Feeling depressed is a common occurrence. Depression less so. Perhaps the most salient reason many people fail to treat those struggling with Depression with appropriate levels of compassion and concern is because they conflate feeling depressed with having a Depressive Disorder. They are worlds apart.
The confusion is understandable, given our use of the same word to describe moods which do indeed share much in common on the surface. It is hard enough for people to distinguish between feeling depressed and being sad, which are also quite different conditions. So, let’s lay out what each is, elucidating the crucial distinctions.
Sad almost always makes obvious sense to the sufferer. They know they are sad, and they typically can identify the reason they are sad about, at least in a general way. Often there is a concrete event that most people would similarly respond to with sadness: a loss of a loved one, divorce, illness, conflict with a friend or family member, recollection of tragic memories, etc. While there is a wide range of intensity of emotionality we might experience, if we told people what we were sad about they would understand why the situation has left us sad.
We know what straight-forward sad looks like. For instance, it often involves tears. Sometimes it is a sad that easily resolves itself with a “good cry”, where we let our whole body feel and express our sadness thereby releasing it. Sometimes the sadness is part of a larger grief process, that might go on for many months, with bouts of crying, physical exhaustion, energetic depletion, loss of appetite, withdrawal and isolation, and disruption of sleep patterns. Sadness can be quite overwhelming and devastating and depending on the cause, can last a long time with many ups and down.
Sometimes we might feel challenged to understand why a particular incident makes us feel so sad, like when a national figure or a distant acquaintance dies, and we find ourselves feeling upset in ways that feel above and beyond the situation. Surely sometimes others will challenge our level or duration of sadness and grief based on their own personalities and world views, such as not understand why some of us become over-come with sadness and grief when their pet dies. But even if we or others judge the depth and breadth of our sadness, most will still recognize the event itself as sad.
Feeling depressed can occur on the heels of a sad event or sad time. But it can also occur in the absence of a specific event. One of the characteristics that distinguishes it from sadness and grief are the primary features of hopelessness and despair. This is in part why it can occur in the absence of a specific event. It is often built on a culmination of issues and feelings that build an experience of believing that events are likely to continue to move in a bad direction.
Sometimes this is a response to what we experience as a series of failures or missed opportunities. Feeling depressed has an existential component to it. It is not more important than sadness, but has a more singular viewpoint. It is driven by certain thoughts/ beliefs/ perspectives that drive a feeling of hopelessness.
The mood of depression can look an awful lot like a Depressive Disorder. While tears may be a component, the most prominent feature is what is experienced as an absence of feelings, a deadening of emotionality. When a person is feeling depressed, we look like life itself has been sucked out of us. It drains the face of color and the muscles of buoyancy. It creates physical and emotional exhaustion. Depressed moods make it hard to work, to function, to laugh, to be emotionally connected with other people.
When someone is feeling depressed, they are likely to view things negatively, imposing their hopeless disposition on all things. From the outside it is often visible that the depressed person’s mind-set is part of the problem, and that their negativity seems to surpass the realities of the situation.
There are multiple diagnosis of Depression including Major Depressive Episode, Dysthymia, Depressive Disorder, as well as Anxieties with Depressive Features. The distinctions between these disorders is not important for the purposes of this discussion. The distinction we are concerned with here is between feeling depressed and being Depressed.
One major distinction is that when a person has Depression it needn’t have a single causative factor in our concrete lives. Nothing significant needs to have happened, and no existential crises need have triggered it. Most commonly Depression is brought on by a glitch in one’s biological/chemical/hormonal system. It may be a glitch they have always lived with, or brought on by a developmental change such as puberty, and sometimes, for reasons we are unable to identify. It sometimes comes on the heels of a sad or difficult event, raising questions for scientists about our mood’s ability to alter the functioning of our body. But in most cases of clinical Depression, the body itself is part of the problem.
This is an important distinction for many reasons. One is that the sufferer might literally have no idea “what is wrong with” them. They may be bewildered as to what is causing their feelings of hopelessness and physical and emotional exhaustion. When people ask them what happened they may legitimately have no clue. This often compounds their Depression as they are likely to blame themselves for this mood they have acquired when “nothing is actually wrong with” them.
Another reason the biological/ chemical/ hormonal contribution is important is that because of it, for many people, they will not get better without a medical intervention. I do not say this lightly. Medication in the form of psychotropics is hardly the first intervention, and although I don’t believe it should be avoided at any cost, usually there are quite a few things we should try before turning to medication. But for some people, a medical intervention must an ingredient in the stew of any viable solution.
Another major distinction between feeling depressed and having Depression is the depth, breadth, and entrenchment of the mood. Besides the profoundness of the feelings, emotions, thoughts and perspectives, the body exhaustion can be so intense that the whole body aches. The person suffering from Clinical Depression frequently has significant disturbances in sleep, in appetite, decreased capacity for or interest in sexual arousal, and aches and pains in their muscles and joints. It is truly a body/mind/soul experience of brutal dimensions.
Why is it Important to Stop Conflating the Two?
Every person with a depressed mood knows the tools for improving the mood.
- Go wash your face
- Go talk a walk
- Call a friend
- Start to exercise
- Spend some time in the sun
- Eat a more nutritious diet
- Try yoga
- Put a positive spin on things
- Let time pass…it will get better
So here is the thing. All those are great suggestions. Most of them will even help with a depressed mood. And most people know that, because most of us have had a depressed mood. And we got better.
But none of this stuff will make even the smallest dent in Depression. Even if the person could do it, which they can’t, because their mood is far too depressed. Period. No matter what the person who has had a depressed mood thinks will help, it just won’t, and it is judgmental, disrespectful, demeaning and damaging to insist that the person with Depression try these essentially useless suggestions.
Real Depression has only two real solutions; psychotherapy/profound unpacking of psychological/societal/existential understandings of self and medical intervention.
Psychotherapy is Usually the First and Best Tool for Depression
The first order of the day is psychotherapy. Of course, there are other tools for a serious unpacking/untangling of the self besides psychotherapy, but it is the most readily available, structured offering for taking a journey through one’s history, their societal and familial world, their psychological disposition, to find the sources of the soul injuries weighing them down. The good news is that therapy will, over time, help alleviate the symptoms of Depression. The bad news is the path out of Depression is anger and sadness. While that hardly sounds like improvement, any Depressed person will tell you they would rather feel something than not, and they would rather have a handle of the themes linked to their Depression than be in the dark about what is going on.
The reasons it is worth avoiding medication if possible are twofold:
- In medical terms it is simply more invasive. Almost all medications come with side-effects; some temporary, some symptomatic, and some we simply can’t access. It is almost always better to start with the least invasive treatment available.
- Most frequently, feelings or sadness, feelings of depressed mood, and even Depression are symptomatic responses to real issues. If we move too quickly to eliminate those symptoms with medication relief, we lose access to the details, the shape, the relevance of the feelings. The symptoms and moods are the guide to exploring the meaning of one’s distress.
Sometimes Medical Intervention is First
Unless the person with Depression is actively suicidal, it is worth trying a few months of therapy before considering medications or other medical interventions. This is because a skilled psychotherapist will be able to help the client assess if therapy is going to be enough to move them out of Depression. The exceptions are these:
- If a person is actively suicidal, the first step should include medication. It is the quickest way to possibly relieve symptoms enough to reduce the risk of suicide. It is rare that medication alone will solve a diagnosis of Depression, but it can usually take the edge off enough to reduce the risk of suicide.
- Medication can also be important early on in treatment if the person is just too depressed to do the work of psychotherapy. To be clear, medication does not work for everyone. In fact, most people may even have to try multiple medications or other medical interventions before they find relief. But because of the potential speed of aid, they can be very helpful when the burden of the work is more than the Depressed person can pull off.
What Should I Do If I think I Might Have Depression?
Go see a therapist. It isn’t that this will magically fix anything…if it was that easy you could have taken care of this on your own a long time ago. But it is the first and most impactful step you can take to getting yourself onto a road to recovery.
What Should I Do If I Think Someone I Know Is Depressed?
Don’t tell them to get out of bed and get some fresh air! Do tell them you are sorry they are struggling and ask them if you can help them get into see a psychotherapist. There are lots of ways you can be supportive, but none of them are giving them advice based on the management of sadness or feeling depressed.
Smith is an analytically oriented psychotherapist with 25 years in practice. She is additionally the Founder/Director of Full Living: A Psychotherapy Practice, which specializes in matching clients with seasoned clinicians in the Greater Philadelphia Area.
If you are interested in therapy and live in Philadelphia or the Greater Philadelphia Area, please let Full Living: A Psychotherapy Practice match you with a skilled, experienced psychotherapist based on your needs and issues as well as your and own therapists' personalities and styles. All of our therapists are available for telehealth conferencing by phone or video in response to our current need for social distancing.
For more or related topics in blog and video blog, follow the links below:
But Do I Need Therapy?
5 Reasons Suffering People Dont Want to Try Medication
Philadelphia Psychotherapy Practice will Match You with a Therapist