Symptoms of Depression | Paul Hutchinson, Ph.

Understanding Depression

Depression: Symptoms, Patterns, Causes, and Treatment

Depression can be confusing and extremely painful. This article is intended to give you some information on depression and the signs of depression to help you understand it better, and to give you some ideas for what you might do about it.

Depression is tied to all the workings of human emotions, which are quite complicated. It is affected by the current events of your life, by your life history, and by your biology.

Everyone has experienced what it feels like to have a bad day or a bad week, typically with feelings of sadness, frustration, loss of motivation, and of getting less pleasure out of life. Depression is what happens when these feelings become extreme, or when they stay with a person as a constant companion over long stretches of time.

The Symptoms of Depression

We use the term "Clinical Depression" when there are a number of symptoms that make it clear that the depression has gotten quite serious. As depression gets more severe, it begins to show itself in physical symptoms as well as emotions. The clinical depression symptoms that therapists look for to assess the seriousness of depression are these:

Has your mood been low or depressed most of the day nearly every day, for at least two weeks?

Have you been a lot less interested, or getting a lot less pleasure from most of the things you used to enjoy?

Have you lost your appetite or your interest in food, or have you been losing weight without trying to? (Or, your eating and weight may go up, especially if you know that you eat when you feel bad.)

Has your sleep been disrupted? Most people sleep more poorly when depressed, often lying awake, or waking up in the early morning. Other people sleep much more than usual when depressed, sometimes sleeping 12 or 14 hours a day.

Have you felt tired or low in energy almost all day nearly every day?

Do you have more trouble than usual thinking or concentrating, or making decisions?

Do you feel down on yourself most of the time, perhaps feeling worthless, feeling guilty, or feeling like a failure?

Do you feel physically slowed down, enough that other people have noticed? Or, some people find themselves wound up and agitated, like they can't sit still.

Do you find yourself thinking again and again about death, or about suicide?

The official way that therapists and physicians diagnose depression is to ask whether you have at least 5 of the 9 symptoms listed here, and whether you have been having those symptoms for at least two weeks. If so, then you have what we call "Clinical Depression," and that is something to take quite seriously, and you may want to consider seeking treatment.

There are some other experiences that often go along with depression, even though they aren't on the official diagnostic list. These include:

Feeling hopeless about the future.

Finding that negative thoughts and memories come to mind all the time, and that positive thoughts and memories are rare.

Feeling irritable, and quick to anger at anything and anyone.

Being tearful or close to tears much of the time.

Losing interest in other people, sometimes with the thought that you don't want to talk to other people because you don't think they would understand.

How Depression Usually Progresses

Serious clinical depression typically comes in "episodes," during which a person is depressed for several months and then gets better. Without any treatment, an episode usually lasts 6 months to a year, and then the person will return to feeling more or less normal. So, one way that depression often works is that a person feels depressed for several months, then feels better for a year or several years, and then depressed again for another "episode."

What we call "moderate" clinical depression feels quite severe and quite painful. What we call "severe" clinical depression can involve feeling so bad you can't get out of bed, can't get yourself to do anything, and can't think of much besides suicide. If you find yourself in circumstances like this, and especially if you are considering suicide, get professional help as soon as possible. You should know, and remind yourself, that it is very likely that you will be able to feel much better than this. This is true even though your depression may make you feel hopeless, and you may be afraid you will never feel better.

For some people depression seems more chronic than episodic. Instead of periods of depression alternating with long periods of feeling better, the depression may go on for years. This version of depression is called "persistent depressive disorder."

The Causes of Depression

There are three things that combine to cause depression. Those three things are the current events of your life, your genetic vulnerability to depression, and your life history. I'll describe the role of each of these.

Losses and stressful events in a person's current life can cause deep sadness, grief, anxiety, and other painful feelings. There is also good research to show that adjusting to life's changes is stressful, and that emotionally significant losses are particularly hard on people. That could include a death, the loss of a relationship, or the losses that go with a life change like moving to a new place. Difficult ongoing events can also contribute to depression, such as a steady grind of stress, loneliness, and overwork.

The second important factor is your biological wiring for depression. We know that depression runs in families (even when we can factor out the effect of parenting), and it appears that some people are genetically more prone to depression, and others are more genetically resistant to depression. Your biology and your brain chemistry fall somewhere on this continuum, from being resistant to depression to being prone to depression. But even if you are biologically prone to depression, treatment can usually make is so that you don't have to spend your life depressed.

The third factor in depression, your life history, is very important, and is an area in which therapy can make a crucial difference. All the important events of your life leave emotional memories and emotional reactions behind. This is especially true of painful events and traumatic events, but it also true of the events of ordinary life. By the time someone is an adult, many of their painful emotions may be caused not by current events, but by the way that current events stir up old painful emotions. This is especially true of fears. Fear is not really a reaction to what just happened; it is a reaction to what might happen next. For example, fear of failure, of loss, or of abandonment are generally fears from the past casting a shadow across the present. In a similar way, traumatic events in the past bring up painful feelings in the present whenever there is a vivid reminder, because any memories that come back to mind bring painful feelings with them.

The other way that your history influences depression in the present is through your choices. Many people find themselves repeating unhealthy patterns, in relationships, in their professional lives or in other arenas. This can make your current life lonelier and less successful, and that contributes to depression. The way out of patterns like these is to understand them deeply in a way that allows you to make different choices.

Treatment for Depression

The primary treatments for depression are psychotherapy and medication. Once you are in the midst of a depressive episode, your brain chemistry changes. Medication can be helpful in shortening a depressive episode. Medication is also helpful at keeping depression from coming back. However, it is far from a perfect solution. First of all, it only helps while you are taking it. Second, for most people medication makes them feel better, but doesn't completely relieve the depression. People often feel better than they did, but not as good as they want to.

Therapy for depression involves working to change your emotional patterns, your thought patterns, and the way that you make choices, so that your life will work differently, and depression is less likely to return. Emotional pain can often be reduced by deeply exploring its sources and working to resolve them. Patterns in choices and in your ways of thinking about things can be changed by exploring and understanding what is happening, allowing you to make choices differently. For more information on the effectiveness of these approaches, see my article on The Effectiveness of Therapy.

Another important strategy to consider is exercise. During a depressive episode, it is almost as if many of the body systems are slowed down and are not functioning well. There is good research that regular, vigorous exercise counteracts this. Several research studies have found that exercise is almost as effective as medication at shortening a depressive episode. Vigorous exercise three or four times a week is best, but even regular brisk walking helps. Of course, if you are struggling with listlessness and low motivation it may be hard to get yourself to exercise, but if you can get yourself to do it, it is likely to help. It typically helps a person feel somewhat better immediately, probably through the release of endorphins, but also helps the depression lift over a period of a few weeks.

Paul Hutchinson, Ph.D.