The last thing you should say to someone who is depressed is, “just relax”. It’s both annoying and a bad strategy. No one likes being depressed. It’s not a personal choice. Telling someone to “just get over it” or “toughen up” is insensitive, unsupportive, and ineffective. If they could, they would, but they can’t. While people can sometimes recover naturally, they can’t recover by just sitting around and waiting. Your support can make a real difference.
Instead of statements like “give it time”, you could use more helpful approaches like “Wow this sounds really hard, why don’t we give it one more try. I'm here for you.” This is a supportive and actionable thing to say because you’re encouraging them to be resilient, reminding them that they’re not alone, and you are showing them that you understand or are at least attempting to understand their pain. Be a breath of fresh air. Depressed people don’t need to be around negative people. They need positive people around them, and you can be that person. Apart from letting them talk it out with you, you could perhaps tell them to speak with a psychologist too.
Symptoms of depression can vary from mild to severe, and they also vary across individuals. Depression can also be expressed differently depending on cultures. For instance, there are expectations of certain cultures where women can be sad, but not angry, while men can be angry but not sad. This expectation affects how depression is expressed. Most often, when men display anger, they’re actually sad, and when women display sadness, they could actually be angry. Depression is becoming more common across age groups. Whether it’s a teenager or a grandfather, anyone can give you a period in their lives when they felt significantly low, and they were significantly unhappy. Just that in the past, there weren’t diagnoses or treatments, so it was just an intense sadness that had to be dealt with. But what’s the difference between depression and sadness?
Sadness is a very normal emotion that everyone will experience from time to time. Some things upset us, and we get disappointed. The key difference is in the person’s ability to function. Sadness impacts a person’s emotions, but it typically doesn't deeply affect the person's function in daily activities, and things that they regularly do. Another difference is that sadness is a temporary impact. For example, if I woke up this morning and my dog died, it’s natural that I’m sad for a period of time but this may not affect my job, sleep, appetite and meaning in life in the long term. Sadness is normal, but if someone is sad for an extended period of time and it impacts the way they operate and function in life, that's usually quite serious.
Sadness usually has a more specific trigger. It is usually specific to a certain issue, time or location, while depression is often more global. When you ask someone who is sad why they are unhappy, they can tell you quite concretely what they're sad about. A depressed person would not be able to be so specific. They'll usually say something very generic like “I don’t know what’s the matter, I just don't feel so great.”
For example, if I see a dog collar and it reminds me that my dog is not here anymore, I will naturally feel sad. When I walk down the street and see the local park where I used to walk my dog and realise again that my dog is not with me anymore, I will feel sad. Depression has less apparent triggers. I could be sitting at home and suddenly my mood sinks. I didn’t see a collar or anything. I just feel down. Or perhaps I wake up feeling low and sad. When there’s no specific reason, it’s likely the person has developed some degree of depression.
When it comes to sadness, there is a loss of joy but in depression, the person is experiencing anhedonia, a condition where happiness seems to have left the body. A joke or an enjoyable activity might cheer up someone who is sad but that wouldn’t cause a reaction in someone who is depressed. If you give a sad person a good burger, they might still be sad, but they’ll say that it tastes amazing. A depressed person would not react. It is as though nothing in the world would make them feel happy.
Depression is a persistent feeling of sadness, hopelessness, and loss of enjoyment from activities that they once enjoyed or loved. Apart from emotional problems, there could also be physical symptoms of depression and even physical symptoms which cause depression. Meaning that the physical symptom could cause depression or on the flipside, depression could cause that physical symptom. Some classic symptoms would be migraines, chest tightness, shoulder tightness, digestive issues or chronic pain.
To diagnose depression and understand the level of severity, psychologists use Diagnostic and Statistical Manual of Mental Disorders (DSM 5th edition), which has eight items to look into. The more items that are ticked, the more serious the condition. In severe cases, patients might be thinking, planning or attempting suicide. At this point, they don’t see the reason for living and want to end their lives, which makes it a serious and dangerous condition.
The first sign, which is most commonly ticked is a depressed mood, which people can feel from time to time. The next sign, which is a little less obvious unless you live with the person, is a diminished interest or pleasure in things that they usually enjoy. But you may be able to pick up that the affected person has withdrawn or stopped activities he or she used to enjoy.
The third sign is weight loss, sleep disturbances, and significant changes in appetite. Another sign is that their movements or thoughts tend to be stuck going round in circles, typically in a negative way. You will hear things like “What's the point? I don't want to. It's not going to go anywhere. It is all hopeless”. In terms of physical movement, there's a certain slowness or lethargy to their movements. A fifth sign would be fatigue and energy loss, which can be somewhat visible and is quite a common symptom. Another physical sign would be an increase in unconscious activity called stimming: repetitive movements like hand wringing, pacing, leg shaking, or other anxious behaviours.
A less visible sign is the feeling of worthlessness and inappropriate guilt. Many people feel guilty over different things, but under a depression diagnosis, the guilt is usually inappropriate. For instance, it’s not their fault that their parents have cancer, it’s inappropriate to feel guilty about it, but they do.
Finally, the last sign is a diminished ability to think or concentrate. You may notice that the affected person is a lot more indecisive or unable to make clear judgement on everyday items. There is also an interaction between these signs that can cause a spiral downwards. For example, difficulty in thinking clearly and making decisions are interrelated and affect each other. They are also affected by the guilt and sense of worthlessness. Furthermore, if they’re gaining or losing a lot of weight, this affects their self-confidence and the way they view themselves.
Some people don’t realise that they’re feeling depressed until they are asked some of these questions. So if you have a loved one exhibiting such behaviour or if you are experiencing this, it’s crucial for you to be aware of it and know that depression can be cured. Many people recover from depression. Just because someone has depression doesn’t mean it is the end of the world, though it could feel that way. There are many things you can do to overcome depression and even prevent the likelihood of it happening or recurring.
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Dr. KC Lee