What are the signs and symptoms of depression? And when do I seek help?
It’s normal to feel down from time to time. Life can be stressful, and things can happen that cause us to feel sad. Generally, we feel sad in proportion to the event that precipitated our feelings, and the sadness dissipates as the brain and body process what happened. Eventually, the body returns to a euthymic, or “normal” state of emotional functioning. However, there are times that our body does not rebound to a state of euthymia and remains depressed for a longer period of time than we would have expected. In addition, there are times when sadness becomes so profound and debilitating that we struggle to function at home and at work. The term Depression is used when sadness lasts longer than expected, and it starts to interfere with our ability to function in life.
Depression is an enduring mood state that may last anywhere from a few days per week, to a longer period of time that can last for months or years. Depression generally occurs in an episodic fashion. For example, depressed mood can occur as one discrete episode (the episode has a distinct starting point and ending point), or depression may occur in a recurrent fashion (i.e. multiple times within the course of a year). Depression causes the individual distress and interferes with the ability to function in life. It is also characterized by a specific set of symptoms. Symptoms vary from person to person, but common symptoms of depression include (the following is a list of symptoms described in the DSM-5; most people that struggle with depression will not experience every symptom in this list, but many people will struggle with a combination of these symptoms depending on the severity of their depression):
1. Depressed mood most of the day, nearly every day
2. Loss of pleasure in activities you used to find pleasurable
3. Significant weight loss or weight gain during the period of depression. Weight loss is unintended and is usually a result of lack of appetite (as opposed to weight loss due to intentional changes in diet and activity level)
4. Inability to sleep-or excessive sleepiness
5. Feeling agitated or restless-or feeling excessively slowed down
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive or inappropriate guilt
8. Diminished ability to think or concentrate; indecisiveness
9. Recurrent thoughts of death. As depression becomes more severe, thoughts of suicide as well as plans to commit suicide may occur
Depression may occur as result of many factors, including (but not limited to): significant life events, genetic predisposition, medical illness, and neurocognitive disorders. The treatment for depression will sometimes vary depending on the cause of depression (aka, a history of childhood trauma vs a diagnosis of Hashimoto’s disease).
In terms of non-medical treatment for depression, I tend to be slightly biased towards therapeutic (counseling) treatment. I think therapy can be very helpful to address depression and any underlying non-medical factors that may contribute to it. (Please refer to my earlier blog post about how to choose the right therapist for you.) In addition, you may also want to consider a few other factors that could impact treatment for depression. For example, if a medical illness is contributing to your depression, then treatment by a physician may be more impactful than counseling. How do you know if your depression is caused by illness? Unfortunately, there is not reliable way to answer this question without the aide of a qualified medical professional. Thus, I always recommend that you visit your primary care physician first and ask him or her to evaluate you for any physical causes that may contribute to depression. Next, if you are actively using mood altering substances, that might also have a negative impact on therapeutic treatment. Consult with your therapist or physician to discuss if treatment for addiction might be warranted given your pattern of use. Next, if you are in a violent relationship, or involved in couples/family dynamics that contributes to your feelings of depression, individual therapy might not be enough to address these dynamics. In these cases, you may want to consider family counseling or couples counseling to address the relational issues that contribute to your depression.
Lastly (and by no means is this a comprehensive list of factors that might impact success in therapy), you may consider medication to help manage your symptoms of depression. Many people prefer to start treatment with a medication option, and just as many people are wary of beginning treatment with medication. Research has shown therapy to be effective for the treatment of depression, and research has also shown medication to be effective for the treatment of depression. Moreover, many studies that have compared individual therapy vs medication management vs therapy and medication combined have shown that greater symptom reduction has occurred when both modalities are used together. Don’t mistake this statement as a blind endorsement for the use of medication before trying out individual therapy, but it is important to understand the research on the subject. In most cases, I recommend that my clients participate in therapy first before they try medication. If therapy is effective and you don’t need to take medication, then I think its best not to interfere with your neuro-chemistry. However, if therapy is not effective, or you are making change in therapy-but not as quickly as you would hope, medication is a perfectly viable option. I should also mention-if you are actively suicidal or making reckless/impulsive decisions that could affect your safety and the safety of others-then I believe it can be very important to start treatment with medication. If you are wary of psychotropic medication, remember that you don’t have to stay on that medication forever. However, you can’t make stable long-term success in therapy if your short-term decision making puts you in a dangerous situation.
Overall, if you take a proactive approach to seeking treatment for depression, then I believe you are on the right path to feeling better. And my last piece of advice-don’t put off treatment for your mental health. The longer you wait, the longer depression has a chance to negatively influence your life, and the longer it will take you to feel better and take control of your emotional health. Make the decision now to improve your mental health, I promise it’s a decision you won’t regret in the long-term.