Sunday, 7 June 2015

What is depression in normal language?

Why would I write an article on depression?  After all, doesn't everyone know what it is and if you don't, can you not just google it?  I decided to write an article about depression because so many of my clients have told me how frustrated they are that close friends and relatives do not seem to understand what they are going through.  Somehow, the clinical descriptions do not do it justice so I figured I would give it a shot using language everyone can relate to.

Too often, people make the mistake of thinking that depression is about feeling sad.  As one of my clients so succinctly put it: "People did not seem to understand.  I was not sad.  When I got depressed, it was more like someone turned a switch, the lights went out and I simply could not function.  I had no energy, no motivation and nothing seemed to matter anymore".   Another client described it this way:  "Being depressed is a lot less about sadness and a lot more about feeling oppressed, trapped, and cornered without any hope of getting out". The word depression is so often used colloquially to mean just feeling down.  As a result, many people who come to my office depressed do not realize what's happening or don't identify themselves as being depressed. Part of it is that clinical depression is much more than just feeling blue but also the nature of the beast of depression is that when you are in it, you may feel so numbed or in the pit, that you don't realize what is happening to you.  As they say, sometimes you do not know you are in darkness until the sun starts shining again!

When I have diagnosed people as depressed, some clients have said: "The notion that I was depressed, never occurred to me.  It was not as if I couldn't get up in the morning". These people have often had a parent or relative who were so compromised with depression that they could not function at all and this then became their idea of what depression looked like.   However, you do not have to be completely unable to mobilize in order to be diagnosed with clinical depression. You may still be able to function at your job or take care of your kids though not at optimal capacity.  Aspects of day-to-day functioning do become impaired.  Basics such as sleep, energy or appetite are often out of balance in some way.  While depression can show itself differently in different people, one of the surest signs of depression is a lack of energy and loss of interest in things that ordinarily have been stimulating and satisfying in the past.  Energy is so low that getting through a day may feel like walking through mud from the waist down. People who are depressed invariably withdraw from those around them because they are too preoccupied; they don't have the energy to give to others; or simply feel so negative that they know they would not be good company.

There are big individual differences in how people experience depression.  Some people become highly anxious when depressed even to the point of having panic attacks (often referred to as "agitated depression") while others may not experience much anxiety at all.  Some people experience strong bodily symptoms such as headaches, stomach upset and aches and pains. Men often show depression differently than women. Socialization plays a role in how depression manifests itself. There is more permission in our society for women to cry so they are more likely to become teary while men are more likely to become irritable and angry.  Both genders usually find themselves far more emotionally reactive and less in control of their emotions than they would like. What some people do not realize is that clinical depression not only effects the body, behavior and mood but also thinking. When depressed, you may have problems concentrating; you may forget things easily and become easily preoccupied and distracted.  Even processing information and fully registering what someone is saying may be difficult. Attention is turned inward and thinking often becomes obsessive; thoughts can spiral into repetitive endless loop tapes.  Needless to say, when you are depressed, it is hard to be present.

Depression can be brought on by a negative life event (sometimes referred to as "situational depression").  More insidious and hard to identify is when it is brought on by an accumulation of stress over time.  People with a biochemical tendency to depression may not be able to pinpoint any external stimulus at all that brought it on.  Becoming unstuck is not an overnight affair and often takes considerably longer than people realize.  It can take a year before you feel like yourself again. One of the things that we know for sure is that if your symptoms are serious enough to warrant medication, then for long term success, it is very important to do therapy as well.  This makes sense as the medication may be able to re-calibrate your biochemistry but it will not help you to find out why you feel in such despair nor will it help you to learn better coping skills.

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