How to know if you are depressed or sad
For months he had believed his symptoms were nothing more than an expected reaction to the financial strain he was enduring. But after his wife insisted he needed help, he consulted me. What scared him was that he had started thinking that he was a jerk and that his family would be better off without him.
My patient was indeed suffering from clinical depression, but his belief that his suffering was just “normal” anxiety is widespread. To say we live in stressful times is an understatement. covid. The climate crisis. A country full of tensions and political discord. What is clear is that the world we live in has taken a toll on our collective mental health. Survey after survey shows us that we are stressed and that rates of depression and anxiety have skyrocketed.
Between 2019 and 2022, rates of anxiety symptoms in adults increased from 8 percent to 29 percent and rates of depressive symptoms from 7 percent to 23 percent, according to the Household Pulse Survey, conducted by the National Center for Health Statistics in partnership with the centers for disease control and prevention. Some of the steepest climbs have been observed among men, young adults, Asian Americans, and parents with children at home.
A quick look into our medicine cabinets is another gauge of our distress. In 2019, the CDC estimated that 15.8 percent of Americans were taking mental health medication; from July it’s 25 percent of us.
These are snapshot studies and it is too early to know if this increase in depressive and anxiety symptoms will lead to a surge in major clinical depression and anxiety disorders. But it’s never too early for people to wonder if they’re just stressed and sad — or clinically depressed.
Sadness is normal, but depression is not
It’s an extremely important distinction. Feeling distressed and sad is a normal and expected response to what we have endured over the past few years, including the social isolation and loss of life caused by the pandemic. It would be remarkable if we weren’t worried, anxious, or sad about what we’ve been through.
But unlike everyday sadness, clinical depression is never a normal response to stress or trauma; It is a serious medical condition associated with significant impairment in our ability to function in important areas of our lives – in relationships, at home and at work.
Major depression is common, affecting 17 percent of Americans at some point in their lives, and is a leading risk factor for suicide. It is estimated that 2 to 15 percent of people suffering from depression die by suicide. (This broad spectrum reflects the fact that depression ranges from very mild to very severe, and the risk of suicide increases with the severity of the illness.)
So how can you tell if you’re depressed or just plain sad?
First of all, depression is a syndrome that involves much more than sadness. Aside from a sad or flat mood, depression typically causes insomnia, loss of libido and appetite, social withdrawal, lack of energy, feelings of hopelessness and suicidal thoughts, feelings and actions.
Sad people are unhappy about a particular event, while depressed people feel down and lose confidence.
If you’re not sure, just ask yourself two questions: How often have you lost interest and enjoyment in the past few weeks? How often have you felt down or hopeless? You can check your score on this Patient Health Questionnaire. If your score is 3 or higher, there is a high probability that you are depressed and not just upset.
Depression is a medical illness
You may be wondering if depression is a medical condition, like high blood pressure or diabetes. But you should not do that. There is ample scientific evidence that clinical depression is associated with marked changes in the brain in circuits that regulate mood, sleep, energy and appetite.
Brain imaging studies have identified several regions where there is altered activity or structure in people with depression. For example, in people with more severe depression, there is a reduction in the size of the hippocampus, an area of the brain critical to learning and memory. The longer and more severe the depression, the greater the shrinkage of the hippocampus.
The notion that depression results from a chemical imbalance in a neurotransmitter like serotonin is simplistic and false. We know this in part because SSRI antidepressants like Prozac and Zoloft increase serotonin levels in the brain within hours — but generally take several weeks before relieving symptoms of depression. If depression were caused by a lack of serotonin, you would feel better within a day or so after taking an SSRI.
Depression is not a disease of a single neurotransmitter or brain circuitry, but rather a systemic disorder involving multiple signaling pathways and their associated neurotransmitters. For example, we know that after several weeks, SSRIs increase levels of a brain-derived neurotropic factor (BDNF) that promotes the growth and connection of neurons, and this timing corresponds to its antidepressant effects.
We don’t yet understand what causes the biological abnormalities in depression in the first place, but we believe they result from a complex interaction between genes and environmental stress. Still, we know a lot about how to treat depression. Both psychotherapy and antidepressants are highly effective for depression. Brief psychotherapies such as cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are empirically proven treatment methods for depression. CBT helps people identify the wrong and distorted thoughts caused by depression and then challenge and correct them, thereby reducing stress. And IPT focuses on restoring interpersonal relationships disrupted by depression.
Therapy and antidepressants are most effective
Psychotherapy is a first-line treatment for people with mild to moderate depression, but when the depression is severe, meaning there are either psychotic symptoms or suicidal thoughts and feelings, then a combination of therapy and antidepressants is the safest and most effective approach.
Antidepressants are not a treatment for everyday unhappiness or stress. Antidepressants will not make you happier unless you have some form of clinical depression with the biological changes that accompany it. Misusing antidepressants to treat normal conditions would be like using an antibiotic to treat a cold that is caused by a virus and is not susceptible to an antibiotic.
Exercise also has significant antidepressant effects, apart from increasing energy and keeping you physically fit. In addition to the known release of endorphins, increasing your cardiac output through exercise triggers the release of BDNF, something exercise shares with SSRI antidepressants.
Social connections, which are often disrupted by depression, are critical to treating depression. I urge patients to keep in touch with friends and family as we are social animals and seek comfort and support from loved ones.
In addition to drugs, brain stimulation therapies such as electroconvulsive therapy (ECT) and, more recently, transcranial magnetic stimulation are very effective in treating depression.
There are promising new antidepressant drugs such as ketamine, esketamine, and psilocybin that provide rapid and sustained antidepressant effects within minutes to hours of administration. These drugs also produce rapid neuroplastic effects, effectively “rewiring” the brain.
My patient was surprised – and relieved – when I explained that he was suffering from major depression and not everyday sadness and anxiety. I started on an SSRI antidepressant and saw him for weekly supportive therapy. His sleep and appetite improved within the first week, and by the end of three weeks his anxiety and catastrophic thinking were gone. “I react to stress like my old self did,” he said. “No more darkness and doom.”
Everyday sadness is universal and will pass on its own. But depression is a potentially serious and treatable condition that should not be confused with sadness.
People often blame their depressed mood on a troubling aspect of the world, such as the state of the economy or politics. Another patient of mine insisted that he was anxious and depressed about the negative impact the economy was having on his business. After successful treatment, however, he said: “The world is the same, but my reaction to it has changed. I thought the sky was falling and now I know that was wrong.”
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