What really is depression?

By Jen Scott, LMFT

Thankfully mental health is becoming less taboo these days, but that doesn’t mean there isn’t still a lot of confusion about it. For this week’s blog I thought it might be helpful to provide basic information about depression. How is it defined and diagnosed and what are some healthy coping skills for managing it?

First off, there are two types of depression - physiological and situational. Physiological depression is a biological issue. This is when the neurons in your brain are not firing correctly resulting in lower serotonin levels. These lower serotonin levels are what leaves the individual feeling deflated, blah, or down. Depression of this kind is due to a chemical imbalance out of the person’s control. Hence when someone says “cheer up” or “snap out of it” it is really painful to hear. Usually when there is this sort of depression going on, we recommend that the client also be working with a psychiatrist that can prescribe anti-depressant medications. Talk-therapy will still be helpful in assisting with developing healthy coping skills and making life style changes to manage the depression. Some clients report that they’re a bit iffy about taking medication. There are other options to consider including diet and/or supplements. That would be a question for the primary care physician.

Secondly, there is situational depression. We see clients suffering with depressive symptoms due to a variety of issues and circumstance. It can be from a divorce, breakup, difficult life transition, overwhelming stress, grief, loss, big change, or a traumatic event.

The criteria to be officially diagnosed with depression are as follows. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.

1. Depressed mood most of the day, nearly every day.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
5. Fatigue or loss of energy nearly every day.
6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.

The last note there at the end points to the significance of depression. Not to be confused with waking up on the wrong side of the bed or having a tough day, depression is a real diagnosis that can be very painful. Now how is it treated?

There are a variety of different treatments for depression. At first, we are going to want to rule out substance abuse or anything medical, and then from there, we’ll work to discern if the depressive symptoms are physiological or situational. Most folks will already know before they come in (as an event or life stress will precipitate the symptoms), but sometimes it can be hard to tell. After gaining some clarity on that we’ll be able to assess whether it would be helpful to recommend a visit to the psychiatrist for help with a chemical imbalance or if we can proceed with just talk therapy.

In continuing talk-therapy, we can do both of two things. We can develop healthy coping skills to manage the depressive symptoms, as well as, begin to process the emotions present. Some healthy coping skills can include things as simple as, increasing exercise, having set bedtimes and wake up times, eating healthily, having quality time with positive family and friends, and setting routines. Depression will want us to get out of our routines and healthy habits but the best thing to do is try to seek some normalcy while combating the depression. Beyond good routines, some space set aside to journal, pray, process and talk about your feelings will also be important. There may be some entangling that needs to be done. Sometimes we think we can do this on our own but keeping things to ourselves can also entangle the thoughts more. There is a lot of power in speaking things aloud in a safe place. With the help of a therapist, the dots can be connected and there can be greater understanding for all of the thoughts and feelings.

I don’t wish depression on my worst enemies. It’s an ugly experience that can be very debilitating. My hope is that you don’t go through it alone and risk speaking up because there is also a lot of help out there and you can be free from it!