For people who are unfamiliar with mental illness, the term “depression” usually applies to someone else. The stigma about mental illness causes people to be uncomfortable identifying with this concept. They may not even think about it, but amazingly, they could have it but not know it.
What is depression? It is a change in the biochemistry of the brain caused by stress. It is consistently estimated that 20-25% of people become clinically depressed at some point in their life. That’s one out of every four or five people. Think about how many people that is!
I worked as an outpatient psychotherapist at a large mental health center for almost 20 years. It was not an infrequent occurrence to have people arrive for treatment after having waited for their depression symptoms to get bad enough to seriously impact their functioning. They would present with issues including insomnia, relationship problems, job-related difficulties, or physical symptoms that had no medical explanation.
Once I identified that a client was depressed, I would say to them:
“Many people walk around with a moderate level of depression without knowing it. They drag themselves out of bed and go to work, because that’s what they need to do. They are able to ‘fake it’ and do okay through the day, but it takes an enormous amount of energy to do this. By the time they get home, they are exhausted from using all their energy to fake it through the day, and they collapse and don’t get done what they want to get done in the evening. Things pile up. Because they aren’t getting things done, they beat themselves up. They may or may not be able to sleep at night, but regardless they are exhausted. They may do things they would normally enjoy to try to cheer themselves up, but they have difficulty enjoying anything. They start to feel like things will never get better, and if it goes on long enough they don’t even remember that this isn’t the way life is supposed to be. It feels normal to them.”
More often than not, the depressed client could completely relate to this description. For the first time in a long time they became hopeful that things could get better. After appropriate treatment, they would often come back and say “Sharon, I can’t believe how much better I feel. I must have been depressed for years without knowing it. I should have sought help a long time ago.”
Unfortunately, for many of these people the next focus of treatment became working through their grief over the years they wasted due to living with depression unnecessarily.
The symptoms of clinical depression include sadness or irritability, lack of interest in activities, sleep or appetite increases or decreases, weight changes, low energy, feelings of restlessness, difficulty concentrating or making decisions, increased feelings of guilt or worthlessness, and feelings of hopelessness. Suicidal thoughts may be present if depression is particularly severe.
If you or anyone you know is experiencing some of these symptoms, please get help. Talk to your primary care physician, and ask for a referral for a psychotherapist.
Next month: Effective Treatments for Depression