Is It the Blues or Is It Clinical Depression?

By Alex Dimitriu, MD

We all feel down, or blue, or sad, at times. Sadness is a natural human emotion, usually triggered by a loss, disappointment, or major life change. This sadness is generally short-lived and dissipates over time as we adjust to a new situation. We often casually refer to this situational sadness as depression, but it is important to distinguish it from clinical depression, a much more severe and long-lasting condition that has serious implications for long-term mental and physical health and must be diagnosed and treated by a medical professional.

Situational sadness following a traumatic event is characterized by feelings of listlessness, frequent crying, anxiety, trouble sleeping, and withdrawal from family and friends. Clinical depression, also called major depressive disorder, may develop as a consequence of failure to recover from an episode of situational depression but more often it is not triggered by a difficult life situation and occurs without a precipitating event. In fact, the individual may acknowledge that life is stable and tranquil and yet feel unrelentingly sad – unable to find pleasure in normally enjoyable activities and close relationships.

Clinical depression typically involves a change in brain chemistry that makes it difficult to maintain mood stability. The precise cause isn’t known but may be triggered by a combination of genetic predisposition and stress. Certain medical conditions and medications as well as alcohol and drug abuse have also been linked to depression.

One key distinguishing feature with depression is almost the opposite of wearing “rose tinted glasses”. To a depressed person, their situation may seem hopeless and it so important to realize how this is very much a part of the condition. When people are truly depressed, they do not see a way out, and there is no hope of getting better. This can be quite a barrier to care, and I often encourage my depressed patients to “let someone you love, do the driving”, with respect to starting and sticking to treatment, and gauging improvement. The hopelessness of untreated depression can be quite substantial. Thankfully, this improves markedly with treatment.

A formal diagnosis of clinical depression is made by a doctor based on specific symptoms over a defined period of time. The diagnosis is based on five or more of the following symptoms being present severely enough to interfere with daily activities nearly every day for a period of two weeks:

• Deep sadness or irritability most of the time
• Loss of pleasure in previously pleasurable activities
• Significant loss of appetite or overeating; changes in weight
• Inability to sleep or sleeping more than usual
• Excessive fatigue or loss of energy
• Feelings of worthlessness or guilt
• Difficulty concentrating or making decisions
• Recurrent thoughts of suicide or harming oneself

Many of the symptoms of situational sadness and clinical depression are similar. The difference is in their severity and duration, with or without a precipitating event. The danger in confusing them is in overreacting to sadness or, more important, in neglecting to seek medical help for clinical depression, a serious mood disorder that seldom resolves without treatment.

Situational sadness may resolve on its own over time or may be helped with lifestyle changes, such as improved diet, exercise, and sleep habits, or with professional help from a therapist or support group. Clinical depression requires longer-term and more in-depth treatment, even hospitalization in severe cases. Generally, it is treated with a combination of antidepressant medication and psychotherapy.

It is crucial both for the individual suffering from clinical depression and for family and friends to understand the disorder. Feeling hopeless and being unable to ‘snap out of it’ are characteristic and can make the likelihood of recovery seem remote. But depression is a common illness with many proven treatment options. With the help of experienced mental health professionals and by sticking to their treatment plans, millions of people have recovered successfully.

Alex Dimitriu, MD, is double board-certified in psychiatry and sleep medicine and is the founder of the Menlo Park Psychiatry and Sleep Medicine Center in Menlo Park, CA. http://www.doctoralex.com