Many times, we hear people use the term “depression” casually or flippantly. “I was so depressed, they were out of cupcakes.” “That show ended on a very depressing note.” However, actual clinical depression is a far different experience, and clinical depression has specific criteria that differentiates it from just sadness. It can be quite difficult to understand the experience of true clinical depression without experiencing it firsthand, though this video from the World Health Organization attempts to demonstrate how pervasive and global the experience can be.
Because clinical depression can exist as a separate diagnosis (for example, dysthymia or major depressive disorder) or as a part of a mood spectrum experience (as in bipolar disorders), typically a mental health provider will refer to a period of depression as an “episode.” Experiencing specific symptoms within a two week period defines an episode, though of course there is not an expiration date – the two week criteria is a minimum threshold, not an expectation that symptoms will disappear after two weeks. Symptoms include, but are not limited to, feeling depressed or hopeless (and in children, this can look like irritability or frustration); decreased interest in pleasurable activities; appetite and energy changes; sleep changes; feelings of worthlessness and guilt; difficulty concentrating and making decisions; and thoughts of death or suicide. One does not need to have all of these symptoms, but a minimum of 5 symptoms, plus an impairment in functioning, can lead a mental health provider to consider a diagnosis that includes depressive episodes.
Regarding severity, many factors play into the severity of depression, including the impact on functioning, pervasiveness of thoughts of death or suicide, and the duration of the symptoms. For mild depression, treatment may consist of talk therapy, working on sleep hygiene, adding physical activity or exercise, and learning techniques such as mindfulness. For moderate depression, research has indicated that a combination of talk therapy and anti-depressant medications can be a powerful combination, though it is not required to undergo both paths of treatment. For severe depression, intervention is critical. A person in a severe state of depression may be in imminent danger to themselves, and a verification of safety and medical treatment is necessary. The National Suicide Prevention Lifeline can be reached via phone, text or online, and has literally been a lifesaver for people in the midst of a severe depression episode.
The modality of treatment and the specific treatment needs vary from person to person. However, when seeking therapy support for depression, commonly the types of therapy of Cognitive Behavioral Therapy (CBT) or forms of CBT such as Dialectical Behavioral Therapy (DBT) or Acceptance and Commitment Therapy (ACT) can be helpful. The premise of CBT is that patterns of negative thinking, or what CBT practitioners call “cognitive distortions” cause undesired feelings, and that awareness of these thoughts and behavioral changes can be effective agents of relief. Others may use psychodynamic or psychoanalytic approaches, which involves exploring prior experiences and unconscious feelings and how they may be shaping current experiences and behaviors. A person experiencing depression may benefit from individual and/or family therapy, to help loved ones understand their experience and how they can help. Group therapy can also be very effective in feeling less alone, and learning strategies and supports from peers with a therapist moderating the group experience.
No matter the origins, or the method of treatment, the most important takeaway is that for a person experiencing depression, there is help. Check out the variety of providers within our Therapy Hive collective group. Know that you can talk to someone at the Suicide Prevention Lifeline 24/7, by calling 1-800-273-8255. Know that you are not alone, and that there are others who understand the feeling.