One of the biggest factors that makes depression difficult to understand as an illness is that everyone feels depressed, or at least profoundly sad, sometimes. This “feeling depressed” is interpreted by many people as being the same thing as Clinical Depression, therefore, when someone reports that they have Depression, they will respond by saying something like, “Oh yes, I know that feeling…I also feel depressed sometimes”. Let me tell you that this would be like saying, “Oh yes, I understand your pain…I also cough sometimes”, to someone who has Lung Cancer!
Sufferers of Depression have their illness minimized and dismissed all the time because people simply don’t get that it is different to their experience of feeling depressed. Sufferers of Cancer don’t get the same response because people that don’t have Cancer don’t have an experience that they can compare it to. Minimization and dismissal are among the reasons that you will find many Depression sufferers reluctant to talk about their illness – I mean, if you were going to get a response like, “Come on, cheer up…we all feel down in the dumps sometimes” wouldn’t you prefer to keep it to yourself?
I think everyone will agree – feeling depressed or at least profoundly sad when you lose someone you love, are having a crisis at work, or are going through financial difficulties, is a normal emotional response. And I’m sure most people reading this can relate to these or to other life events that have induced such an emotional response. But how many people can relate to two solid weeks of being unable to get of bed other than to go to the toilet? To lacking the drive even to take a shower and get dressed? To neglecting their children to the extent that they cannot prepare their breakfast before school, or indeed even take them to school? To a total loss of interest in absolutely everything in life that used to bring pleasure? To considering ending their life at their own hand, or at least wishing something would end it? EVERY DAY FOR 2 SOLID WEEKS?
I have had people tell me that their Depression is the worst pain they have ever experienced even although they cannot put a finger on the location or exact nature of the pain. Others have said they would rather lose the use of their legs than continue suffering their Depression. With the insights that I have gathered over many years of working in the mental health industry, I can say with absolute honesty that I would rather live with Paraplegia than with severe, unremitting Depression. With Paraplegia, I could adapt, with Depression in a severe form, without remission, I would surely prefer to die.
It is true like with many physical illnesses, Depressive Disorders come in varying degrees of severity, and can therefore be viewed on a continuum as pictured above. It’s response to treatment also varies with some people responding well and enjoying relatively mild symptoms and good functioning for long periods of time. However, just like with TB, there are treatment-resistant forms with symptoms being severe for long periods of time, even forever. It is also true that there are a number causes, including genetics, neurophysiology and life events or experiences, and depending on these, there are a variety of treatment approaches. Therefore, if you want to give yourself the best chance of optimal treatment and remission, see a Psychiatrist, not a GP, just like you would see an Oncologist, not a GP, if you had Cancer.
People often ask me how they will know if they are just “feeling depressed” or if they have Clinical Depression? Essentially, it comes down to 3 things:
- Number and severity of symptoms;
- Duration of symptoms; and
- Functioning in activities of daily life.
If you have been having five or more symptoms constantly for 2 weeks or longer, and you have noticed a decline in your ability to attend to usual activities such as self-care, domestic chores, family responsibility, recreational, social and work activities, you could be suffering from Clinical Depression. The symptoms as per the DSM-5 include the following:
- Depressed mood most of the day, nearly every day.
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
- Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
- A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly 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, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
So, the next time someone tells you that they have Clinical Depression, please don’t say you know exactly how they feel…unless of course you do. And if this person happens to be one of your employees, investigate the details before you dismiss their inability to come to work as a form of laziness or lack of discipline.
Take care everyone.
Your Partner in Mental Health Matters @ Work
Lesley