After interviewing and counseling with hundreds of clients and their families over the last 15 years, one of the most common questions that I have received concerns confusion about the difference between sadness and depression. My experience has been that Clinical Depression (sometimes called Major Depression) and other forms of depression are widely misunderstood, even in a modern age where mental health treatment is slowly becoming more accepted. It’s difficult for many people who have not experienced depression to understand that the feelings of sadness that we all experience at various points in our lives as human beings are not necessarily the same as a person with clinical depression. We will all feel “sad” at one point in our life or another, but most of us will not experience “clinical depression.”
So how do we know the difference? The best example that has always come to mind for me is Charlie Brown in The Peanuts cartoons. I remember when I was watching the Charlie Brown Christmas episode with my children, after not seeing it since childhood, and realizing, “Charlie Brown is clinically depressed!!” He speaks numerous times during the show about wanting to kill himself and always seems to have a dark cloud raining on him even when it is sunny out for everyone else. After meeting with many clients about their experiences of depression, the image of having a dark cloud following you around on what should and would be a beautiful sunny day is exactly what I envision when I think of what depression is like.
Sadness is more fleeting and when a situation in a person’s life gets better, or as time passes, the person begins feeling better. With depression, even when an individual's situation begins to improve (if there even is a stressor at all), he or she still may not begin to feel better. In fact, they typically feel worse and worse over time despite any improvements in their lives. Major Depression as defined by the DSM-5 (the manual used by doctors and mental health professional to diagnoses mental health disorders) as a person having 5 of the following symptoms for at least 2 weeks “nearly every day.” The symptoms include feeling depressed, having loss of interest/motivation, decrease or increase in appetite, sleeping too much or too little, loss of energy, feeling restless or slowed down, feelings of worthless or guilt, difficulty concentrating, recurring thoughts of death –either wishing to die, fear of dying, or passive or active suicidal thoughts. Along with at least 5 of the above symptoms, they must also have significant impairment or decrease in functioning in one or more areas of their life and the mood should not be caused by substance abuse, medications, general medical conditions, or grief less than 2 months old.
One of the most difficult things to understand about depression is that there also does not necessarily have to be a stressful event or trigger at all for someone with clinical depression to feel depressed. I have had countless clients tell me that they have no reason to be “depressed” and yet they still are.
This is still more evidence that depression most certainly has a true biological root with the specific chemicals that regulate our mood internally. Maybe this is why depression is so hard to wrap our minds around, because unlike a physical cut that we can see and put a band-aid on to heal instantly, most people can not “see” depression because the wound is internal and may come out in unpredictable emotions, not in a blood test or in an x-ray. Persons with depression also often become very skilled at masking how they are really feeling around others so they may not often appear outwardly depressed to others, even those closest to them.
So then when do you know when to get help? Well, certainly all situations that may be causing discomfort whether they involve grief or another loss, various life transitions, marital issues, conflicts with families or other loved ones, and more, then counseling can be effective and beneficial. However, when your mood begins affecting your ability to function well in your life, whether at work or home, then intervention is most definitely needed. If diagnosed with some form of depression, medication and/or counseling may be recommended by your doctor. For moderate to severe depression, medication treatments in addition to counseling have been consistently proven to be the most effective combination.
The bottom line is that we all need to pay attention to our own body’s signals. If you don’t feel like yourself and are having difficulty functioning in some way or another then please do not ignore it. Depression as well as a variety of mental health diagnoses such as Bipolar Disorder and Anxiety Disorders, just to name a few, are highly treatable and the vast majority of people can live happy, healthy, and productive lives.