The following is a transcript of an audio presentation I made about depression:
We are looking at what are the symptoms of depression and specifically, we are looking at what is clinical depression. And by clinical depression, I mean a depression, a type of depression that disrupts your life in a way that either you notice or the people around you notice, and it isn't pleasant.
I think the best place to begin in looking at a definition is to think of how most people think of depression. They think of it as just being really, really sad. In fact many people use the word depressed and sad interchangeably. They say, "Oh, I had this deadline at work and I was so depressed because I had to miss out on this concert I went to." And all they mean is just some minor disappointment or they are sad. So that results in a lot of confusion when someone says that they are depressed, and therefore can't do something major.
So we might start with an overly simple definition and that is that clinical depression is when the brain undergoes a significant change in its baseline mood for longer than a few weeks. Now notice what this means. It means that most people use the word depressed to simply mean sad, whereas psychologists and mental health professionals think of depression as meaning 'a change in the brain, ' a change in the baseline mood of the brain, so that it always seems to come back to a new normal.
And many of the common symptoms are slowing; you just feel like sometimes a person who is clinically depressed feels like they are just moving through molasses, everything is slower. Or, they feel much less tolerance to stress; things that used to never frustrate them now frustrate them. Things that never used to irritate them now they really find irritating. There is a significant loss of hope, so that they just find that they are not looking forward to things.
And one of the most distinctive aspects of clinical depression is the loss of pleasure. I find that many times the telltale sign of depression is that people just do not experience pleasure anymore or they experience much less pleasure in activities that normally they would regard as fun or enjoyable.
Another common symptom is sleep problems, either sleeping way too much and feeling like you need 14, 15 hours of sleep a day or waking up in the middle of the night and not being able to get back to sleep.
Now with these things in mind, let's look at a few illustrations and pictures, so we can put in our mind that will help us really solidify this definition "understanding depression."
If you picture with me an elastic band, maybe like one of these scrunchy hairbands that women use to put their hair up in a ponytail. If you think of any kind of elastic band and you think of stretching it out with two hands and then letting go, what does it do? It goes back to its normal state, which is contractive. Now if you do that over and over and over, if you do it enough times, you are going to wear out the elastic to the point where you now have a new normal, so that it doesn't go back to its original state, it wants to go back to this sort of stretched out, distorted place.
That's what clinical depression is like. Even when you feel good for a time, your baseline mood wants to go back, always moves back to that place of either mild or severe misery.
Now another picture to illustrate this would be a balloon with a hole in it. When you blow up a balloon that doesn't have any holes, you blow it up, you tie it and there it is. It stays that way at least for a while. But when you have a pinhole in a balloon, you blow it up and even though you have got it fully expanded, it is already moving back to a deflated state, a depressed state. And you can blow it up again and that would maybe represent doing something that you enjoy or makes you feel good, but it always wants to go back to that deflated, depressed state.
Another picture would be a computer that goes out to all the wrong websites with no virus protection. So, you can clean it up, you can remove the viruses, but it just keeps collecting more. And that's a picture of how clinical depression makes us more susceptible to stress, to frustration. It lowers our frustration tolerance. And feeling good becomes the exception rather than the rule. And enjoying something is more like the dying flicker of a light bulb rather than the light of day.
Now one of the illustrations or metaphors that I like for clinical depression is to think of a swamp. When we feel sad, normal sadness is that something disappointing happens and you feel sad. If something really disappointing happens, you feel very, very sad. But then after a few days or weeks, you rebound, where you come out of it. It is like falling into a dark, muddy river. Now you are in it for a while and then you get out of it, you dog paddle to shore and you walk out of the river. That's what normal sadness is like.
But with clinical depression, it is more like falling into a swamp, a swamp where not only do you have difficulty getting out of it and not only is it extremely unpleasant to be there, but there is this swamp monster with tentacles that lives inside the swamp. And it is like the depression has a life of its own and this swamp monster with its tentacles wraps its tentacles around your ankles, so that even when you try to use your normal typical strategies for snapping out of it and getting out of your crummy mood, the swamp monster drags you back into the swamp. And your brain just keeps going back to that new normal state of being in the swamp of unpleasantness.
Now, what does it feel like to be clinically depressed? I mentioned slowing, there is less tolerance to stress, there is lack of pleasure in things, but I find that when depression gets pretty serious, people often feel trapped. They even use that word "I feel trapped." And if they don't use it, I find that when I use it for them, they immediately say "That's it."
And they often say things like "I would never do it, but I find myself having these fleeting thoughts about death." Or they wake up every night about three or four in the morning and they feel tired. They don't feel worried about anything. They just can't get back to sleep. Or they feel tired all the time and sleep several more hours per day than they usually do. They rapidly gain weight or they rapidly lose weight even though they are not trying to.
And perhaps most importantly everything is harder. I often describe it, as it's a feeling like "you are hanging on by your fingernails as you go through the day." You feel irritable and especially with men, I find that anger is much more a telltale sign of clinical depression than sadness. Men will get angry when they are clinically depressed often more frequently than they would become teary eyed or feel like crying.
People who are clinically depressed get frustrated with their memory. They keep forgetting things that they never used to forget. They start having to write things down even though they never used to have to do that. They have difficulty getting started. It's just such an effort to get going to start doing something and then that increases the feeling of low self-esteem because you think, what is wrong with me, how can I be this way.
There is also a difficulty following through with things. There is difficulties concentrating and staying focused to the point and that becomes either frustrating or discouraging.
Now, what does all this mean? Here are just a few implications of this understanding of depression. First, a person cannot just snap out of it. So if you are clinically depressed, you can make a good amount of progress immediately just by realizing this fact. Because what happens is people fall or slide gradually into a clinical depression and they are used to being able to just snap out of a blue mood by changing their activity or just through sheer will power.
But clinical depression doesn't let you do that, you can't just snap out of it. And so then you become depressed that you are depressed. And that just furthers the downward spiral. So often times it is helpful to people right away just to realize that you can't just snap out of it, you have to have another strategy. You can't climb the face of the mountain; you have to look for another trail up to the top. Also, this helps when you are living with someone who is clinically depressed and it helps you avoid making things worse for them by telling them to just snap out of it.
Now, another implication of our definition of depression here is that it is not all in your head. It clearly becomes a medical issue because it affects your entire body. It affects the way your brain works, and your brain controls your whole body. No matter how a clinical depression gets started, it actually becomes a physiological medical condition.
Now that is a hard thing for many people to grasp, because they think, "Well you know, it is not really a significant depression, because well I am depressed because there is nothing wrong with me, it is just that I lost my job and I am really, really bummed out about that." Well, what they don't realize is that it doesn't really matter how it got started, it can start through a variety of different ways.
But by definition, a clinical depression is when the brain kind of loses this elasticity to come back to a normal pleasant mood and keeps sliding to this new normal, this swamp condition. So, the brain undergoes this chemical change.
Now another implication is that a man or a woman can be clinically depressed while no one sees them as particularly sad. They can be putting on a happy face, going to their job, laughing at jokes, but there is an enormous strain at maintaining that exterior as they go deeper into clinical depression.
Depression instead of being defined by sadness, is probably better defined by a laundry list of symptoms. Now, I say laundry list, that is depression on paper, but it actually feels more like the swamp. So the confusion comes because so many people use the word sad and depressed interchangeably.
Now in summary, what most people call depression is what psychologists and mental health professionals think of as simply sadness. When psychologists, doctors, and mental health professionals use the term depression, they usually mean clinical depression. It is a change in the typical working of the brain so that you are usually in the swamp of these various symptoms: physical, emotional and mental symptoms of depression.
And when you do feel good, which you can feel good when you are clinically depressed, but the difference is, it is like you are standing on the solid ground, you are out of the swamp, but the swamp monster still has its tentacles wrapped around your ankles, and so you will be pulled back in eventually, and usually after several hours or few days.
Now in contrast, depression that is not clinical which is just part of life, such as several days of anger or sadness or deep discouragement about something that has happened, that is like spending most of your time outside the swamp. You may occasionally fall in, but there is no swamp monster to hold you there and to make it your new home.
So, we have been looking at what is depression in this first lesson. I hope this has been helpful to you. In our next lesson, lesson two, we are going to look at the levels of depression. And we are going to look at the problem of what I call "under the radar depression, " a type of depression that most people do not understand and many, if not most, mental health professionals and therapists often miss it when they are evaluating people. It is very easy to miss.
These lessons are no substitute for treatment, they can be useful in keeping in mind what you are dealing with, the nature of the beast.
If you think you may be suffering from clinical depression, I urge you to be evaluated by a medical doctor or a psychologist or therapist, especially if you are having frequent thoughts about death. That doesn't necessarily mean you are suicidal, what it does mean though, it is an indicator of how severe things are. It is like that engine light on your dashboard. You ignore it only foolishly.
