What is Clinical Depression?
Many people suppose that depression is simply a feeling of overwhelming sadness. If someone has a terrible week, they might say, “I was so depressed.” But what they really mean is “I was very sad.” What doctors mean by the word depression is not the same as the common usage of the term. But if sadness is confused with depression, it is also true that genuine depression is often overlooked entirely.
I have spoken to many people who have suffered from depression for many months or even years, but they don’t think of it as depression. Why? Depression is a beast unlike the sadness that naturally comes from disappointment. Depression can morph into anger or numbness.
It is an animal that lands on our shoulders and takes up residence. Sadness, on the other hand, is more like a bird that lands on our shoulder, but soon flies away. If sadness doesn’t fly away, it can become part of a clinical depression or even cause it. Sadness does not lead into clinical depression until it:
(1) lasts for several days (e.g., 2 weeks) and
(2) becomes disruptive to your life (relationships, work, or school).
To make things more complicated, a person can be clinically depressed without feeling particularly sad. How can this be?
Everyone experiences mood changes as a part of living life. Good things happen. Bad things happen. But depression involves a cluster of symptoms of which sadness is only one. Pouring rain is not a flash flood, but it is part of the combination of factors that produce a flash flood. Depression is usually defined as a constellation of any five of the following symptoms that persist for 2 weeks:
- Sad mood most of the day, nearly every day
- Noticeable loss of interest or pleasure in nearly all activities most of every day
- Significant change in weight not due to dieting (weight gain or loss of more than 5% of body weight in a month)
- Sleep problems nearly every day (excessive sleeping or insomnia)
- Agitation (irritable attitude and physical tension) or marked slowing of one’s thoughts and actions (e.g., much more difficulty getting started on something than usual)
- Fatigue or loss of energy every day
- Feelings of worthlessness or excessive (or inappropriate) guilt nearly every day
- Diminished ability to think or concentrate or indecisiveness, nearly every day
- Recurrent thoughts of death (not just fear of dying), recurring thoughts about suicide, or a suicidal gesture (deliberate carelessness in dangerous situations) or an attempt, or specific plans.
Most people have experienced one or more of the above symptoms at some time in their lives. But when five or more of them combine and take hold, they can cause agonizing distress and can disrupt one’s ability to function well at work, at school, or socially. When this happens the depression is considered “clinical” because it is tenacious enough to need some type of treatment. If a person is having thoughts about death that keep returning, this is almost certainly an indicator of clinical depression, whether or not the person can recognize any other symptoms.
As you can see, a person may or may not feel sadness as their main symptom. The cluster of symptoms, and not any one of them, is what makes a person begin to see the impact on his or her life. When we have normal, everyday sadness or the blues, our brain bounces back. With clinical depression, our brain starts working in a different way and gets stuck there.
What is Anxiety?
I will write more about anxiety in other articles, but for now we need a way of remembering the contrast between depression and anxiety. They are both awful to experience, but they each have their own kind of awefulness. Anxiety revs up the engine of our body making us feel vulnerable to danger. It puts us on high alert. Depression, on the other hand, makes are engine idle even when we try to step on the gas pedal (i.e., try to motivate ourselves). It makes us feel vulnerable to stress.
Does Anxiety Cause Depression or Does Depression Cause Anxiety?
The answer to this is simply, "yes." When we feel depressed we feel less able to cope and this makes us anxious about things that might not bother us if we weren't depressed. If we start out in the grips of an anxiety disorder, it can easily cause depression by restricting a person's life to the point that feel shut out from the normal flow of life.
This is why depression and anxiety help are best sought together. They are not the same, but they often march into a person's life holding hands with each other.
