Depression is the leading cause of disability in the world. Close to 10 percent of the US adult population suffers from the disease. Because it is a mental illness and not an observable disease, it’s less tangible than something like high cholesterol, and much less intuitive. One of the greatest sources of confusion is the difference between depression and being depressed.
It is safe to say that almost everyone has felt depressed at some point or another. A bad grade, losing a job, having a fight with a significant other, a rainy day — any of these can spur a bout of sadness. Sometimes there’s no apparent cause: it just happens out of the blue. And then the circumstances change, and the sad feelings stop. Clinical depression is different.
First, it’s a medical disorder that you cannot will out of existence because circumstances change. It involves symptoms like a low mood, loss of interest in hobbies, changes in appetite, feelings of worthlessness or excessive guilt, sleeping too much or too little, poor concentration, being restless or sluggish, low energy, or recurrent thoughts of death or suicide. If you have five or more of those symptoms, the diagnostic criteria say you have depression.
But beyond the behavioral symptoms is the functioning. Depression is an internal, physical occurrence, within the brain. First of all, there are gross structural changes that can be seen, for example, if you had X-ray vision and could zoom way inside the brain, you would see a smaller frontal lobe and smaller hippocampal volumes. On a smaller scale, there is a cascade of things associated with depression: neurotransmitter abnormalities, for example: abnormal transmission or depletion of serotonin, norepinephrine, and dopamine, blunted circadian rhythms (think sleep issues), or very specific changes in the REM or slower wave part of your sleep that your Fitbit would track, and hormone abnormalities, like high cortisol and deregulation of thyroid hormones.
So we know that, but the complexity of the interplay between genes and the environment is such that we don’t yet understand what drives depression as a disorder. We don’t have a diagnostic test that allows us to anticipate where or when it will turn up, because even though we know, in theory, how mental illness works, we can’t yet predict how it will manifest. It’s also hard to know who might look fine but is in desperate agony because these symptoms aren’t objective. According to the National Institute of Mental Health, for the average person suffering from a mental illness, getting help is more than 10 years away.
But there are effective treatments. Medications and therapy complement each other to boost brain chemicals. In severe cases, electroconvulsive therapy, like induced seizures in the brain, is a very effective treatment. Other treatments in the pipeline, like transcranial magnetic stimulation, are being studied as well. All of this is important to understand, especially if you know someone with depression.
If you can, gently urge them toward some of these options. Offer to help with specific tasks, like looking up therapists in the area, or making a list of questions to ask a doctor. These initial steps can feel overwhelming to someone with depression. If they feel guilty or embarrassed, remind them that depression is like a medical condition, analogous to asthma or diabetes. It’s not a weakness, it’s not a character flaw, and they should stop expecting that it will magically get better.
If you haven’t suffered from depression, don’t compare what they’re going through to a normal bout of the blues.
Comparing these suicidal thoughts to normal, grief-like sadness can make sufferers feel guilty. Even just talking about it can help. Research shows that discussing suicide actually lowers your suicide risk. Open conversations about mental illness reduce stigma and make it easier for people to ask for help. And the more patients ask for help, the more we’ll learn about depression. The better the treatments will get.