Depression: What it Is and How to Beat it

What is depression? How is it different than Sadness or Unhappiness?

Depression is no just sadness or unhappiness, neither is it a normal reaction of grief. However, these are the three states with which most people confuse them.

• Sadness is a normal, temporary state, that we all experience once in a while.
• Unhappiness may present with sadness. But, more often than not, it is a chronic (or temporary) state of frustration and dissatisfaction with life.
• Grief is a normal reaction. It is feeling sad and bereaved for a longer period of time (a few months to a few years) after you lost someone you love.
• “Clinical depression” is a disorder of the mind and is never normal. You are in a state of depression if you feel sad, have low energy, cry often, have unexplained physical symptoms, experience bodily aches and pains, can’t feel good no matter what, and see no hope in your life circumstances.

The Impact of depression on individuals and society

Depression is the second most common mental health disorder in the United States and around the world–only behind anxiety disorders in frequency.  Depression is a condition that is growing rapidly in numbers. Today major depression is the most common form of disability worldwide.  In short, depression has become “the common cold” in XXI’s century psychiatry.

At this point in time—because of the COVID19 pandemic and its massive economic and psychological effects–depression has reached epidemic proportions in the US and around the world.  The COVID19 pandemic has put the last nail on the coffin of an already “depressed world” multiplying the number of cases and their severity manifold.  The true numbers for depression reflecting today’s situation are still unknown; but they are much higher than the older official statistical ones I will present below.

The different types of depression

First of all, I have to make a small introduction here to help you understand the different forms of depression and the levels of severity of the condition. A first useful consideration is to divide depressions in two major forms:

• Unipolar depression
• Bipolar depression (may have only manic episodes or alternate depression with manic states).

“Unipolar” depression means you only get depressive episodes. Just one pole of mood is altered: the down one. “Bipolar” depression, on the other hand, means that you get manic or hypomanic episodes interspersed with the depressive ones.  The term “Bipolar” means that, in the long term, you will experience either extreme of the poles of mood: Depression or Mania (Which is the exaltation of mood to abnormal levels). 

Keep in mind that Unipolar depressions are much more common than Bipolar ones. It is vital to understand the differences between these two illnesses as they have different severity, course, genetics, family history, and prognosis.

Depression and suicide risk

Overall, bipolar disorders are more severe than unipolar ones and they lead more frequently to suicide. Up to 15 percent of people who suffer from Bipolar wind up committing suicide.  While only 10 percent of people with unipolar depression die by their own hands.  Death in major depression is highly associated with suicide.  And Major Depression is the major cause of suicide in the US and around the world.

Another useful distinction: Typical versus Atypical depression

1- “Typical depression” is more common in older people. It presents with loss of appetite, weight loss, and insomnia. This form is more common in males.

2-“Atypical depression” is today the most common form of depression. It presents with increased appetite, weight gain, and excessive sleep. This form is more common in females. It is associated with weight issues, low self-esteem issues, and high sensitivity to rejection.

Depression in terms of severity

Depression is divided in “Major Depression,” which is the definition of clinical depression given by the DSM 5 (The Diagnostic and Statistical Manual of The American Psychiatry Association, 5^th Edition). And the so-called “minor depressions.” The latter include the mild to moderate depressions that are not severe enough to meet criteria for major depression. 

In the DSM 5, the only diagnosis that represents this group is the so-called Persistent Depressive Disorder (which used to be called “Dysthymia” before). This other form of depression is less severe than major depression, but is also more prolonged in time.  This chronic depressive state must last at least 2 years to meet the criteria for the diagnosis. This condition used to be known before as “depressive personality.”

How do you know if you are depressed?

Let’s first look at the symptoms required by the DSM 5 to meet criteria for a major depressive episode diagnosis. I will modify the criteria by putting them in five groups of symptoms in different realms:

1 Physical, organic, or “neurovegetative” (such as changes in appetite, weight, sleep, and energy levels). These symptoms may be accompanied by bodily aches and pains. These are the symptoms you experience in your body.

2-Affective, mood, or emotional symptoms: Depressed mood (feeling sad, empty, hopeless, or having frequent crying spells). Be aware of the fact that in children and adolescents, it may manifest with irritable mood.

3- Hedonic symptoms: A marked decreased in interest–or in pleasure–in all–or almost all–activities that used to give you pleasure before. This symptom is called “anhedonia” which is the inability to enjoy.

4-Cognitive symptoms (or those you experience in your thoughts, and not just in your body or in your emotions). “Cognitive functions” are attention, concentration, memory, and decision-making. (The last one known as part of the Executive functions). These superior frontal lobe functions are all affected in a state of major depression. The problems in this area of cognition leads many people and clinicians to erroneously give people a diagnosis of Attention Deficit Disorder (ADHD).

5-Functional symptoms: you find that you cannot carry out the tasks you were able to when you were not depressed. If you do them, they are carried out with low efficiency, you do them with great effort, or it feels “like a chore” doing them.

You have to have at least 5 of the following symptoms present during at least two weeks in a row. The main two symptoms to clinch the diagnosis are:

1-Depressed Mood

2- Inability to experience pleasure.

These are usually accompanied by other symptoms such as:

• Weight and appetite changes.
• Your appetite and weight go down in some depressions and up in other types
• These changes are associated with other physical symptoms, such as insomnia or hypersomnia (excessive daytime sleeping); psychomotor retardation (being too slow in your movements); agitation (being extremely restless due to anxiety); feeling lack of energy; and feelings of fatigue and exhaustion.

At the psychological level you may feel:

1. You experience dark, negative thoughts, most of the time that you can’t shake off. There may be feelings of hopelessness, helplessness, and of the end of the world. There is no light at the end of the tunnel for you.

The “Time Requirement” for the diagnosis in the DSM5

The DSM5 requires that these symptoms last over 2 weeks and they be severe enough to interfere with your normal day-to-day functioning. 

Always see your general doctor first. Since, to arrive at this diagnosis, a medical exam must rule out other medical conditions that may resemble depression.

The effects of the COVID19 pandemic on depression

Because of the effects of the COVID19 pandemic many people are more depressed than ever before. Causes of depression during the pandemic are:

• losing our health or our loved ones
• losing jobs and health insurance
• Being deprived of our freedoms and places to go
• homelessness and the economic depression
• Dealing with social distancing and lockdowns.
• As a result of this barrage of negative events caused by the COVID19 pandemic, depressive states have skyrocketed in the last 10 months.

Bereavement, isolation, loss of income, uncertainty–and fear–are triggering new mental health conditions or exacerbating existing ones.  Many people may be facing increased levels of alcohol and drug use. They may also experience insomnia and anxiety. Needless to say, the excessive use of alcohol and or drugs to self-treat greatly contribute to making depression and suicidality much worse.

The direct effect of the viral infection on our brains

COVID-19 often infects the brain. The virus in itself can lead to neurological and mental complications, such as delirium (mental confusion), agitation, and stroke.  COVID19 can make people feel tired for weeks, if not months after recovering. 

People with pre-existing mental, neurological, or substance use disorders are also more vulnerable to the COVID19 infection.  They may stand a higher risk of severe outcomes and even death.

Depression is the malady of our times. 

This is evidenced by the following facts:

• More than 264 million people suffer from depression worldwide. (World Health Organization, 2020)
• Depression is the leading cause of disability in the world. (World Health Organization, 2020)
• Neuropsychiatric disorders are the leading cause of disability in the U.S. with major depressive disorder being the most common. (National Institute of Mental Health, 2013)
• An estimated 17.3 million adults in the United States had at least one major depressive episode. 
• This number represented 7.1% of all U.S. adults (or some 28 million people in 2020).

How depression affects different populations:

How depression affects the genders:

Major depression is more common in women (8.7%) compared to men (5.3%). The condition is twice as common in them. (National Institute of Mental Health, 2013) . This is true for unipolar depressions.

The frequency of bipolar disorder is about the same for both genders: males (2.9%) and females (2.8%).  While an estimated 4.4% of U.S. adults experience bipolar disorder at some time in their lives.  

The increasing high frequency of Bipolar Depression

There are huge numbers of people diagnosed as “bipolar” these days.  Not all of them are true “Bipolars” though. (this differential will be the subject of a future post on this matter). And bipolar disorder is a diagnosis that has become much more popular in US clinical settings in the last 30 years. This is so to the point that it has been diagnosed not only on adolescents but in prepubertal children. To give an idea of this change in prevalence in Bipolar disorder, we see that the frequency of bipolar disorder was estimated at 1.2 percent of the population in the late 1980s. It has doubled in only 40 years.

What to take home from this fist post:

This initial post on the series on mood and depression is geared towards you becoming aware of depression–both in its unipolar and bipolar forms.  And to understand the difference between depression, sadness, unhappiness, and a normal grief reaction.

Keep the following tips in mind:

• It is important you check yourself–and others in your family–for the presence of these symptoms of depression.
• If your symptoms are severe enough, consult with your doctor immediately. 
• The treatment of medication in common circumstances is a combination of psychotherapy (most commonly used is CBT) and antidepressant medications. 

I will address the specifics of these forms of treatment in future posts.

If you liked or benefited from the content of this post, let others know by giving it a “Like it.” As always, feel free to ask a question or leave a comment below. If you are interested in mental health matters, sign up to this blog free of charge by entering your email address below after pressing “like it.” I hope to see you in my next post.  Till then, stay safe and sound. Have a peaceful holiday season,

Dr T