There are countless people around the world that have experienced some degree and intensity of clinical depression. It is a common experience that a lot of people can relate to and feel as if they are not alone in their experience. It can be a very debilitating experience for some and for others “manageable” throughout the day yet still difficult and challenging to contend with. Although depression has been clinically known and researched for a very long time, sometimes people can be too quick to label a mood state as depression when it may not be. Therefore, lets take some time to talk about what depression is and what it isn’t and some “causes” that develop it.
To have a common framework when discussing clinical depression lets give it a definition. According to the APA dictionary of psychology (2022) Major Depression is: a period in which an individual experiences anhedonia or is persistently sad, pessimistic, or otherwise overly negative. Additional symptoms include poor or increased appetite with significant weight loss or gain; insomnia or excessive sleep; psychomotor agitation or psychomotor retardation; loss of energy with fatigue; feelings of worthlessness or inappropriate guilt; reduced ability to concentrate or make decisions; and recurrent thoughts of death, suicidal ideation, or attempted suicide. DSM–5 retains these same symptomatic criteria but has removed its predecessor’s qualified exclusion of bereavement with respect to major depressive episode and replaced it with a broader advisory (see bereavement exclusion). One or more major depressive episodes are a characteristic feature of major depressive disorder and bipolar disorder.
As you can see there are a variety of clinical criteria that exist to properly recognize and diagnose major depression. When someone is experiencing clinical depression, it is called a major depressive episode, and this can be a single episode or recurrent episode. Along with specific symptoms that need to be present to qualify for the diagnosis, severity must be also indicated as: mild, moderate, and severe levels. There are even more specifiers such as with anxiety, mixed anxiety and depression, melancholic features, etc. It all needs to be as specific as possible to properly identify the current issues the individual is dealing with but also the accompanying treatment for that exact diagnosis. All depression is not the same even if two individuals have the same diagnoses. All must meet the criteria requirements however how they “express” it can vary amongst individuals. For this reason, I suggest everyone learn how their diagnosis and symptoms work and interact with them and the outside world. This way we go from a generalized view of depression to my specific view and experience of depression.
There are various causes that lead to someone developing a depressive episode. It can be a job loss, ending of relationship, medical issues (although this one has specific causes), loss of a loved one, poor outlook in life, financial issues, etc. Its very person and perspective specific. In my years of practice, I can say we can become depressed due to just about anything. This is in no way a judgement but anecdotally based on the many people I have treated and their explanations for their symptoms. Although their narrative is different how many became depressed is similar. There is no one single causes that leads to depression but a combination of factors that create its environment to develop. I like to describe the “Big 3” as being influencing to varying degrees in influencing the development of depression and most other mental disorders. The “Big 3” are the biological, psychological, and social aspects of an individual. There is a form of clinical depression that develops from mostly biological factors such as the commonly known “chemical imbalance” where no matter the medication or treatment depression remains to some extent. Using the “Big 3” for me in therapy is useful as I like to understand how they function and interact with an individual and in understanding them to a deeper degree. It’s the reason for not usually offering “coping skills” at the outset of meeting a person although it can be done if necessary.
Since we have an understanding as to what is depression, lets talk a little about what isn’t clinical depression. All too often I hear people expressing that they are depressed and after conversing we come to conclude that they aren’t depressed however its more of a “less than good day” or an inconvenienced day or bored or other. Its important to know that the clinical criteria is for your specific diagnosis because if you are not meeting that criteria you do not meet the depression. One reason for recommending this approach is to avoid creating a mindset and perspective about a specific mood state we are “in” when we are not in it. Our minds are powerful, and we can unintentionally predispose ourselves to creating the circumstances, internal and external environment that reflects the perspective we are taking about life. This will help us create mental boundaries to stay within that will assist us in being more grounded and moving us from the mindset we are in, to something more useful and beneficial. Its helpful to move ourselves from the mental frame we are in as quick as possible to provide ourselves are greater opportunity at making use of our awareness and implementation of any strategies or skills we have learned along the way.
There are various evidence-based treatments available to someone experiencing clinical depression. Medication management is useful and beneficial for some although others choose therapy as they approach alone or in combination with medication. The approach that has the highest degree of “success” is medication with therapy however I respect everyone’s choice to take or not take medication. Cognitive Behavioral Therapy (CBT) is one of the leading if not the leading psychotherapy model to treat clinical depression. It provides an individual to gain the perspective of the triad of thoughts, emotions and behaviors and how they interact and influence each other giving us the experience we have. Although this was a brief education on clinical depression, it is important to get to know how depression is expressed in you to help you gain control over the symptoms.
