Depression - The Black Stuff
Major depressive disorder is also known as major depression, clinical depression, or unipolar depression.
The term unipolar refers to the presence of one pole, or one extreme of mood - depressed mood. This may be compared with bipolar depression which has the two poles of depressed mood and mania (i.e., euphoria, heightened emotion and activity).
Different people are affected in different ways by major depression. Some people have trouble sleeping, they lose weight, and they generally feel agitated and irritable. Others may sleep and eat too much and continuously feel worthless and guilty. Still others can function reasonably well at work and put on a "happy face" in front of others, while deep down they feel quite depressed and disinterested in life.
There is no one way that people look and behave when they have major depression. However, most people will either have depressed mood or a general loss of interest in activities they once enjoyed, or a combination of both. In addition they will have other physical and mental symptoms that may include fatigue, difficulty with concentration and memory, feelings of hopelessness and helplessness, headaches, body aches, and thoughts of suicide.
For those who have recurrent episodes of major depression, the course of the illness tends to vary. Some people experience bouts of depression separated by years between episodes in which there are no symptoms.
Others may have periods of several episodes. Still others may have more and more occurrences as they age.
The development of major depressive disorder may be related to certain medical illnesses. As many as 20%-25% of those who have illnesses such as cancer, stroke, diabetes, and myocardial infarction are likely to develop major depressive disorder sometime during the presence of their medical illness. Managing or treating a medical condition can be more difficult if a person is also clinically depressed. The prognosis for the medical problem may also be less positive.
It has been shown that other mental health conditions may often co-exist with major depressive disorder. Some of these are alcohol/drug abuse, anxiety and panic disorders, obsessive-compulsive disorder, eating disorders, and personality disorders.
So what does all that mean?
Please note I am not a medical professional and all I am trying to do here is give you an idea of what depression has been like for me only - someone else may have a completely different view.
Depression is an insidious disease which colours the way you see everything and everyone in your life. I liken it sometimes to wearing dark sunglasses - everything is tinted black, there are shadows everywhere and no matter what you do, you can't take the glasses off. I tend to sleep a lot, sometimes all day and all night, my body feels physically tired and I feel slow, as though everything is in slow motion and/or heavy, like I am moving through thick liquid.
It's hard to describe just how completely depression affects your life. Every single thing has been coloured. There's no hope and no light. I lose interest in all activities; things I used to enjoy doing become hard to do, and I just don't want to do them. It's like being at my wit's end, with no options. "What's the point?" is not just an excuse, when I'm depressed, it becomes a valid question, because nothing at all has any point anymore.
I tend to retreat to my bed a lot when I’m in the midst of depression. There just seems to be something comfortable and safe about bed – snuggling under the covers and ignoring the world. I know when I start to sleep too much, it is one of my warning signs that I may be going to have another episode. I find myself avoiding life, people, the world, in any way I can.
Luckily, there are many great treatments, therapies and medications for depression out there, and we do not have to suffer in silence any longer. If you feel you or a friend might be depressed, or are thinking of suicide, please reach out to someone - there is help out there. Those sunglasses colour your world, but that's not the truth, only how it looks for a while. There is hope.
The Scientific Stuff
DSM IV Criteria for ‘Major Depressive Episode’
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
(4) insomnia or hypersomnia nearly every day
(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
(6) fatigue or loss of energy nearly every day
(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
B. The symptoms do not meet criteria for a Mixed Episode.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism)
E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
DSM IV Criteria for ‘Major Depressive Disorder’
Single Episode:
A. Presence of a single Major Depressive Episode
B. The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.
Recurrent:
A. Presence of two or more Major Depressive Episodes.
Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode.
Getting Help
If you suspect you or a loved one has depression, or are thinking of suicide, please, please, please, talk to someone. It could be your family doctor, a helpline, a teacher/adult/parent, or a good friend. There is a lot of very good help out there and we do not have to put up with feeling this way. It’s not your fault that you are depressed – and no one will blame you. It’s simply an illness, one of those things that happens, and fortunately, it’s treatable. Please don’t be ashamed. You are not weak or a horrible person for feeling this way and having these thoughts. You are an amazing person and you deserve to be helped.
For more resources on Mental Health, please click HERE to go to the Mental Health Resources page on this site.
Blessed Be...