicidal thoughts or wishes, and worthlessness.

Somatic symptoms include loss of pleasure, crying, agitation, loss of interest in things, indecisiveness, loss of energy, change in sleep patterns, irritability, change in appetite, concentration difficulties, tiredness and/or fatigue, and loss of sexual desire.

Beck’s list doesn’t cover all the physical symptoms. According to WebMD, depression can also cause symptoms such as chronic pain, digestive problems, or dizziness.

I tried applying these criteria to myself. I don’t really have much of the feeling symptoms, but I have many of the somatic ones, such as loss of interest in things, indecisiveness, and loss of energy, appetite, and sexual desire. It’s like my body is depressed but my mind isn’t.

That is not unusual. Bodies can be depressed, too. If you have a condition like diabetes or multiple sclerosis, you may well experience the bodily changes that go along with depression, such as having less energy.

So what is depression exactly?
Why should you care if you are officially “depressed” or not? I think it helps to understand what is going on inside you. If you’re depressed and don’t know it, you might not make useful changes or get needed help. If you think you’re depressed and you’re not, you might spend time and effort barking up the wrong tree.

Three things often confused with depression are distress, despair, and grief. People distressed about diabetes or some other life situation (such as money) will often develop symptoms of depression. When the distress is relieved (with better self-management, social support, or reduced expenses,) their so-called “depression” lifts.

People can have despair, meaning they have no hope that things will ever get better. My friend Trina wanted to kill herself because she was in so much pain from a degenerating spine. It kept her from doing anything except staying inside and suffering. Doctors wanted to treat her for depression, but she wasn’t depressed. When a new treatment came out that partially healed her back, her suicidal wishes went away.

People can also be in despair about things in the world, such as global warming. There is no treatment for this, but doing something about what’s causing the despair makes us feel less helpless.

Extreme sadness, called grief, is a normal response to loss, like the death of a loved one or the amputation of a limb. After such a loss, a person will be sad, will need to cry, and will need support, but this is not depression. Grief normally eases up over time, but if it goes on too long, brain chemistry can change it into depression.

If you’re depressed, then what?
If you know you are depressed, or you show up depressed on a test like this one-minute online screening, what can you do? You can seek help from a therapist, counselor, or friend, or you can see a doctor about medicines. And you can self-manage it.

The most important form of self-management is exercise. According to author Carol Lynne,

Exercise may…boost feel-good chemicals like endorphins, release muscle tension, help you sleep better and reduce levels of the stress hormone cortisol… All of these changes in your mind and body can improve such symptoms as sadness, anxiety, irritability, stress, fatigue, anger, self-doubt and hopelessness.

Other important self-management strategies include getting into the sunshine and having pleasant social contacts, which can include neighbors, friends, family, coworkers, or a support group. It’s also good to self-monitor by retaking a depression screening every once in a while to see if you’re getting better or worse.

I might write about this more soon; it depends how I’m doing with my own depression, if that’s what it is. Today I started walking more and went to lunch with some neighbors. I already feel better than when I started writing this article.

Please consider if you might be depressed or heading that way. If you are, do something about it, including getting some help.

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