What are the symptoms of depression?
How does a depressed person feel?
Depression has a very wide variety of symptoms and each individual shows a different pattern. Generally speaking, these people usually have been sad for prolonged periods without obvious cause. The onset of depressive symptoms is usually very slow and insidious so a person doesn't realize that they are slowly sliding into depression. They just gradually adjust to an ever worsening mood and assume that they are reacting normally to life's circumstances. The onset of depression is often during the teen years but at that time the symptoms may dismissed as just an "adolescent phase".
In my clinic, after someone has recovered from depression, I always ask them when was the last time they had felt as well as they did after treatment. The answer is commonly, "I have never felt this well in my life" or "not for at least twenty years." This was a shock to me in my early years but it illustrated how gradually the condition takes hold and how people just get used to being depressed.
They lose interest in most activities of life which previously gave them pleasure. They feel defeated, useless, hopeless and unworthy of anyone's love or forgiveness. They consider themselves to be a failure. Plagued by guilt, they condemn themselves for not being able to "snap out of it". Some have increased irritability and will attack everyone around them as the likely cause for their unhappiness. They find it hard to relax or ever feel content. There is a diminished interest in sex or any kind of intimacy.
Depressed people often have great difficulty falling asleep due to persistent and uncontrollable racing of unpleasant thoughts or worries through their mind. Many will awaken at four a.m. and will be unable to fall asleep again because of the same racing of thoughts. Others oversleep and use it as an escape from an unpleasant reality. Concentration on work, pleasure or reading becomes impossible while struggling with the continuous stream of unpleasant and depressing thoughts which cannot be kept out of the mind. When reading they will see the words but have to reread the sentence many times before understanding what was said. It is hard for them to keep their minds on anything. Their memory seems to fail and it becomes very difficult to finish any project due to fatigue or lack of interest.
Figure 3:
Chemical imbalance prevents the Mood Control Centre from restoring normal mood so thoughts slide into depression.
Fatigue becomes overwhelming in eighty percent of depressed people. Daily responsibilities which were previously easy and pleasant are seen as enormous undertakings. Everything becomes such an effort that all activities are avoided. A depressed person also finds it very hard to make decisions since their self confidence is so low and concentration is so impaired. Anxiety becomes a continuous thought pattern which cannot be turned off. The depressed person will worry about everything, even tiny details of life which never before attracted their attention. Fifty percent of depressed people can't stop worrying. Intense fear and worry may induce unusual behavior patterns like repetitive hand washing to rid themselves of a sensation of being dirty. This is also known as Obsessive Compulsive Disorder (O.C.D.), see chapter 14.
There may be a preoccupation with body symptoms and frequent visits to doctors with complaints that can never be diagnosed or treated. Chronic pain is often present and it hides the underlying depression. Medical treatment is then directed at the pain so the mood remains untreated and the emotional disability continues undetected and untreated. Sixty percent of chronic pain patients have a medical depression but they may hide behind the legitimacy of pain to prevent the detection of a less socially acceptable condition.
Depressive thought patterns can take many forms
Socialization is difficult during depression. Crying becomes a frequent event. There is a tendency to blame others, especially spouse, family members or God for their state of unhappiness.
All of the above symptoms by themselves are common and do not always indicate a mental illness. When however, a number of these signs are present continuously for over two months, then treatable illness must be suspected.
The onset of depression is often during the teen years but at that time the symptoms are dismissed as just an "adolescent phase" (see chapter seven). Most of my patients have been suffering for over ten years before they realize that help is available. The onset is so insidious that it goes unnoticed and the person and their family just adjust to the changes. It becomes the new normal for that person so they sense no need of corrective treatment.
Depression affects every part of our ability to think and feel. It clouds our personality and changes how we interpret events and how we relate to others. It magnifies physical pain, disrupts relationships, blocks communication and changes our eating and sleeping patterns. It also affects everyone around us in a negative way. There are very few illnesses known, that cut such a broad path of devastation and disability. It is a very common condition but it often goes undiagnosed since there is no confirmatory test and it can be masked by chronic pain, fatigue and burnout.
One common type of depression only occurs during the winter months. It is called "Seasonal Affective Disorder" or "S.A.D." In this depression, a person can be totally symptom free in the summer but will notice a drop in mood every Fall. During the winter months the symptoms are identical to conventional depression but they remit spontaneously in the Spring. These sufferers may only need medications during the winter months. Light therapy is also effective in some people. It involves sitting in front of a special type of lamp for several hours daily in place of taking medications.
It has been my observation that most of those who have come to my clinic suspecting that they had S.A.D. did in fact have depression symptoms year round but were only aware of them in the winters. They responded best to continuous year round treatment rather than winter only medications.
Figure 4:
The onset of depression is insidious and can continue
undetected for a lifetime.
Dysthymia
Most cases of depression are mild. If you refer to figure three, the arrow is usually just slightly into the black zone. When symptoms are mild, most people ignore them and are never treated so it leaves them chronically emotionally disabled but unaware of it. Researchers estimate that at least six percent of the population are chronically unhappy, in a state of mild depression. This state of mild depression has now been termed "Dysthymia." People with this form of depression are very susceptible to becoming severely depressed with advancing years or increasing stress. Dysthymics often suffer from chronic vague physical symptoms that don't easily fit medical symptom models like persisting headache, abdominal pain, poor sleep, fatigue and poor appetite. They can't be easily diagnosed or treated since their problems are so ill defined. Dysthymics also have chronically poor relationships.
Once again we can draw a comparison to vision abnormalities. Most short sighted people have only mild symptoms, very few ever need a "white cane" which indicates blindness. We commonly, however, prescribe glasses to the mildly impaired since we know it will help them with reading and driving and improve their quality of life. The same should be the case in mood disorders. Mildly depressed people should also be treated since their disability is definitely interfering with their lives and relationships. Unfortunately, this group is the hardest to detect and the most difficult to convince to get help. Mild depression and dysthymia responds to the same treatment as severe depression. A symptom checklist for dysthymia can be found in chapter 17. With any of those checklists, you will be able to diagnose yourself or a loved one and know if medical treatment is needed. These kinds of depression are broadly referred to as unipolar depressions.
Why do people commit suicide?
Depression is a potentially fatal illness and unfortunately, suicide is common. Up to twenty percent of depressed people will attempt suicide. Some researchers estimate that fifteen percent of untreated depressed people will successfully kill themselves.
When people consider or plan suicide it's because they become overwhelmed with hopelessness and see death as the only escape from the torment of their present reality. Depressed people are much more likely to commit suicide if they are abusing drugs or alcohol, if they have another serious illness, if they have recently experienced a major loss in their lives or are under significant stress. People who have previously attempted suicide are more likely to commit suicide at a later date.
Many who attempt or talk about suicide are actually calling out for help. It is at this point that we should take the threat seriously and guide them into treatment. It is wrong and dangerous to ignore them believing that "it's only a cry for help, they won't do it." Many lives will be saved if we could intervene at this stage.
If you are concerned about the risk of suicide in someone you love, watch for any of these classical warning signs. A person's mood may rapidly decline so that they are preoccupied with hopelessness and despair. Watch for reckless behavior that is out of character, where they no longer care about consequences. Some will become more socially withdrawn, lose interest in activities or friends, stop eating and give away important possessions. The most obvious signs would be a rewritten will, insurance application or openly discussing death. If you see these signs, the person is in need of urgent medical assistance. Don't ignore them!
If someone has recently attempted suicide, they will need a great deal of love and support since they suffer from an added burden of guilt and shame on top of the preexisting depression.
The text of this section contains excerpts from "Healthy Moods".
Illustrations by Rev. Jim Keddy
For more information visit Answers to common mental health questions.
Copyright Dr. Grant Mullen. No part of this website can be reproduced without the written permission of the author and publisher.
