Pamela P. Siller, MD
All of us know what sadness feels like. Some may feel disappointment with a less-than-perfect grade in school. Others get upset after an argument with a spouse. Many of us have cried after a loss, whether a death, argument, or even a geographic relocation. Sadness is expressed differently by each of us, as we are individuals. Yelling, crying, and irritability are the most common reactions to loss or unhappiness, but sometimes our feelings get bigger than we can handle. They can affect the way we function at a job, or in school, and even the way we take care of ourselves. The feelings of hurt can take a life of their own and translate into aggression towards ourselves and others. At times they can change the way we view ourselves and cause the desire to self-injure, or even obliterate life, leading to self-injurious behaviors or suicide.
Depression is defined clinically as “feeling sad, blue, down, depressed or irritable, with a loss of interest or getting less pleasure from activities that used to be enjoyed, for a period of more than two weeks, which causes impairment in functioning.” This differs from sadness by the time frame and the impairment in one’s day-to-day functioning.
How is functioning impacted?
- Sleep - Sleep can be used as an escape. Some sleep all day and avoid expectations and social interactions. Others cannot sleep, as thoughts and worries circle their mind continuously, not allowing respite or relaxation.
- Appetite - Some may eat continuously, seeking comfort; others will feel a lack of interest in food.
- Energy level– Many will find themselves with a decrease of energy, causing it to take a great deal of effort to complete everyday tasks, such as bathing and performing at school and work.
- Concentration– Concentration is similarly affected as thoughts of the sadness or loss may intrude wantonly.
- Anhedonia– Lack of interest in activities, or social interactions, which is associated by all symptoms listed above.
- Feelings of guilt, worthlessness, hopelessness, or helplessness.
- Psychomotor agitation or retardation– Movement throughout the day is either slowed – feeling the weight of the world on one’s shoulders – or increased, with the desire to outrun the sadness.
- Recurrent thoughts of death or suicide – This is the scariest part of depression, as suicide is thought of as “a permanent solution to a temporary problem.” Unfortunately, the problem does not feel temporary to the person suffering.
Depression is usually a gradual process. Sometimes it is precipitated by a life-changing event (or one that is felt to be life-changing). At other times, there is no clear situation that marks the onset. It is possible that a person can present with depression after the same circumstance which they have weathered many times before. Depression can also exist at a low level (called dysthymia), for many years before it abruptly worsens.
Sadness transitions to depression with an impairment in daily functioning. This can present as a drop in grades for a child, difficulty performing tasks at work or in child care, not showering or bathing daily, as well as reticence to socialize and increased isolation. As depression gets worse, thoughts of death may intrude, as a means of escape from misery or from being a burden to family and society. Some may feel the desire to injure themselves as a perceived punishment deserved. It is important to seek help before the depression gets debilitating, and suicidal thoughts predominate. The earlier the depression is noticed and help is sought, the shorter the time will be needed to manage, and hopefully eradicate it.
How is depression treated?
- Therapy – Therapy is imperative as the person will be able to learn long-term coping skills which will be helpful throughout life. However, therapy can take longer to be effective, as a cornerstone of therapy is the rapport (relationship) between the person and the therapist, which can take time to grow and develop.
- Medications – The most common medications are antidepressants (SSRI’s) which increase a chemical called Serotonin in your brain. They are generally well tolerated, with few side effects. At times they are needed only for the short-term. If the depression recurs, they may be needed for a longer period of time.
Will depression go away by itself?
Depression is usually cyclical. At times it can go away by itself, but there is always a possibility of a recurrence. The length of the cycle differs for each individual. However, a strong support system and a loving environment is always a protective factor.
Life hands us curve balls, as well as shining moments. Hopefully, there will be many more times of joy than darkness. However, when depression starts, it is important to intervene before it gets overwhelming. If you notice a change in the personality or functionality of a family member or friend, encourage them to seek professional help. You may be able to save a life.
Pamela P. Siller, MD is a Board Certified Child, Adolescent and Adult Psychiatrist who provides medication management as well as individual and family therapy to children and adults. She maintains a private practice is in Great Neck, New York. Dr. Siller is also the Acting Division Chief of Child and Adolescent Psychiatry at Westchester Medical Center, where she is also the unit chief of the adolescent inpatient unit, and is a staff psychiatrist at Interborough's mental health center in Brooklyn.