The Many Faces of Depression

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by

Dawn Ferrara, Psy.D

 

When you think of being depressed, what comes to mind?

  • Crying
  • Sadness
  • Staying in bed with the covers over your head?

These behaviors can absolutely be associated with depression. In fact, a persistent sad mood is typically associated with depression and is the predominant criteria for the diagnosis of a major depressive episode.1

Depression is more than just the blues or being sad about something that happened though. It is common to refer to those feelings as “being depressed” but the fact is, depression is a very different experience. Depression, clinically referred to as major depressive disorder, is a serious mental health issue that adversely affects how you think, how you feel and how you behave. It can cause both emotional and physical problems as well as affect how you function at work, at home or socially. It can even affect your relationships.

Not everyone experiences depression in the same way. Not everyone will experience the same symptoms and those symptoms might be experienced differently from person to person. Depression has many faces – and some of them might surprise you.

Not Just One Depression

One of the things that surprises many people is that there is not one single disorder called “depression.” Depression is actually commonly used to describe a type of mental health issue that can range from being bothersome to being downright severe and debilitating.

The American Psychiatric Association’s  Diagnostic and Statistical Manual, 5th edition (DSM-V) is the standard set of criteria mental health professionals use to categorize and diagnose mental health disorders. The DSM-V actually identifies several types of depression, each with its own unique features. 1

Major Depressive Disorder – Often referred to as clinical depression, is the type of depression that is considered a serious mental health issue. Symptoms can be quite severe. Major depression requires the help of a mental health professional. This type of depression is characterized by symptoms such as:

  • A persistent sad mood (at least 2 weeks)
  • Feelings of helplessness or hopelessness
  • Increased irritability
  • Anhedonia – the loss of interest in pleasurable activities and interests
  • Increased fatigue and problems with sleep
  • Appetite and/or weight changes
  • Thoughts of death or suicide, or suicide attempts
  • Somatic complaints (e.g., aches and pains) without a clear physical cause and/or that don’t get better even with treatment

Dysthymia – Have you ever known someone who just seems kind of blue all the time? Not overtly sad but just not quite happy? That’s what dysthymia looks like.

This type of depression, also known as persistent depressive disorder, is low grade and persists over a period of years. Dysthymia robs the person of their zest for life but they are still able to go about their daily lives. Professional help is sometimes needed.

Here’s an interesting fact:  Sometimes, a person who is dysthymic can experience a worsening of their depression. When that happens, they can experience what’s known as a major depressive episode on top of their dysthymia. This is commonly known as “double depression.” It is estimated that about 75% of people with dysthymia will experience a major depressive episode at some point in their lives.2 When this happens, a visit to your mental health provider is in order.

 

Bipolar Disorder – Commonly referred to as manic depression, bipolar disorder is not the same as depression and might not look the way you think. This type of depression has also been called “split personality” but that term is not accurate. People with bipolar disorder sometimes have quite severe mood swings that can go from mania to an extremely low, depressed state. They might present with more manic behavior and less depressive signs. You might even call it “hyper” but it is much more complex than that. Or they might show more depressive symptoms. Bipolar disorder is about fluctuations in mood and how that shows itself. It’s a serious disorder that requires professional intervention.

Seasonal Affective Disorder (SAD) – Ever wonder why dark, dreary winter days can make you feel kind of blue? Blame it on the sunlight. This type of depression, sometimes called winter depression, tends to show up in the winter when there is less natural sunlight which is thought to affect levels of serotonin and melatonin. It generally resolves in the spring when the bright sunshine and longer days return. SAD also tends to occur more in northern states. Interestingly, SAD may not look like typical depression. The depressed mood is often accompanied by atypical symptoms of depression such as an increased appetite, wanting to sleep more and a craving for carbs.1,3

Postpartum Depression – This type of depression occurs in women following the birth of a child. More than just the “baby blues”, postpartum depression is a major depressive episode that can be so severe that the woman is unable to care for herself or her baby. Some of the symptoms might include  persistent feelings of sadness or hopelessness, crying spells, anxiety, irritability, poor sleep, isolating from family and friends and having doubts about the ability to care for her child.  In severe cases, the mother may have thoughts of harming her child or herself. It is estimated that about 15% of mothers may experience postpartum depression. It requires professional intervention.1,4

Who Are The Faces Behind Depression?

Not everyone experiences depression, and not everyone who is depressed experiences it the same way. So now that we know the faces of depression, who are the faces behind depression? The answers might surprise you.

Gender Differences – Both men and women experience depression but the way they experience it is very different.

  • Women are twice as likely to experience depression as men. They tend to experience depression at an earlier age and are more likely to experience severe and longer lasting episodes of depression.5 This difference is thought to be due to hormonal and genetic differences.
  • Women are more likely to have atypical symptoms of depression such as sleeping too much and over eating, have a comorbid anxiety disorder and  attempt suicide.6
  • While women tend to be more expressive about their feelings, men tend to mask or minimize their symptoms. They may present as more irritable or angry.7
  • According to the Centers for Disease Control, men are at much higher risk for completing a suicide. Seventy-five to eighty percent of all people who complete a suicide are men.8

Children – Children with depression don’t always show the typical, expected sadness and crying spells. In fact, children who are depressed will often present with signs such as increased irritability and angry outbursts, a decline in school performance or social withdrawal. Depression can be easily overlooked in kids. These signs can be misconstrued as another disorder or even as willful disobedience.1,9 Kids are not good at describing how they feel. They show us in their behaviors. That anger just might be the mask the child’s depression is wearing.

Older Adults – Depression in older adults is sometimes very hard to recognize. They often have other illnesses, various medications and other circumstances (e.g. cognitive decline) that can mask classic depressive symptoms. They generally seek help for other ailments such as aches and pains, headaches and such. They often don’t report sadness or depression right away.10 If you’re seeing changes in behavior in elderly persons, it’s a good sign to pay attention to what they’re saying and what they’re not saying.

Culture Matters – Different cultures recognize and exhibit depression in very different ways. While the criteria for depression are clear, the way in which a person copes with or shows their depression may not look like you think it might. In some cultures, being sad may be viewed as “normal” and a non-issue. In other cultures, depression may be masked or expressed via somatic complaints (e.g., headaches, GI distress) rather than speaking about feelings.11 What may be acceptable and expected in one culture may be at odds or even taboo in another culture.

The Takeaway

When it comes to depression, it is both the same and different for people. No two people will experience the exact same depression in the exact same way. There is the pervasive sadness. But there are also individual differences that make your experience uniquely yours.

If you find yourself or a loved one struggling with depression, know that there is help available. A skilled mental health clinician can help you  understand what’s happening and identify treatment options that are right for you and the type of depression that you are experiencing. A lot of people worry that the only option is medication. Know that medication is but one of many treatment options for most people. There are very effective treatments for depression. All you need to do is reach out and a skilled clinician will be there to help.

 

 

 

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
  2. Gelenberg AJ, et al. “The State of Knowledge of Chronic Depression,” Primary Care Companion to Journal of Clinical Psychiatry(2006): Vol. 8, No. 2, pp. 60–65.
  3. What are the DSM-5 criteria for the diagnosis of seasonal affective disorder (SAD)? (2019, April 23). Retrieved from https://www.medscape.com/answers/286759-14708/what-are-the-dsm-5-criteria-for-the-diagnosis-of-seasonal-affective-disorder-sad
  4. NIMH » Postpartum Depression Facts. (n.d.). Retrieved from https://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml
  5. Oquendo M. A., Turret J., Grunebaum M. F., et al. (2013). Sex differences in clinical predictors of depression: a prospective study. Journal of Affective Disorders,150(3):1179–1183.
  6. Gorman, J. M. (2006). Gender differences in depression and response to psychotropic medication. Gender Medicine, 3(2), 93-109.
  7. Winkler, Dietmar, Edda Pjrek and Siegfried Kasper. (2006). Gender-Specific Symptoms of Depression and Anger Attacks. The Journal of Men’s Health & Gender,3(1). 19-24.
  8. Ten Leading Causes of Death and Injury. (2019, April 10). Retrieved from https://www.cdc.gov/injury/wisqars/leadingcauses.html
  9. Maughan, B., Collishaw, S., & Stringaris, A. (2013). Depression in childhood and adolescence. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 22(1), 35–40.
  10. Sözeri-Varma G. (). Depression in the elderly: clinical features and risk factors. Aging and disease, 3(6), 465–471.
  11. Lehti, A., Hammarström, A., & Mattsson, B. (2009). Recognition of depression in people of different cultures: a qualitative study. BMC family practice, 10, 53.

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