What is Depression?

The answer to that question is not as easy as you might think! There is a variety of mood disorders which have the following theme in common:

Depressed mood:

  • State of low mood and aversion to activity or apathy that can affect a person’s thoughts, behavior, feelings, and sense of well-being.
  • People with a depressed mood can feel:
    Sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, angry, ashamed, or restless, may lose interest in activities that were once pleasurable, experience loss of appetite or overeating, have problems concentrating, remembering details or making decisions, experience relationship difficulties and may contemplate, attempt or commit suicide.
  • Could also be present: Insomnia, excessive sleeping, fatigue, aches, pains, digestive problems, or reduced energy
  • May also be a normal reaction, as long as it does not persist long term

Mood Disorders
Let’s start with the most familiar one:

Major Depressive Disorder (aka “Depression”)

  • Characterized by at least 2 weeks of low mood present across most situations.
  • Often accompanied by: Low self-esteem, loss of interest in normally enjoyable activities, low energy, pain without a clear cause
  • Some people have periods of depression separated by years in which they are normal while others nearly always have symptoms present.
  • Can negatively affect a person’s personal, work, or school life, as well as sleeping, eating habits, and general health.
  • A depressed person may report multiple physical symptoms such as fatigue, headaches, or digestive problems
  • Often coexists with physical disorders (stroke, cardiovascular diseases, Parkinson’s disease, chronic obstructive pulmonary disease)
  • Depressed children may often display an irritable mood rather than a depressed mood! Most lose interest in school and show a decline in academic performance.
  • Cause: Unknown! Believed to be a combination of genetic (40 %), environmental, and psychological factors.
  • Causes the second most years lived with disability after low back pain!
  • Females are affected about twice as often as males!
  • 2–7% of adults die by suicide!

Subtypes
Melancholic depression
Loss of pleasure in most or all activities, failure of reactivity to pleasurable stimuli, quality of depressed mood more pronounced than that of grief or loss, a worsening of symptoms in the morning hours, early-morning waking, psychomotor retardation, excessive weight loss, or excessive guilt.

Atypical depression
Mood reactivity (i.e., mood brightens in response to actual/potential positive events) and positivity, significant weight gain or increased appetite (comfort eating), excessive sleep or sleepiness (hypersomnia), sensation of heaviness in limbs (leaden paralysis), significant social impairment as a consequence of hypersensitivity to perceived interpersonal rejection.

Catatonic depression
Rare and severe form involving disturbances of motor behavior, either remains immobile or exhibits purposeless or even bizarre movements.

Postpartum depression
Intense, sustained and sometimes disabling depression experienced by women after giving birth with an incidence rate of 10–15% among new mothers. Can last as long as three months.

Seasonal affective disorder (SAD)
Depressive episodes come on in the autumn or winter, and resolve in spring.


Adjustment disorder (exogenous/reactive/situational depression)

  • Occurs when unable to adjust to or cope with a particular outside stressor or a major life event.
  • Generally resolves once the individual is able to adapt to the situation.
  • Mild depressive symptoms, anxiety symptoms, traumatic stress symptoms or a combination of the three.
  • May be acute or chronic, depending on whether it lasts more or less than 6 months.
  • Adult women are diagnosed twice as often as are adult men.

Dysthymia (neurotic/chronic depression)

  • Less severe but longer-lasting symptoms (former “depressive personality”)
  • Chronic depressed mood, which persists for at least 2 years (1 year for children and adolescents)
  • Sufferers may experience symptoms for many years before it is diagnosed, if diagnosis occurs at all => They may believe that depression is a part of their character, so they may not even discuss their symptoms with doctors, family members, or friends.
  • Often co-occurs with other mental disorders.

Bipolar disorder (aka “Manic depression”)

  • Periods of depression and periods of elevated mood
  • Mania/Hypomania (depending on severity or presence of psychosis): One or more episodes of abnormally elevated mood, cognition and energy levels.
  • Often make poorly thought out decisions with little regard to the consequences. Need for sleep is usually reduced during manic phases.
  • Depression: Crying, negative outlook on life, poor eye contact with others
  • Anxiety disorders and substance use disorder are commonly associated
  • Risk of death from natural causes such as heart disease = twice that of the general population (poor lifestyle choices and side effects from medications)!
  • Suicide risk is high (> 6 percent over 20 years)
  • Self-harm occurs in 30–40 percent

Subtypes
Bipolar I disorder
At least one manic or mixed episode (features of depression and mania occur either simultaneously or in very short succession). All experience a hypomanic stage before progressing to full mania.

Bipolar II disorder
At least one hypomanic episode and one major depressive episode and never experienced a full manic episode.

Cyclothymic disorder
More chronic but less severe symptoms. Absence of any major depressive episode, manic episode or mixed episode. 15–50% advance to the diagnostic criteria for bipolar I/II disorder.


So – what does it feel like?
This article describes really well what it feels like to be depressed!

Excerpt:
“Imagine feeling constantly overcome by a loneliness so profound that you feel homesick all of the time, even when swaddled in the oh so soft, familiar arms of home.”

“Depression is visceral, not intellectual. It lives in the heart, not in the head, which is why we’re unable to rationalize ourselves out of it.”

“It was the loneliest feeling imaginable. It was the kind of loneliness that can’t be remedied because the disconnect I felt was a disconnect from myself.”

“The less we talk about mental health, the more ashamed we feel when we’re experiencing dark feelings we can’t control.”

“Shame is what makes us suffer in silence. Silence is what kills so many of us.