What, exactly, is depression?

We hear the word "depressed" thrown around frequently these days, applied to many situations that may or may not relate to true depression. We also hear terms like "clinically depressed," "major depression," or simply "depression" when describing mood diagnoses. This post will break down how to differentiate between situational sadness, typical mood fluctuations, and the mood disorder known as Major Depressive Disorder. 

It is a normal and expected part of life to have ups and downs in mood. To feel sad when disappointed by someone, to be burdened by grief after a major loss, to feel frustrated and angry at a boss, to feel defeated when getting a low grade on an exam; these are typical human reactions to life's many stressors. As Buddha said, life is suffering. So, we can expect those fluctuations within our days and weeks. 

However, a persistent low mood can reflect something beyond situational sadness. This is the point at which we look at the possibility of a Major Depressive Disorder (MDD), which is how depression is currently diagnosed. To be diagnosed with MDD, you must meet at least five of the following criteria:

• Depressed or irritable mood most of the time
• Loss or decrease in pleasure for most activities, including ones that used to give joy
• Significant change in weight or appetite
• Sleep disturbance (too much/too little)
• Feeling either restless or slowed down in moving
• Energy depletion - feeling tired, fatigued
• Feeling worthless or excessive guilt
• Struggling with thinking clearly, making decisions, focusing, concentrating
• Having thoughts of death or suicide
  
  

Now that we've covered primary symptoms, let's look at the key differences between situational sadness and MDD:

• Cause: Typical fluctuations with low mood are situational; that is, you feel sad/down/angry about something. MDD often feels like low mood with no real cause or trigger. 
• Pervasiveness: MDD symptoms must persist continuously for at least two weeks to qualify for the diagnosis, whereas situational sadness comes and goes with gaps of normal or positive mood in between. 
• Energy: Although not true for everyone, many clients who struggle with MDD describe their depression more as a sapping of energy than feeling sad or weepy. It can feel as though all of your vitality has drained from your body and mind, the world has lost its color, and you are running on a gas tank on E. Situational sadness can also be tiring, but typically the sad feeling dominates over feeling depleted. 
• Impairment: For most struggling with situational sadness, maintaining key areas of functioning generally is not a major issue. Keeping up with work, household responsibilities, and important relationships are not compromised in a significant way. However, those with MDD often experience impairment in their functioning to different degrees. It can look like withdrawing or avoiding contact with family and friends, taking excess days off from work, being unable to get out of bed to take care of responsibilities, or falling behind in school.

If you or someone you know seems to be struggling with MDD, it is important to seek help. Untreated MDD can spiral into more severe symptoms, greater impairment in functioning, and increased risk of suicide. Psychotherapy is great resource to manage symptoms depression. Others utilize medication, which is most effective when combined with psychotherapy. There are also exciting new treatments on the rise, including Repetitive Transcranial Magnetic Stimulation (rTMS) and physician-administered psychoactive drugs, such as Ketamine, that are being implemented for treatment-resistant cases of MDD. 

Here's to a brighter future and better treatment for MDD. Thanks for reading!