(Approx. 5 min read)
The information on this page is not intended to diagnose or to replace professional help. If you are experiencing a life-threatening emergency, dial 911 immediately.
Depression is probably the most commonly used mental health term in day-to-day conversations and pop-culture alike, or at least some derivative of it. For example, "I'm so depressed today!" or "Ugh! Why is my mom so bi-polar?!". And, given that many people suffer from loneliness, guilt and grief around the holidays, it seems like the perfect topic to write about for my first blog post of the new year. Consider this an introductory post about depression and keep an eye out for a future post discussing some of the more advanced aspects of this issue. I also want to be clear that the discussion below is focused on moderate to mildly-severe depression and not the severe and disabling depression that some people experience.
Because the term "depression" is so commonly used, I first want to talk about what depression is not. Depression is not feeling sad. Feeling sad is a healthy and necessary part of the human experience. We can feel sad because the next episode of Game of Thrones won't come out for another year or we can feel sad because someone that we love died. Note the hyperbole here. Wanting to see the next episode of your favorite television show and losing a loved one are obviously two very different types of "being sad", but neither is necessarily depression. So, if even losing someone you love doesn't necessarily mean you have a clinical mental health issue, what does? In short, time and interference.
Time: Anybody who loses a loved one will feel sad and will likely grieve (as a professional, I would actually be more worried about someone who isn't grieving than someone who is), but the question here is for how long? When faced with painful situations like loss, chronic physical pain, or being let go from a job, many people will sleep, too much or too little; others will eat, too much or too little; others still will work, too much or too little. But, when working with someone in this situation, I would ask "For how long have you been sleeping, eating or working, too much or too little?" There are some common periods of time that a therapist will use to decide whether a person has a clinical issue, but these can vary from culture to culture. The length of time that you feel sad has a lot to do with whether or not you have depression.
Interference: The question here is whether or not the way this person is coping with the sadness is harmful to themselves or others. One thing I can count on when working with a client is that when they mention using alcohol or other drugs, they seem to feel like they have to explain that "I only drink two beers and I never drive!" or " I smoke pot but it's not a problem!" Well, I'm going to be very clear: using substances does not make you an "addict" and even using substances to deal with sadness or anxiety doesn't necessarily make it a problem. There. Do you feel better now? Well, don't get too excited because although many people can use a substance in a healthy way, people who use them to cope with their emotions are definitely at risk of addiction and/or depression. The point I'm trying to make here is that the behavior you are engaging in to deal with your sadness, whether it be smoking marijuana, sleeping, staying away from people, or working, can easily cross the line to being harmful. Are you sleeping so much that you get in trouble because you don't show up to work or school? Are you starting to lose friends because you don't hang out with them anymore? Is your alcohol or marijuana use starting to cost too much money or putting you in dangerous situations? Have you started abusing the prescriptions that your doctor gave you? The level of interference of things that you do to cope with your sadness is indicative of whether or not you have depression.
I want to tell you something else that you may not expect to hear from a therapist. More people than you may think have thoughts about death and even fantasize about no longer living and there is a big difference between having thoughts about death and having a plan to harm yourself. Still, if you are having thoughts about no longer living, I strongly suggest you reach out to a professional as this can be a strong indicator of depression.
So what should you do if you think you are struggling with depression? I'm obviously biased towards seeking professional help, especially because of the relationship that clinical depression can have with suicide, but some of the general points I work to help clients get to are:
Know when to reach out. If you are having thoughts around hurting yourself, seek help or call 911 immediately.
Find the things that are okay in your life and spend as much time around them as possible.
Understand the processes that are taking place inside you. Depression is a series of chemical and biological processes and not your choice but with patience and help, you can influence these processes.
Don't believe everything you think. In some ways, your mind has turned against you. It has a condition where it will focus on what is not okay in the world and in yourself and it will do mental gymnastics to keep you feeling blamed, ashamed, guilty and hopeless.
Depression is not just a feeling, but a chemically-fueled series of thoughts, feelings and actions that create a downward spiral.
Try doing the opposite of what you feel. If you feel like you're a bad mother, hug your kids. If you feel hopeless, bake cupcakes with rainbow sprinkles. Simple actions can cause a shift upwards in the cycle of depression.
Work to have curiosity and compassion for yourself, and when you're done doing that give yourself more curiosity and compassion! Try to accept that this is where things are but that doesn't mean they will always be like this. Pain always whispers two big lies to us: "You are the only one" and "this will never end". But you aren't alone, millions of people are struggling with depression. And, when was the last time that any feeling or thought stayed forever, including happy ones?
Stop trying to be happy. Accept where things are so that you can begin to make realistic changes that may help.
What works? Mindfulness-based clinical approaches and Cognitive-Behavioral Therapy (CBT) can be as effective as medications for depression. In cases where the person is struggling with severe depression, medications may still be needed. CBT-based family therapies can also be very effective for depression, especially for adolescents who are struggling. All these fancy clinical treatments really have only one goal in mind: To help the person who is struggling to get a basic foothold so that they can see just a little bit out of the hole that they feel they are in. Once they get there, they can pull themselves out and get back into the life that they want to live.
Good treatment for depression is long-term and it works on dismantling the thousand-thread knot that has taken up residence in a person's mind, heart, and body. That "curiosity and compassion" that I mentioned above goes a long way in helping a loved one and in helping ourselves. When it really comes down to it, the ultimate healing from depression is a sense of humanity in ourselves and a sense of humanity in the world, and therefore hope for ourselves and hope for the world around us. For those who struggle with depression, this only comes incrementally and with time.
Note from the author: I am the executive and clinical director of Thrive Counseling in Albuquerque, New Mexico. I would like to thank Lindsey Barela for editing this article and for supporting me as I attempt to put what's in my brain out into the world!