Many people suppose that depression is simply a feeling of overwhelming sadness. If someone has a terrible week, they might say, “I was so depressed.” But what they really mean is “I was very sad.” What doctors mean by the word depression is not the same as the common usage of the term. But if sadness (only one of several signs and symptoms of depression) is confused with depression, it is also true that the misery of clinical depression is often overlooked entirely.
I have spoken to many people who have suffered from signs and symptoms of depression for many months or even years, but they don’t think of it as depression. Why? Depression is a beast unlike the sadness that naturally comes from disappointment. Depression can morph into anger or numbness.
It is an animal that lands on our shoulders and takes up residence. Sadness, on the other hand, is more like a bird that lands on our shoulder, but soon flies away. If sadness doesn’t fly away, it can becomes one of the signs and symptoms of depression — clinical depression. So when do the signs and symptoms of depression become a medical condition that needs treatment? These two important criteria must both be true:
- The signs and symptoms of depression last for several days (at least 2 weeks)
- Depression symptons become disruptive to major areas of a person’s life; the depression symptoms negatively and noticeably impact relationships, work, or school
To make things more complicated, a person can be clinically depressed without feeling particularly sad. Consider for a moment what that means: a person can be clinically depressed without showing sadness–one of the signs and symptoms of depression most emblematic of depression. How can this be?
Everyone experiences mood changes as a part of living life. Good things happen. Bad things happen. But depression involves a cluster of symptoms of which sadness is only one. Pouring rain is not a flash flood, but it is part of the combination of factors that produce a flash flood. Clinical depression, or Major Depressive Disorder, is usually defined as a combination of any five of the following signs and symptoms of depression that persist for more than 2 weeks:
- Sad mood most of the day, nearly every day
- Noticeable loss of interest or pleasure in nearly all activities most of every day
- Significant change in weight not due to dieting (weight gain or loss of more than 5% of body weight in a month)
- Sleep problems nearly every day (excessive sleeping or insomnia)
- Agitation (irritable attitude and physical tension) or marked slowing of one’s thoughts and actions (e.g., much more difficulty getting started on something than usual)
- Fatigue or loss of energy 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 (not just fear of dying), recurring thoughts about suicide, or a suicidal gesture (deliberate carelessness in dangerous situations) or an attempt, or specific plans.
Most people have experienced one or more of the above symptoms at some time in their lives. But when five or more of them combine and take hold, they can cause agonizing distress and can disrupt one’s ability to function well at work, at school, or socially. When this happens the depression is considered “clinical” because it is tenacious enough to need some type of treatment. If a person is having thoughts about death that keep returning, this is almost certainly an indicator of clinical depression, whether or not the person can recognize any other signs and symptoms of depression.
As you can see, a person may or may not feel sadness as their main symptom. It’s the number of depression symptons and the combination of depression symptoms that makes a person begin to see the impact on his or her life. When we have normal, everyday sadness or the blues, our brain bounces back. With clinical depression, our brain starts working in a different way and gets stuck in a mode that displays the signs and symptoms of depression.