It's one of those words that gets thrown around a lot, and we all think we know what it is to be depressed, but do we really? Unless we've been there ourselves or had specialist training, then it's hard to know what a full-on clinical depression is -- but one thing it's not is simply feeling a bit down.
Rather than seeing depression as just a one-dimensional illness of low mood, I think it's better viewed as a collection of features which affect both mind and body. Everyone's precise mix will be unique to them, and will often vary from day to day -- even from hour to hour. So, let's take a look at some of the most common symptoms of depression.
Motivation and energy: Even the simplest and most mundane of tasks can feel like an overwhelming, daunting challenge of Everest-like proportions -- brushing teeth, preparing simple food, going out to the local shops.
Social engagement: The world can seem a threatening, scary and insurmountable place when depressed, and interacting with others can require a superhuman effort of putting on a front and trying to function. No wonder, then, that withdrawal and isolation are so common.
Cognitive abilities: Memory and concentration can be massively impacted, and I frequently hear from patients that they thought they were getting dementia, so profound is their loss of mental sharpness. Names, phone numbers, appointments, well-known bits of information... all fall to one side, as the mind shuts down all but the most essential functions.
A short fuse: Irritability, agitation and feeling tense, "wired" and angry are all common. It won't take much to set someone off, and sparks can often fly with family members or work colleagues.
Aches and pains: There's a huge interplay between mental health and how we feel physically. Although we don't fully understand the mechanisms for this, doctors have long known that depression will take a physical symptom like pain or tinnitus, and make it worse -- it's as if it's cranking up the volume dial on these features by a couple of notches.
Biological features: Many basic bodily functions can be impaired or diminished -- appetite shrinks, and food becomes bland and utterly lacking in pleasure; sleep is disrupted and unrefreshing. Often, people will wake early in the morning at 3 or 4am and be unable to get back to sleep -- the classic "Early Morning Wakening." And to top it all off, libido tends to go out the window.
Co-existing illnesses: It's actually rather uncommon for depression to exist purely on its own. Typically, a range of anxiety features are right there as well -- I often tell patients that depression and anxiety are like two sides of the same coin. Alcohol use is also something that frequently accompanies depression, as sufferers try whatever they can to self medicate and gain some temporary relief, although with significant long term effects.
... and finally, yes, low mood. "Bleak, numb, empty, grey" are all commonly-used words to describe someone's spirits. I ask patients to rate their mood on a scale of one to 10, 10 being the best they've ever felt, and one the worst. It often helps to capture mood as a single number, especially when words are hard to find. When mood is down at a one, two or three, suicidal thoughts can often be present, and it's at times like these that depression can become an emergency, requiring rapid professional assessment.
It's now abundantly clear that depression is a serious and debilitating medical illness. Going through a list like that above can be helpful for anyone trying to understand what's happening, whether it be family members or managers at work.
One person at a time, it's time to change beliefs around depression... and above all, the good news is that there is so much which can be done to help.