Alan Prosser
As adults, feeling a little “off colour”, feeling a little “blue”, is a normal part of life, something we are all likely to experience from time to time. When we talk about feeling “depressed” often what we are describing are feelings of unhappiness, disappointment, or sadness. And this may be in reaction to a whole variety of life experiences, such as a missed promotion, argument with a loved one, or failing an exam. Generally these reactions are time-limited. If these feelings persist, then we may be moving into the realms of what may be called clinical depression. Our depressed mood has become severe enough and persistent enough to now be regarded as an illness. If clinical depression is present, mood will be predominantly and persistently low. Other changes are likely to be noticed, such as a decrease in energy levels, difficulty concentrating, disrupted sleep patterns, and a loss of interest and pleasure in activities that would typically be rewarding. Other changes might also include changes in appetite and weight, feeling chronically tired, unable to make decisions, being more easily moved to tears, and more irritable than usual. A person who is depressed may also express feelings of worthlessness, and sometimes guilt about past events. Thoughts about death or suicide may also occur along with depressed mood.
Having outlined the more significant markers of depression, it is important to note that you do not need to have all of these signs and symptoms in order to be diagnosed as having a clinical depression, (known in formal psychiatric terms as a Major Depressive Episode). But this can cause some confusion for a person who is querying whether or not he/she might be depressed, or a concerned friend or partner is pondering the same question about a friend or family member. Simply put, depression can present in a variety of ways. And the severity of symptoms can vary significantly; at one end of the continuum we may describe most of the typical markers of depression, and the symptoms are of such severity we struggle to get out of the bed in the morning, we are almost completely shut down to the outside world, and the thought of going to work and interacting with others may trigger severe anxiety and panic; and our partner or friends may express confusion and grief about having “lost” their partner/friend as the depressed person becomes increasingly more withdrawn and emotionally inaccessible. Towards the other end of the continuum the symptoms are not so debilitating, and so may be described as of moderate or mild severity. In this case, the person may continue to work, continue to go to the gym, or pottery class; but what is noticeable is that there is not the same degree of enthusiasm, focus, or enjoyment as there once was. Also, some people may describe feeling more anxious or worried than normal; this anxiety in turn can cause various physical symptoms including headaches, rapid pulse, and hyperventilation. These anxiety-related symptoms may in fact be the reason we seek assistance because they are more “obvious” as well as being distressing and uncomfortable, and at the same time being unaware that the anxiety symptoms may be secondary to an actual depression. When experiencing a milder form of depression we may find ourselves more concerned about our level of performance at work for example (even though we are maintaining our normal standards), and we may be more vulnerable to feeling hurt or offended by others. With mild depression, whilst we are able to continue caring for our family and go to work, mood-wise we are not our “normal old selves” – our spirits are down somewhat, it is not as easy to see the funny side, and our spontaneity is often blunted. We may be more likely just to do the necessities simply because we feel more tired and less energised than normal.
To illustrate the difference between a mild depression and a more severe depression, a person may be trying to decide which pair of shoes or which tie to wear to work, and where the mildly depressed person might give such a decision little thought because they just don’t care that much, the more severely depressed person may spend a long time trying to make a decision and in the process becomes increasingly more agitated and stressed, may become tearful, and often feelings of uselessness and despair are set in motion.
Being mildly to moderately depressed has been described as a mental water torture. It is a condition which typically creeps into our life in a somewhat subtle and insidious way, and over time we tend to adapt and accommodate the various changes in our functioning. At the same time the condition is slowly, over time, wearing us down. We might label these changes as “burnout” or “stress” and initially this might be a quite accurate and rational explanation. But, as the condition persists and gradually grinds us down, then depression – of whatever severity – may well evolve, and this process could go on for many months or even years. Mild depression can go unnoticed, or remain unattended to, because we are not feeling sufficiently unwell enough to talk to somebody about it, professionally or otherwise. And, the more depressed we become, the less likely it is that we have the energy or inclination to do anything about it, and so the downward spiral continues on.
Because the symptoms of mild to moderate depression are often experienced by the sufferer as ill-defined, confusing, and therefore not really worthy of attention, the ongoing untreated condition will typically relentlessly undermine our quality of life.
Depression is a serious matter. Thus, whatever the level of severity of the symptoms, it is important to seek assistance, and a family doctor may be a very appropriate first step. Treatment-wise, there is no one formula. Any person experiencing a depression will present with a unique clinical picture, and the role of the health professional is to decide what might be the most appropriate way of addressing the depression. If a diagnosis of depression is made, at the very least we now know what we are contending with – that there is a name for this group of symptoms – and hopefully be there will also be some therapeutic intervention which will address the depression.
As a final note, there are many myths and misconceptions about depression (or what Winston Churchill referred to as his “Black Dog”). Probably most hurtful or damaging is the notion that a diagnosis of depression implies that we are mentally incompetent, weak, and that all we need to do is “pull ourselves together”. Such beliefs or misunderstandings can sometimes lead to tragic consequences.
