All people feel sad at times, and it is a normal part of life to occasionally feel “down” for a few days, particularly when losses are experienced or bad things have happened. Some people find themselves stuck in feelings of helplessness, hopelessness, and worthlessness, sometimes for weeks and even years at a time. This dark and empty state is often labeled clinical depression. In this state, motivation to do the things that once seemed worthwhile and meaningful drains away and not much feels worth doing. This pain is real and can feel devastating, but you are not alone in this suffering. In fact, nearly 10% of adult Americans could be diagnosed with some form of depression in any given year. Depression can take various forms, and each individual’s struggles are unique. Some of the various forms of depression include:
Major Depression. The DSM-IV is a book that provides the most accepted guidelines for distinguishing between various forms of depression. The DSM-IV describes Major Depression as a period of at least two weeks in which a person feels sad or empty, or does not have interest or take pleasure in things that used to be enjoyable. Other symptoms include significant changes in weight and appetite, over or under sleeping, being restless or slowed down, fatigue or loss of energy, excessive feelings of worthlessness or guilt, difficulties with concentration and decision-making, and recurrent thoughts of death or suicide. These symptoms last most of the day, nearly every day, and can be distinguished from the symptoms associated with medical conditions (e.g., thyroid problems) or bereavement.
Bereavement. While sometimes extremely painful, the grief felt in response to the loss of a loved one, technically speaking, is not a form of depression. A person who is experiencing grief usually does not require therapy, but eventually comes to terms with the loss with the guidance of their cultural support system. However, some grieving individuals may choose to seek additional support from a therapist to help relieve associated symptoms (e.g., insomnia). It is possible for a person to experience both bereavement and depression, in which case additional support is likely to be helpful.
Dysthymic Disorder. A person with dysthymia has many of the symptoms of Major Depression, though the symptoms tend to be less severe. The key feature of dysthymia is it’s chronicity – the DSM-IV says the symptoms must have lasted at least two years.
Bipolar Disorder. People with Bipolar Disorder experience the symptoms of Major Depression, but also experience periods of persistently elevated, expansive, or irritable mood. Despite sometimes being depressed, they may also sometimes feel “on top of the world” and become very active in pursuing pleasurable activities that are later regretted (e.g., buying sprees, sexual indiscretions). Other symptoms of feeling “keyed up” may include a decreased need for sleep, being more talkative or feeling pressure to keep talking, racing thoughts, and distractibility. These “manic” symptoms last several days at a time and can sometimes lead to hospitalization.
Seasonal Affective Disorder. When depression is tied to the winter months but resolves over the summer, it is possible that the person is experiencing Seasonal Affective Disorder (SAD). This form of depression is specifically linked to the winter months and is not better accounted for by changes in lifestyle (e.g., seasonal work).
HOW PEOPLE GET STUCK IN DEPRESSION
Sometimes depression can seem like a major struggle in a never ending battle. At other times, depression means not feeling like doing anything at all. The apathy drains out all motivation, and it’s hard to see the point of going on living. A person who is depressed is likely to give up, stop striving for anything, and can’t picture how the world could ever mean anything again. What remains is a desire for the pain and suffering to go away, to finally have some relief.
Because depression is so painful, we can become consumed with trying to get rid of it. We try to look on the bright side, find a silver lining, drink alcohol, use drugs, take prescription medications, exercise, sleep in, ruminate, read books, go to therapy, seek spiritual guidance, give up, and try all over again, desperately trying to make the pain go away. Unfortunately, our attempts to escape the suffering that comes with depression can actually backfire, leading to more of the very thing we were trying to escape. The problem is that focus on escaping the suffering can cause us to lose contact with the activities and people that connect us with a sense of purpose and meaning in life.