What is Depression?
Clinical depression is a medical illness which constitutes an emotional state of dejection and sadness that affects a person’s mood, mind, body and behaviour. We all feel sad (even despair) as well as struggle with the meaning of our lives and our sense of worth from time to time, but clinical depression disrupts a person’s work performance, social life, family relations and often leaves the person incapacitated when it comes to participating in daily living activities. For some people who experience mild episodes, functioning may not be as severely impaired, but it requires a substantial effort on their part to sustain normal day-to-day living. An episode of clinical depression may last anything from a few weeks to a few months, but dystymia, a milder but more chronic form of depression, can last for years.
Clinical depression is most commonly known as a disturbance in mood which is distinctly different from one’s normal level of functioning, and which manifest in a persistent sad or sorrowful mood (often accompanied by constant tearfulness for no reason) and/or a marked loss of interest or pleasure in previously enjoyed activities (including sex). However, in children and adolescence it may be solely an irritable mood and in some cultures depression may be experienced mainly in somatic symptoms such as unexplained and persistent headaches, nausea, stomach pain or backache.
Clinical depression consists of a cluster of symptoms which often vary from person to person in degree and manifestation.
The biological markers include unintentional changes in sleeping and eating patterns, levels of energy and psychomotor activity. Sleeping too much, insomnia, waking up in the middle of the night and difficulty in falling asleep are possible signs of depression. A sudden loss or increase of appetite resulting in either weight loss (while not dieting) or weight gain is another possible clue that something is amiss. Tiredness, lack of energy and a noticeable slowing down in responsiveness (sometimes the reverse is true with agitation being the symptom), speech and body movement, occasionally culminating in an almost catatonic state leaving a person paralysed when it comes to participating in life, are other indicators. These physical symptoms may cause a person to feel overwhelmed and often lead to neglect in self-care, personal appearance and responsibility.
Cognitively, depression affects a person’s memory, ability to concentrate, think clearly or make decisions. Psychologically a person may experience feelings of worthlessness, helplessness, excessive and inappropriate guilt, exaggerated self-blame, low self-esteem and shame. These symptoms often manifest in ruminative negative thoughts and may in some instances take on delusional proportions, such as a conviction or belief that they are responsible for something that is clearly none of their doing. These factors directly erode the person’s sense of self and being in the world. Contrary to common fallacies, a sufferer cannot simply snap out of it, pull themselves together and change their attitude to a more positive one. Another popular myth surrounding depression is that the sufferer is simply lazy and lacks motivation or drive. It is true that a person’s drive is affected and there is a loss of vitality, but this is not by choice and is severely distressing to the person experiencing it. The person may feel unwanted, lonely (even amidst loving, nurturing relationships) and disconnected from other people. This often leads to a withdrawal from people and society (such as not leaving their room much) and social isolation. The hopelessness people may feel, doubt as to whether they may ever recover or that things may improve, while they find themselves in this unbearable painful state, often leads to thoughts of death, dying and ending it all – some succeed. Warning signs are expressions of suicidal thoughts, which need to be taken seriously.
Clinical depression is at the extreme end of normal feelings and responses in the face of stressful life events and loss. In the case of an identifiable stressor and a less disabling impact on a person’s life, the diagnosis of adjustment disorder may be more appropriate. Divorce, bereavement, illness, loss of job, stressful pregnancy and/or childbirth and relocation are amongst the external stressors which may erode a person’s natural resilience. On a less tangible level, a loss of sense of self, dreams and hopes may slowly and insidiously erode a person’s well-being which may eventually culminate in a depressive episode. Sometimes people find themselves entangled in relationships (either unsupportive or abusive) and circumstances (such as poverty or unemployment) that do not affirm their sense of self and being-in-the-world, but adversely affect their dignity, self-respect, self-esteem and sense of mastery. This often leads to increase in low mood and feelings of meaninglessness which, when they persist without intervention, may spiral into a full-blown clinical depression.