Monday, 17 November 2008

Depression is not just being Blue

Everyone feels low or sad sometimes. Often those feelings are in response to a negative event or life problem. Those feelings are perfectly normal. Indeed the ability to experience these emotions may be an essential part of what it means to be human.

These feelings will frequently lead to changes in our behaviour. That is, they help us adapt to our environment – often by enhancing our use of social supports. That is why we feel better when a friend, parent or family member gives us a hug or spends quality time with us. These feelings can also be helped by us seeking out and participating in activities that we usually enjoy.

Sometimes we feel low or sad for no reason. This is also normal. Our moods fluctuate over the course of a day, monthly and yearly. Spontaneous mood changes may be more pronounced over the teen years but everyone has them. These changes are short-lived, do not lead to pronounced social, interpersonal or job problems and usually go away as mysteriously as they came. When these feelings are there you can help them leave by hanging around with people you care about, exercising, listening to music or doing things you like to do.

Unfortunately, we often refer to these normal feelings as depression. This is a shorthand for a whole host of different emotions, including the following: despondent, distressed, despairing, demoralized, disturbed, frustrated, blue, sad, low, etc. Not only does the use of the shorthand “depression” to mean all of the above detract from our ability to communicate the rich nuances of our feelings, but the word depression used as a substitute for these normal feelings can be confused with the concept of clinical depression – which the word depression could be reserved for.

A clinical depression represents a failure of brain adaptation. Unlike feelings of sadness, distress, despondency, etc. which signal brain adaptation, a clinical depression describes a state of being in which a person’s functioning is impaired – that is, they cannot do what they usually do because of how they are feeling. Fundamental to understanding a clinical depression is the decline in functioning that it causes; such as, poor performance at school or at work, problems in interpersonal interactions, social withdrawal, etc.

Unlike the usual and common feelings of sadness, despondency, distress, etc. which are often alleviated by increased positive social interaction or usual enjoyable activities, a clinical depression will usually require a more specific and sustained intervention – usually a psychological or biological treatment. That does not mean that doing things that usually make you feel better (for example: talking with friends, exercising, etc) are not helpful – on the contrary, they may well be. What this means is that for clinical depression these interventions are unlikely to be helpful by themselves. If someone is living with a clinical depression they usually require professional help – from a therapist or physician. These professional helpers will provide additional specific treatments that have undergone rigorous empirical scientific evaluation and have been generally shown to be effective in promoting recovery from the clinical depression.

In addition to the functional impairment, a clinical depression differs from usual low moods in many ways. The low feelings must be persistent and sustained; there is a marked loss of interest or pleasure; there are substantive and persistent feelings of worthlessness or hopelessness; there is often fatigue, lack of appetite and sleep difficulty and there frequently are persistent ideas about suicide or even suicide attempts. Clearly, this state is not a brief response to environmental adversity or a temporary blip in mood.

So, depression is not the blues. Personally, I would really like to see us get away from using the word depression as a shorthand term. So instead of saying “I feel depressed because my boyfriend broke up with me” say instead “I feel distressed (or unhappy, or pissed off, or hurt, or despondent, or whatever) that my boyfriend broke up with me”.

Let's start using the rich lexicon of our language to identify the varied and nuanced expressions of our moods.

~ Dr. Stan Kutcher

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