Depression – It’s more than just being sad
By, Jennifer Boisture, MD
“I’m depressed.” Not surprisingly, as a psychiatrist, I hear this a lot from my patients. If I’m meeting a patient for the first time, almost invariably, I respond by asking, “What do you mean when you say ‘depressed’?” This partly because people so often say, “I’m so depressed,” or “That’s so depressing!” when what they mean is something more like “I’m hurt,” or “That’s really disappointing.” But I also ask that question because having Major Depressive Disorder means so much more than simply feeling sad.
First, there is the matter of the degree of sadness. When someone is suffering severe depression, they don’t just feel sad, they are often unable to experience joy or happiness at all, even in response to events or circumstances they intellectually know are positive. As an example, a patient told me recently how painful it was to attend her son’s wedding and not be able to experience it as a joyful event. This wasn’t because she didn’t want him to marry her now daughter-in-law, she very much did; rather, it was because she simply couldn’t truly feel any happiness about it.
But, while clinical depression is technically classified as a mood disorder, it affects a lot more than our emotions. This includes impacting how we feel physically. Some of the common complaints I hear from my patients with depression including changes in sleep, appetite, and energy. People with depression often are unable to sleep even though they feel incredibly tired and loss of appetite can lead to an unhealthy degree of weight loss. On the other hand, a condition known as “atypical depression” (which is a misleading term because it is quite common), some people with depression may find themselves sleeping far more than normal and gaining weight in part because their appetite is so increased. Many people with depression will complain they lack the energy to do the things they normally do without much effort. Others experience an uncomfortable increase in energy and describe feeling restless and agitated.
Depression doesn’t just affect the way we feel, though, it can also profoundly change our thinking. One of the crueler symptoms of depression is the way it affects how people see themselves. With depression, even the most accomplished and capable person may feel like a complete failure. Even in the face of loving friends and family, they can feel worthless, as if they can never measure up or are deeply flawed, undeserving of love. Depression can bring with it feelings of excessive guilt that, in its most severe form, can be frankly delusional and leave someone feeling somehow responsible for everything bad that happens. Another example of depression affecting what we think, there are also common thought patterns, otherwise known as cognitive distortions, associated with depression. Among other, these can include: black and white thinking (i.e. if things are perfect, they are terrible) and over-generalization (i.e. my Monday morning meeting went badly, therefore, my whole workweek is going to be bad). People with severe depression also can experience recurrent thoughts of death, find themselves wishing they could simply disappear or thinking of ways to commit suicide.
Not only does depression affect what we think, but it also can affect various aspects of cognitive function, or how we think. On standardized cognitive tests, people with depression often demonstrate slower information processing and poorer attention, memory and executive function than their non-depressed peers. Studies also show patients with depression often have distorted information processing (e.g. overvaluing the negatives of a situation and undervaluing the positive) and increased cognitive rigidity (e.g. ability to adapt to changes in circumstances or information). In real life, this means my patients with depression often complain of not being able to think clearly, struggling to concentrate, make decisions and plan effectively and difficulty problem-solving. This aspect of depression is particularly troubling as recent studies show these symptoms may persist in a large percentage of patients whose depression is otherwise considered in remission. That is, we are coming to understand even our best treatments for depression may not fully address the many ways this disease affects brain function.
How can one disease lead to so many different kinds of symptoms? The short answer is that we don’t know (yet). The longer, but still incomplete answer is it likely has to do with the incredibly complex network of connections between the different parts of the brain responsible for various functions. If we think of the brain as a series of interconnected parts that all have to work together to regulate our bodies, our emotions, and our thinking, it makes sense you cannot affect one part of the system without affecting others. Understanding how those systems interrelate will no doubt prove crucial to developing better treatments.
If you or someone you know is suffering from depression, please know there is help available and you can feel better. If you are not already in treatment with a psychiatrist or a therapist, contact your primary care physician. If you are feeling as if you want to die or are having thoughts of committing suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255.