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How Do You Know If You're Depressed?
Unlike in physical medicine, there is no objective laboratory testing to identify the difference between depression symptoms and the presence of biological depression. Thus, it is imperative to be very specific about the words one uses to describe “feeling depressed”.
The word depression is used indiscriminately to describe a variety of mood states. When a psychiatrist utilizes this term it represents a clinical entity that requires medication and/or psychotherapy. When asked why they are here to see me, my patients frequently state that they are feeling depressed. My task is to then determine what they mean by these words. The practice of psychiatry is a unique specialty. If an endocrinologist is consulted by a patient to determine if the individual has sluggish thyroid (hypothyroidism) there are very specific blood tests to rule-in or rule-out this disorder.
So, how can we differentiate a state of unhappiness (feeling depressed) from clinical depression? On a simplistic level one can say that unhappiness is an emotional state produced by a life situation or event. However, individuals with an underlying biological predisposition for clinical depression can suffer a depressive episode that is triggered by an external event. Additionally, this same individual can suffer a de novo depressive episode with no clear precipitating event. Biological (aka medical) depressions tend to be recurrent, and, more troubling, tend to recur more frequently over time.
One would hope that a person’s depression symptoms would allow for the differentiation of unhappiness from depression. This is not always the case. Take the loss of a loved one and the grief period that ensues. The mourner can evidence frequent crying spells, can be constantly feeling lonely or feeling blue, have impaired sleep, poor appetite with weight loss, hopelessness, negative thinking, social isolation, poor hygiene and grooming, etc. that can last for days or weeks. Theses are textbook depression symptoms. However, the mourning period is time limited and responds favorably to emotional support and comfort. Generally speaking, episodes of unhappiness and feeling down such as seen after loss of job, test failure, or romantic rejection are short and time limited.
The depression sufferer will tell you that, when feeling depressed, their painful emotional state felt like the fog rolled in and would not burn off, like a black cloud or wet blanket that hung around seemingly forever. When it the midst of a depressive episode my patients tell me that they believe that they will never recover and that nothing will help them. This helplessness and hopelessness is one of the most painful depression symptoms in this disorder. People say that they experience a difficult-to-describe inner pain that is worse than any physical pain; some have even stated that this “pain” is worse than cancer-based pain.
To summarize, unhappiness or feeling down is generally associated with a specific event and is time limited: it is an isolated emotional state that the individual usually has the belief will be short-lived. Clinical depression (aka major depressive disorder) is a recurrent medical disorder with depression symptoms that take on a life of their own, that markedly interferes with functioning, leads to hopelessness, helplessness, and a significant degree of inner emotional pain.
Do not despair if you suffer from clinical medical depression instead of simply feeling depressed, for modern treatments that incorporate advancements in psychotherapies and medication therapies, have resulted in effective relief from depression symptoms and in prevention of this disorder.