05 December 2006

Being Sad vs. Depression -- What's the Difference?

Over the past few months, in dealing with my depression, I've noticed something that's both disturbing and annoying. When I tell people -- especially my friends and acquaintances -- that I have depression, they really don't understand what I'm talking about. I put most of the blame for this on the English language, itself.

You see, "depression" is a synonym for "sadness," the meaning of which is related to "being sad." However, having depression is much, much more than "just" being sad or being in a state of sadness. In searching for definitions of these words, the meanings themselves become convoluted and twisted, intertwining different aspects of the different definitions together. Let's take a look:

The American Heritage Dictionary of the English Language, Fourth Edition, defines depression as
    1. The act of depressing.
    2. The condition of being depressed.
which then goes on to define "depressed" as
  1. To lower in spirits; deject.
Now let's switch for a minute to the definition of "sad" (sadness):
  1. Affected or characterized by sorrow or unhappiness.
  2. Expressive of sorrow or unhappiness.
  3. Causing sorrow or gloom; depressing: a sad movie; sad news.
  4. Deplorable; sorry: a sad state of affairs; a sad excuse.
  5. Dark-hued; somber.
As can be seen, the third definition for "sadness" is "depressing," which is defined as "to lower in spirits; deject." So in essence, sadness and depressed are one and the same, which is why it gets very, very confusing when talking about depression, because depression, although remotely related to sadness, is much, much more than merely having one's spirits lowered or dejected. As Wikipedia goes on to explain,
This is quite distinct from the medical diagnosis of clinical depression. However, if depressed mood lasts at least two weeks, and is accompanied by other symptoms that interfere with daily living, it may be seen as a symptom of clinical depression, dysthymia or some other diagnosable mental illness, or alternatively as sub-syndromal depression.

In the field of psychiatry, the word depression can also have this meaning of low mood but more specifically refers to a mental illness when it has reached a severity and duration to warrant a diagnosis, whether there is an obvious situational cause or not; see Clinical depression. The Diagnostic and Statistical Manual of Mental Disorders (DSM) states that a depressed mood is often reported as being: "... depressed, sad, hopeless, discouraged, or 'down in the dumps'." In a clinical setting, a depressed mood can be something a patient reports (a symptom), or something a clinician observes (a sign), or both.

Are we confused yet? Let's try some other definitions out there. The National Alliance of Mental Illness has this to say about depression:
Major depression is a serious medical illness affecting 15 million American adults, or approximately 5 to 8 percent of the adult population in a given year. Unlike normal emotional experiences of sadness, loss, or passing mood states, major depression is persistent and can significantly interfere with an individualÂ’s thoughts, behavior, mood, activity, and physical health. Among all medical illnesses, major depression is the leading cause of disability in the U.S. and many other developed countries.
And in their fact sheet publication entitled Understanding Major Depression and Recovery (PDF), they restate the definition in somewhat simpler terms:
Major depression is a mood state that goes well beyond temporarily feeling sad or blue. It is a serious medical illness that affects oneÂ’s thoughts, feelings, behavior, mood, and physical health.
About.com further explains the differences between beindepresseded and having depression:
Although depression is often thought of a being an extreme state of sadness, there is a vast difference between clinical depression and sadness. Sadness is a part of being human, a natural reaction to painful circumstances. All of us will experience sadness at some point in our lives. Depression, however, is a physical illness with many more symptoms than an unhappy mood.
Now, here's where I find their response to become quite interesting and meaningful to me:
The person with clinical depression finds that there is not always a logical reason for his dark feelings. Exhortations from well-meaning friends and family for him to "snap out of it" provide only frustration[,] for he can no more "snap out of it" than the diabetic can will his pancreas to produce more insulin. [Emphasis supplied.]
I can't tell you how many times I've had people -- including friends and even some healthcare workers in the mental health field, tell me that I just need to "snap out of it." Depression the illness (as opposed to depression the feeling) is not something that you choose or have much control over (untreated), just as in all other illnesses. I think that that's one of the key points that really needs to be stressed about Depression: it's an illness. Just because it's a illness doesn't mean that it is any less of an illness as, e.g., cancer, heart disease, or Alzheimer's. The only differencbetweenen Depression and the other diseases is that the part of the body that's affected is the human brain.

In other words, people who say "that depression is 'just the blues' or worse a 'made-up disease'" are in reality "obscur[ing] the real facts about a debilitating and potentially deadly medical condition." Depression Is Real -- it's a real illness, not something that's made up. It's not me being lazy. It's not something that I can just snap out of. Like most other diseases where treatments are available, there are symptoms and guidelines for diagnosis, which include
  • Persistent sad, anxious, or "empty" mood
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
  • Decreased energy, fatigue, being "slowed down"
  • Difficulty concentrating, remembering, making decisions
  • Insomnia, early-morning awakening, or oversleeping
  • Appetite and/or weight loss or overeating and weight gain
  • Thoughts of death or suicidesuicidede attempts
  • Restlessness, irritability
  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
About.com has an on-line screening test for depression. I took it. Here are my answers to the questions, as they as them:
  1. Yes, sad and irritable at times.
  2. Yes, there are very few activities that I now enjoy, even if I can perform the same activities as before my accident, I don't receive a sense of joy or pleasure from them.
  3. Yes, my weight has gone up and down a lot lately, and my appetite has decreased, except that one of my medications has caused mappetitete to increase dramatically.
  4. Yes, I've either been sleeping too much (20 hours a day) or not enough (3 hours a day).
  5. Yes, I feel guilty for being alive. I survived 9/11, and then a horrendous automobile accident.
  6. Yes, my concentration and memory are horrible. I've been working on this entry for the past eight hours now, and I have all of the information in front of my fingertips on the computer screen, but I'm still having difficulty pulling it all together.
  7. Yes, my energy level is horrendous. Most days I don't even want to get out of bed. And this is where people think I'm just being lazy because I lie around all day. It's not that I want
  8. to lie around all day, it's literally because I can't gather up the energy to move about. It gets so bad at times that I have had a conversation with myself as to whether or not I can get up to go to the bathroom or whether I should just urinate on myself, because I literally don't have the energy to get out of bed to walk the ten feet over to the bathroom and relieve myself.
  9. Yes, others have asked me what's wrong because I appear to be restless, or lethargic.
  10. I don't feel completely worthless, as I do know that I have some capabilities, but nothing like before my accident. So I do feel worthless, for the most part, but not completely. As for hope, there's no hope in life anymore. Why do I even want to continue living in this world? It's not going to change, and things are just going to get worse.
  11. Yes, I've had thoughts of suicide and death. I've had plans, and when I start making plans to kill myself I put myself into the hospital. Right now, I'm not thinking of killing myself, but I am thinking that I wish I could just die. I mean, I wish there was some sort of thought process that we, as humans, could transverse which, when performed in a certain ritualistic way, would cause our immediate and sudden death. Kind of like a self-destruct mechanism or something along those lines.
So that's ten out of ten questions that I answered affirmatively, and according to the site, answering a mere half of the ten questions in the affirmative could result in a diagnosis of clinical depression. Not that there really was any doubt about it, of course.

But my point is that having depression is something very real, and it goes way beyond mere feelings. I know I have a lot more to say about it, but I need to take a break. So I'll write more later. And I'll probably edit this over the next few days, as well, to clean up my writing and throw in a few more links. But if you're one of my friend's who's concerned about me, instead of telling me to snap out of it, maybe you could be a bit more understanding, and read up on some of the resources I've outlined above. CBS also has a list of some resources for depression on their web site.

There are some great tips on how to deal with people you care about who have been diagnosed with depression. The site is geared toward children with depression, but I believe that what they have to say is more universal in nature:

What Can I Do to Help?

Most parents think that it's their job to ensure the happiness of their child. When your child's depressed, you may feel guilty because you can't cheer him or her up. You also may think that your child is suffering because of something you did or didn't do. This isn't true. If you're struggling with guilt, frustration, or anger, you may want to consider counseling for yourself. In the long run, this can only help both you and your child.

Other ways to help:

  • Make sure your child takes any prescribed medicines and encourage healthy eating too, as this may help improve your childÂ’s mood and outlook.
  • Make sure your child stays active. Physical activity has been shown to help alleviate the symptoms of depression. Incorporate physical activities, such as bike rides or walks, into your family's routine.
  • Say that you're there, that you love and care about your child and want to hear what he or she has to say, even if it isn't pleasant. Although these things may be difficult for your child to believe, it's important for you to say them. Eventually, they'll be acknowledged.
  • Accept the situation and never tell your child to "snap out of it." Remind yourself that it isn't laziness causing your child's inability to get out of bed, complete chores, or do homework. He or she simply doesn't have the desire or the energy.
  • Keep up treatment for your child and watch for warning signs. Make sure the prescribed treatment is followed, whether itÂ’s medication, therapy, or both. Call the doctor if you see signs that your child may be thinking about suicide because untreated depression is the top cause of suicide. If your child talks about suicide, to you or anyone else, or shows warning signs such as giving belongings away and being preoccupied with death, call your child's doctor or mental health professional immediately.
And now, I'll leave you with these true stories of famous people who have been diagnosed with depression, until I can get up enough energy again to continue this posting.