Depression and Sadness

Depression and Sadness

Dr. Rijusmita Sarma

(The writer is a counselling psychologist.

Can be reached at 8638716076

T he terms ‘depression’ and ‘sadness’ are often used interchangeably. It is also seen that the term ‘depression’ is used very arbitrarily. But ‘depression’ and ‘sadness’ are very different from each other, both qualitatively and quantitatively. Knowing the differences is important to dealing with them effectively. Sadness is an emotion every human being experiences. It is a state of unhappiness, distress, and sorrow.

But depression is different from sadness in terms of quality, quantity, pervasiveness, duration, and effects on the functional level of a person. It is a clinical condition that affects the way a person thinks, feels, and acts. It is characterised by the following signs and symptoms for at least two weeks or more:

n Persistent sadness or inability to experience happiness or pleasure

n Lack of interest in activities the person enjoyed earlier

n Persistent fatigue or lethargy

In addition to these, there may be

n Changes in sleep and an increase or decrease in appetite

n Crying spells

n Feelings of hopelessness and worthlessness

n Guilt

n Death wishes and suicidal thoughts, with or without intent

n Early morning awakening

n Social withdrawal

n Loss of libido

n Physical symptoms like vague pains and aches, with no organic abnormalities found in tests and scans

n Increased irritability.

It is a myth that depression cannot happen to children and adolescents. In them, the condition may be presented as:

n Clinging behaviour or crankiness

· Anger outbursts

· Withdrawal (refusal to play)

n Changes in appetite or sleep

n Crying

n Trouble concentrating

n Academic decline

n Fatigue or low energy

n Physical complaints

n Feelings of worthlessness or guilt

n School refusal

n Thoughts of death or suicide

Unlike other physical illnesses, depression is not diagnosed by laboratory tests and imaging but by clinical examination.

Optimistic bias can contribute to our thinking that mental illnesses like depression cannot happen to us or the people in our immediate surroundings. But the statistics might compel you to rethink. According to the National Mental Health Survey 2015–16, one in 20 individuals suffers from depression. Depression, like any other mental illness, can happen to anyone. Unfortunately, there is a huge treatment gap of 85.2%, which is leading to appalling consequences. The reasons for this could be:

n Ignorance

n Lack of insight and acceptance

n Less access to treatment

n Affordability of treatment.

The biopsychosocial model explains that the causes of depression could be both biological (genetic influences, neurochemical factors, abnormalities in the hormone regulatory system, neurophysiological and neuroanatomical factors, sleep, etc.) and psychosocial (stressful life events, certain personality traits, lack of social support, relationship issues, work stress, chronic medical illness, poverty, family environment, etc.).

Depression can coexist with other mental health conditions, like:

n Substance use or dependence (50–55%)

n Anxiety disorders (35%–40%)

n Personality disorders (25–30%)

n Chronic medical illness (60–70%)

n Obsessive-Compulsive Disorder (50–60%)

Depression can worsen other medical conditions and increase morbidity and mortality.

However, depression is a treatable condition. It can be treated and managed by medications, therapy, and counselling, which includes cognitive, behavioural, and lifestyle interventions.

Through this write-up, I would like to shed light on some common myths associated with the state of depression:

n “Depression isn’t real”: Depression is often mistaken for mere sadness. Unfortunately, to fuel the already distressing condition, it is even considered a sign of weakness of character and spirit. However, depression is a clinical mental health condition.

n “We can get over depression overnight if we wish to”: It is believed that depression can be cured only with positive thoughts and a will to recover. Nobody chooses to be in the pangs of depression. It needs treatment like any other medical condition.

n “A bad event has to happen for a person to experience depression”: Depression may occur even when everything is going well in a person’s life. Depression doesn’t always need a negative incident.

n “If parents have depression, their children will”: A positive family history of depression might mean that we are more likely to develop depression. However, the significance of genetic predisposition isn’t clear yet. Hence, it doesn’t mean that if parents have depression, their children will invariably have it too.

n “Children and adolescents cannot have depression”: Even toddlers can be affected by depression. It is painful to reveal that children as young as six years of age can contemplate suicide.

n “Depression is just self-pity”: Mental toughness is admired in our society, and people who share their vulnerabilities are often labelled as ‘whiners’. But depression is a medical condition, and it is not about feeling sorry for oneself.

n “Depression only affects women”: Depression can happen to anyone, irrespective of gender. But due to societal orientation and expectations, men are often not comfortable sharing their feelings or asking for help, which is relatively easier for women. So, depression might be presented in a very different way in men, making it difficult for themselves or their loved ones to identify it.

n “Talking about it will make things worse”: It is mistakenly believed that discussing our difficult feelings reinforces them and keeps us focused only on the negative aspects. But the fact is, it is much more dangerous and harmful when people are alone with their disturbing thoughts and feelings. Sharing with a non-judgmental, patient, supportive, and reliable listener can be the first step towards recovery.

Depression can be imagined as a monster that keeps us trapped and inflicts pangs of distress. But the good news is that this monster can be tamed. And we can continue living meaningful and fulfilling lives. Quoting Aaron T. Beck on depression, “Some authors have conceptualized depression as a ‘depletion syndrome’ because of the prominence of fatigability; they postulate that the patient exhausts his available energy during the period prior to the onset of the depression and that the depressed state represents a kind of hibernation, during which the patient gradually builds up a new story of energy.” My eight years of experience as a therapist help me relate to this, as I have come across many individuals suffering from exhaustion along with other signs and symptoms of depression. But with team efforts, they have recovered, learned the skills to tame the monster, and found new zeal and purpose to live their lives.