Looking forward to the Holiday Season?! Me too! Looking forward to all the personal questions?! Me neither!!!
For most of us the holidays are a season in which we spend LOTS of quality time with friends and family, most of whom you haven’t seen in quite a while. Questions about your life are inevitable. Therefore, it might be useful to have some ideas or talking points in mind about how to approach the difficult topic of depression and answer some of the most common questions.
It can go something like this:
Q: Glass of wine?
A: I’m not drinking right now, thanks.
Q: Why?
A: Oh, because I’m taking medication…
[awkward pause]
Q: What kind of medication?
A: Antidepressants
“Aren’t we all sad or depressed at some point in our lives?”
Looking at it from a psychological point of view, sadness and depression are ABSOLUTELY different things. It is very important that we learn the distinction between the two terms and stop using them as synonyms.
Sadness is a normal human emotion that we all experience many times throughout our lives and is generally caused by a difficult experience or situation. In other words, we tend to feel sad about something.
Depression, on the other hand, is “an abnormal emotional state, a mental illness that affects our thinking, emotions, perceptions, and behaviors in pervasive and chronic ways” [1]. When someone is depressed, that person might feel sad and/or uninterested towards everything.
Depression does not necessarily require a difficult event, situation, or loss as a trigger. In fact, it often occurs in the absence of any such triggers. A depressed person’s life might seem to be fine and yet they still feel horrible.
A helpful analogy to fundamentally answer this question would be hunger: we experience it several times a day as a normal bodily function (sadness), but in its extreme version (depression) it becomes starvation, which can kill its victims.
“So then… what does it really mean to be depressed?”
A depressive disorder is an illness that involves the body, mood, and thoughts. It interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her. Doctors call this condition “depressive disorder,” or “clinical depression.” [2]
People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years.
In the words of Andrew Solomon [7],
“Illness of the mind is real illness. It can have severe effects on the body […] As organs go, the brain is quite an important one, and its malfunctions should be addressed accordingly.”
“Why take medication? Do you really have to?”
People with mental health problems are among the most vulnerable in society— depression is the most common form of disability in the world today. There is now strong evidence that mental illness is just as threatening to life expectancy as other public health threats such as smoking. [3]
Part of what is contributing to the proliferation of this epidemic seems to be the stigma surrounding mental health. Therefore, it is critical that people realize that depression is a common but serious illness and most of those who suffer from it need treatment (which does not necessarily mean medication) to get better. [4]
In my case, for example, I tried meditating, exercising, changes in diet, positive affirmations, visualization, homeopathy, therapy (to name a few) before deciding that I needed medication. It was not a decision I took lightly. Many of these methods can and often do help people with depression; but every person is different.
“Ok. So now it sounds really serious…
What are the symptoms?”
Diagnosis is as complex as the illness and should always be done by a professional. However, a person needs to experience five or more of these symptoms, for at least two weeks continuously, in order to be diagnosed.[5]
Loss of interest or loss of pleasure in all activities
Change in appetite or weight
Sleep disturbances
Feeling agitated or feeling slowed down
Fatigue
Feelings of low self worth, guilt or shortcomings
Difficulty concentrating or making decisions
Suicidal thoughts or intentions
Furthermore, if the depression is disabling, it needs to be treated immediately. If it’s only mildly distracting, it’s not as severe.
“Why are YOU depressed? What caused it?”
There is no single known cause of depression. Rather, it likely results from a combination of genetic, biochemical, environmental, and psychological factors.
Research indicates that depressive illnesses are disorders of the brain. Brain-imaging technologies, such as magnetic resonance imaging (MRI), have revealed that the brains of people who have depression look different than those of people without depression. The parts of the brain responsible for regulating sleep, appetite, thinking, mood, and behavior appear to function abnormally. Additionally, important neurotransmitters—chemicals that brain cells use to communicate—appear to be out of balance. But these MRI images do not tell us why this occurs. [6]
You take a breath and realize Enya’s Christmas Album has almost played through and everyone is kind of fidgety for desert— its time to bring your Depression 101 class to a riveting close with these highlights;
BASICALLY:
Depression is not a decision, a choice or an attitude, it isn’t laziness or weakness, and it is definitely not normal or ordinary.
Being treated for depression doesn’t mean that I don’t ever want to feel sad/unhappy, that I want to numb out my feelings or that I’m expecting to always feel OK & live happily ever after. I am aware that life can sometimes be difficult, painful and full of challenges.
What I do believe is that some forms of pain & suffering [like breaking a leg] should not have to be endured if they can be treated and eventually overcome.
By talking about depression we are attempting to eliminate the stigma associated with mental illness and therefore the dangers/risk that it posses for many individuals.
Ideally, at the end they will thank you for sharing, compliment you on your capacity to articulate such a complex subject and move on to desert and presents. Maybe tomorrow we can tackle anxiety over leftovers.
Need help now?
Call the 24-hour, toll-free confidential National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or go to www.suicidepreventionlifeline.org.
[Disclaimer: Even though it’s fundamental that we differentiate between sadness and depression, we are by no means minimizing other forms of emotional pain. Of course there are some terrible experiences of sorrow and grief such as heartbreak, loss of a loved one, disappointment, betrayal, among many others. But in those cases grief is in proportion to circumstance, while depression is grief out of proportion to circumstance.]
References:
[1] https://www.psychologytoday.com/blog/the-squeaky-wheel/201510/the-important-difference-between-sadness-and-depression
[2] https://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know-12-2015/index.shtml
[3] http://www.ox.ac.uk/news/2014-05-23-many-mental-illnesses-reduce-life-expectancy-more-heavy-smoking
[4] https://www.psychologytoday.com/conditions/depressive-disorders
[5] https://www.nami.org/Learn-More/Mental-Health-Conditions/Depression#sthash.aV97ZD4Y.dpuf
[6] https://www.psychologytoday.com/conditions/depressive-disorders
[7] The Noonday Demon