Am I depressed or just sad?

What’s the difference between sadness and depression?

From time to time, everyone experiences sadness. Sadness is a natural emotion that can be a reaction to situations that cause emotional upset or pain.

Often sadness is linked to a specific trigger and a number of life events can make people feel sad such as feeling stressed, sudden personal failures, or the death of a loved one. Like other emotions, sadness is temporary and will usually fade with time.

People who are sad may find some relief in crying, talking about their problems, or perhaps cheering themselves up using humor. If the sadness does not pass or if the person is finding it difficult to resume to their normal functioning, this could be a sign of something more serious.

Clinical depression is a longer-term mental health condition where a person will feel intense feelings of sadness nearly every day, impairing social, occupational, and other important areas of normal functioning.

How do I know if I’m sad or depressed?

When feeling sadness, it may feel all-encompassing at times but there should be moments where people can feel comforted or able to experience happiness in most other aspects of their lives.

Those with depression however find that their depressed feelings will affect all aspects of their lives and may find it hard or even impossible to find enjoyment in anything, including activities they used to enjoy. Depression is more than an emotion; it is a mental illness.

Those with clinical depression may not just experience sadness, they can also have intense feelings of helplessness, hopelessness, and feeling worthless. They may describe an ‘empty’ feeling inside and may believe that life is not worth living.

In sadness, a person may feel regret or remorse for something, but they will not experience any permanent sense of worthlessness or guilt as one might find in depression. A person who is sad may cry, spend some time alone, then get back to normal within a short span of time.

This is not the case of someone with depression who often find their feelings last for weeks or months. Clinical depression is a common worldwide illness with an estimated 3.8% of the population being affected (World Health Organization).

It is also a very serious condition as many people with depression may have suicidal thoughts, self-harming behaviors, or may even attempt or commit suicide because of their depression.

Symptoms of clinical depression

Below are some of the symptoms that could be experienced by someone with depression. Note that symptoms of depression present differently in everyone and in severity, and not everyone will experience every symptom:

Diagnosis of clinical depression

To diagnose clinical depression, criteria must be met in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Individuals must be experiencing 5 or more of the following symptoms during the same 2-week period and at least one of the symptoms should be either 1. Depressed mood or 2. Loss of interest or pleasure:

1. Depressed mood most of the day, nearly every day.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Sufficient weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings).
5. Fatigue or loss of energy nearly every day.
6. Feelings of worthlessness or excessive inappropriate guilt nearly every day.
7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

For a diagnosis to be made, the symptoms must be causing the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The symptoms must also not be as a result of substance abuse or another medical or mental health condition.

Coping with sadness

It is important for those who believe they may have depression to seek help and undergo treatment so that they can overcome their intense struggles.

However, for those who are experiencing the emotion of sadness, there are ways to express sadness in a healthy way, to help people get through this emotion. These may also work as preventative methods to stop sadness turning into depression:

• Allowing the sadness — sadness is something that is natural and unavoidable. It can be detrimental to hold back these feelings, which can in turn make someone feel worse.It can be better to accept the sadness and cry or express these feelings to someone to help overcome it.
• Planning a day to feel sad — if experiencing a lot of sadness, it may be helpful to take a day off to be alone and to reflect on emotions and thoughts.This can help people to move past the sadness into a happier mood.
• Think and/or write about what may be causing the sadness — taking time to understand the context behind the sadness and exploring these feelings can help people feel better.
• Take a thoughtful walk — being in nature with the fresh air and some quiet time, along with some exercise, can help people work through their thoughts and change their perspectives.
• Talk to a close friend or family member — having a support network, or even just one person who can be contacted when feeling sad, can help people work through their feelings and feel supported.
• Being kind to oneself — when feeling sad it can be useful to do activities that make the individual feel good such as taking a long hot bath, having a nap, or eating their favorite food.
• Documenting emotions — many people find it useful to keep a journal to express their emotions.This could be used to write down positive things that the individual is grateful for, to help them shift their negative perspective to a more positive or realistic one.It may also be beneficial to write about life goals and the steps that need to be taken to achieve this, so that the person has something to focus on and work towards.

Treatment for depression

Medication

For depression, there are many treatment options available. A doctor may prescribe medicative treatment, which usually will affect the neurotransmitters of the brain. Antidepressants are a common medication for those with depression and these come in different varieties.

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that, as the name suggests, affect the neurotransmitter serotonin. These work by blocking the reuptake (or reabsorption) of serotonin of the presynaptic neuron which released it.

This means there will be more serotonin circulating around the synapse, making it more likely that the chemical will reach the receptors of the next neuron. SSRIs usually take a few weeks to work but they are widely prescribed for people’s tolerance towards them and their effectiveness in increasing mood and decreasing depressive symptoms.

They do however come with some possible side effects such as headaches, dry mouth, and nausea.

Serotonin norepinephrine reuptake inhibitors (SNRIs) are another type of antidepressant that works in the same was as SSRIs in that they block the reuptake of serotonin, but they also block the reuptake of the chemical norepinephrine.

This means there will be more of both chemicals circulating the brain and having a positive effect on mood and depressive symptoms. In some instances, SNRIs appear to more effective at treating depression than SSRIs. However, SNRIs tend to produce more side effects and so may not be as tolerable as SSRIs.

Monoamine oxidase inhibitors (MAOIs) are an older class of antidepressants which work by blocking the function of the enzymes which break down the neurotransmitters, called monoamine oxidase.

If the enzymes are blocked by the MAOIs, this means there will be more serotonin, dopamine, and norepinephrine circulating around the brain.

These days, MAOIs are not typically prescribed since they have strong and several side effects, as well as dietary restrictions which must be followed if taking this medication.

Cognitive behavioral therapy (CBT)

For the most effective treatment of depression, doctors will usually recommend taking medication alongside some type of talking therapy.

CBT is a popular therapy and has proved to be even more effective than medications in some instances as it helps to deal with the root cause of the issue rather than just the symptoms.

CBT works on tackling the negative thoughts that a person has about themselves and changing these thoughts into something more realistic and helpful.

Together with the therapist, automatic negative thought patterns can be addressed, and goals can be set for what the client wants to achieve after completing the sessions.

Activities can be completed during sessions to tackle specific concerns the client may have, as well as ‘homework’ assignments being given such as completing worksheets or practicing relaxation exercises so that the techniques can be practiced outside of the sessions.

Research suggests that CBT can have lasting effects after the sessions are completed and that these effects can often prevent further relapses of depressive symptoms.

Brain stimulation therapies

In cases where other types of therapy do not work, those with severe symptoms of depression may be advised to try brain stimulation therapies. A type of this is electroconvulsive therapy (ECT) which involves transmitting short electrical impulses into the brain.

When proven unresponsive to other treatments, ECT has produced effective results for those with severe depression.

Most people report improvements after around 4 to 6 treatments lasting about 10 minutes each time. Some possible side effects of ECT include headaches, nausea, and some memory loss.

Another brain stimulation therapy is transcranial magnetic stimulation (TMS). TMS creates magnetic fields to stimulate neurons in the brain to help improve symptoms of depression.

With TMS, a large electromagnetic coil is placed on the person’s head and short pulses are directed into an area of the brain believed to control emotions. Several sessions of TMS of around 40 minutes each are generally required over a period of weeks.

This therapy is not recommended for those who have depression with psychosis or those with a high risk of suicide and can have side effects such as muscle contractions in the face and headaches.

Lifestyle

Other ways to treat depression can include to exercise, especially aerobic exercise. A systematic review found that aerobic exercise improved the symptoms of those diagnosed with depression compared with antidepressants or other treatments (Morres et al., 2019).

Likewise, taking up relaxing exercises such as yoga, meditation, or mindfulness training could also be beneficial for helping some symptoms of depression.

Types of depression

Depression can take form in many different types depending on the cause and the symptoms being experienced:

• Major depressive disorder
• Seasonal Affective Disorder
• Disruptive mood dysregulation disorder
• Premenstrual dysphoric disorder
• Substance-induced mood disorder
• Persistent depressive disorder, also called dysthymia
• Depressive disorder due to another medical condition

Depression may have other features alongside it, such as:

• Anxious distress — when anxiety is experienced alongside the depressed feelings
• Mixed features — both depression and mania is present, including periods of high energy, talking too much, and high self-esteem
• Atypical features — an individual can feel good after happy events but also feel hungrier, need to sleep a lot and are sensitive to rejection
• Psychotic features — this is where hallucinations or delusions may be present
• Catatonia — an individual cannot move their body normally — either still and unresponsive or have uncontrollable movements
• Peripartum depression — this is where symptoms of depression begin during pregnant or after giving birth
• Seasonal pattern — the depressed feelings get worse during the changes in the seasons, usually in the wintertime

Causes and risk factors

There is not always a known or direct cause for what triggers the onset of depression. It could be that a combination of a variety of factors causes depression, such as:

• Genetics — mood disorder such as depression can have a tendency to run in families
• Brain changes — imaging studies have shown that the frontal lobes become less active when a person is depressed. Depression is also associated with changes in how the pituitary gland and hypothalamus respond to hormone stimulation.
• Trauma — if negative events are experienced at an early age, this can cause long-term changes in how the brain responds to fear and stress.
• Life circumstances — including relationship changes, finances, and where someone lives.
• Other medical conditions — people who have a history of sleep problems, medical illnesses, chronic pain, and anxiety are more likely to develop depression. Some medications could also cause some symptoms of depression.

Studies on the beliefs that people with depression have about the causes of the condition have identified a variety of probable causes (Khalsa et al., 2011).

These include interpersonal problems (such as poor social skills and mistreatment by others), developmental events (such as childhood problems and unresolved family issues), personality or cognitive causes (such as irrational concerns, emotional upset, and depressive ways of thinking), biological factors (e.g., genetics and biochemical imbalances), and environmental factors (e.g., stress, illness of self and others).

A common biological theory of depression is an imbalance of neurotransmitters in the brain.

Neurotransmitters are chemical messengers who travel through the nerve cells (neurons) of the brain. The neurons help to transmit the neurotransmitters onto the next neurons by attaching to receptor sites on the postsynaptic neuron so that they can influence the brain, mood, and behavior.

There are three key neurotransmitters which are believed to play a role in depression:

• Serotonin — a key hormone which stabilises mood, feelings of well-being, and happiness.
• Dopamine — plays a role in motivation, reinforcement, pleasure, and reward.
• Norepinephrine — plays a role in arousal, energy levels, attention, and the regulation of emotions.

This theory of depression explains that serotonin, dopamine, and norepinephrine levels are low in the brain and thus this contributes to feelings of depression.

There are many reasons why these neurotransmitter levels could be low, including:

• The molecules that help produce these neurotransmitters are in short supply.
• There are not enough receptor sits on the postsynaptic neurons to receive the neurotransmitter.
• The presynaptic neurons which released the neurotransmitters are reabsorbing the neurotransmitters back before they have had a chance to reach the receptor sites.
• There are too few of the molecules that build the neurotransmitters.
• There is too little of a specific neurotransmitter being produced.
• Too much of the neurotransmitter is being broken down by enzymes in the synaptic cleft (gap between two communicating neurons) before reaching receptor sites.

This theory of the cause of depression seems to make sense as a lot of the medications used to treat depression specifically target serotonin, dopamine, and norepinephrine and have shown effectiveness in decreasing the symptoms of depression.

In a 2020 study, it was discovered that depression, self-harm, and suicide attempts in U.S. teens significantly increased between 2011 and 2018. It was suggested that an increase in social media and technology use could have played a role in this significant increase.

It was found that heavy users of technology were twice as likely to be depressed or have low well-being compared to light users of technology.

Although technology use is not the cause of most depression, increased time spent on technology may be a contributing factor to the sudden increase in depression being diagnosed (Twenge, 2020).

Although, it could be argued that teens that are experiencing depression anyway, may have chosen to use technology more as a way to escape the struggles of daily life, or they may be drawn to technology more if they are isolating themselves from others.

Other life events could be a potential cause of a rise in depression such as financial worries or worries about health. With the COVID-19 outbreak, more people have had to isolate themselves for a long period of time, sometimes separating themselves from their support networks or not being able to do the activities that they find enjoyment in and worrying about the world and people’s health.

As a result, research may find that consequently, more people are finding themselves depressed or suffering from other mental health issues.

Sources: 1,2,3,4,5,6,7

Originally published at https://www.beyondsciencetv.com on November 10, 2022.