Overall, as a culture we sometimes tend to shy away from difficult topics. We may not share our struggles with others for fear of “burdening them” or we may subscribe to toxic positivity in an attempt to avoid facing the difficult things in our lives. In my work as a clinical therapist, I’ve found that we live our most positive and MEANINGFUL life when we are able to identify and work through the inevitable difficulties that come with being human. If we avoid difficult emotions, they come out sideways in unhealthy behaviors. Depression is a topic that can be difficult to discuss– but the outcomes can be dangerous if avoided.
If you’re someone who is well acquainted with depression, you’ll probably echo my statement here that depression isn’t just an extended form of sadness. Yes, sadness that doesn’t resolve over time can lead to depression, but depression actually presents itself in many forms, including sadness but also encompassing a sense of numbness, loss of interest in the things you once enjoyed and sometimes even agitation. Depression can result in agitation toward others and, interestingly, anger turned inward toward oneself. In fact, a psychologist named Aaron Beck, who was one of the early contributors to cognitive therapy, found that some depressed patients engage in self-blame, self-criticism, and self-dislike to the point of self-disgust and self-hatred. This identity struggle can become self-destructive because when you’re depressed, you already don’t feel like the best version of yourself. Some people have even described their depressive state as feeling like a “shell” of themselves.
Depression is hard, and experiencing it or loving someone in the throes of it can leave us feeling helpless. Sometimes we enter into a state of depression so slowly that we don’t even realize we are depressed. We go through the motions for so long that we don’t realize that the enjoyment of life is hard to find. We may feel as if we’ve lost ourselves and yet we don’t have the tools to “find ourselves” again. The first step in walking through a depressive season is identifying that you may be depressed.
The main guidebook practitioners use diagnostically in determining depressive episodes (and other mental health challenges) is called the DSM- V. It stands for the Diagnostic and Statistical Manual of Mental Disorders. It’s not a perfect resource but it’s been well-researched, revised many times (hence the 5th edition) and it can be immensely helpful in noticing patterns.
According to the DSM V, for someone to be diagnosed with a major depressive episode, they have to exhibit certain characteristics. Just like you recognize a cold by a runny nose, congestion and a sore throat, these “symptoms” of depression are what we look for in helping clients understand what they are dealing with —- so that they can get the appropriate treatment.
In order to be diagnosed with a Major Depressive Disorder, an individual must have 5 or more of these symptoms present for at least 2 weeks (and it must not be the result of substance use or another mental disorder):
Depressed mood
Most of the day, nearly every day; may be subjective (e.g. feels sad, empty, hopeless) or observed by others (e.g. appears tearful); in children and adolescents, this can be irritable mood.
Loss of interest/pleasure
Markedly diminished interest/pleasure in all (or almost all) activities most of the day, nearly every day; may be subjective or observed by others. I think it’s important to note that depressed mood or loss of interest in things you once enjoyed are required for a diagnosis of major depressive disorder. These other factors may or may not be present (any combination of 5 or more constitute a diagnosis) but depressed mood or loss of interest in the things you once enjoyed must be present.
Weight loss or gain
Significant weight loss (without dieting) or gain (change of >5% body weight in a month), decrease or increase in appetite nearly every day; in children, may be failure to gain weight as expected. Some people eat less when they are depressed, other’s eat more as a way to seek enjoyment in a difficult time. The key here is that your appetite and eating habits are different than your normal.
Insomnia or hypersomnia – In simple terms, this means not sleeping or sleeping all the time. This can include sleeping to escape from life on a regular basis. We all have moments when we feel like we just need a “do-over” and a good night’s rest will help. However, if we are repeatedly curling up in bed to avoid our daily activities, we may be “sleeping to escape”, which can be a sign of depression.
This insomnia or hypersomnia, per criteria, needs to be happening nearly every day – Do you notice a pattern here? Depressive symptoms are not so much about one specific extreme or another but rather just being on AN extreme end of the spectrum compared to your baseline. Eating a lot or a little, sleeping a lot or not enough…
Psychomotor agitation or retardation
Essentially this means moving very fast or very slow. Some people I know have described their depression as feeling like they have lead feet. This needs to be happening nearly every day and observable by others (not merely subjectively restless or slow).
Fatigue
Or loss of energy, nearly every day. This isn’t connected to a physical reason, you just find that you don’t have the energy to do the things you want to do.
Decreased concentration
Nearly every day; may be indecisiveness; sometimes depression can feel like your brain is working so hard just to get through the day, any extra decisions seem overwhelming and unnecessary. Decision fatigue doesn’t always mean you’re depressed, but when you’re depressed you often have decision fatigue.
Thoughts of death/suicide
This can be hard to talk about… but recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without specific plan, or suicide attempt, or a specific plan for suicide are cause for concern.
Listening to people’s stories for the past 15 years, I’ve come to see that someone has to be in an immense amount of pain to consider ending their life… we simply can’t judge their decision as “selfish”. Their pain is real and valid but that pain doesn’t go away completely when they end their lives— it transfers to the survivors. Most people who consider suicide actually believe the lie that their family and friends would be better off without them. Every family I’ve ever counseled after a family members suicide has confirmed this is NEVER the case. However, if you start hearing this kind of talk from others or your self-talk begins to head in this direction, please please call the National Suicide hotline: 800-273-8255
Feeling worthless or excessive/inappropriate guilt
Nearly every day; guilt may be delusional and not appropriate; not merely guilt about being sick or depressed, which also happens and can send folks into a spiral of shame about feeling depressed, which hinders getting help. In these spirals the depression can feel like a bottomless pit— thoughts like “I’ve already cost my family enough time and energy, I don’t deserve to invest time in myself in the form of therapy.” This just simply isn’t the case and the fog of depression can limit us from seeing the long-term effects of getting help.
Paradox of Getting Better
Getting help for depression or any mental illness can seem paradoxical because our ability to live in the life we want is directly proportional to our willingness to experience it’s opposite:— To get healthy, we must first come to terms with the fact that we are sick, facing your depression will have you feeling broken at first when it’s actually the first step toward healing. Taking time to invest in yourself will have you feeling selfish when it’s actually equipping you to be fully alive to serve and help others. Sometimes reaching out is the hardest thing you can do and it takes the last bit of energy that you have left, but it can lead you to healing that will provide you with energy to live your life fully alive.
Perhaps you recognize yourself or someone you love in some of these symptoms. It takes energy and intentionality to reach out for support- whether that’s to a friend, a pastor, or a family member, but reaching out for support is the first and most crucial step. Reach out to someone who will validate your pain and not tell you “its all in your head” or that you should just “pray harder.” Knowing that you’re not carrying this all alone can lift off some of the heavy burden of depression. I encourage you to hold close to your heart the truth that “God is near to the brokenhearted”– allow His love to dissipate the lies you may believe that God has abandoned you or that He will heal everyone but you. There is healing to grasp and it’s here…for you, today. Take our free assessment to get started.
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