There is a great difference between sadness, brief unhappiness, and depression.
Sadness occurs when one is disappointed or unhappy with a situation. Brief
periods of unhappiness occur after losses. Depression, however, is another
matter all together.
Depression has many forms. There is a brief or normal and reactive depression.
When we have lost a job or a position or a relationship, we can often respond
with a brief and reactive and appropriate depression. During this time we are
upset, there may be some changes in our general habits, but most people pass
through this and pull themselves back together. Mild symptoms are often
associated with depression. These may be a mild decrease in appetite, loss in
weight, slight lowering of self esteem, an uneven sleep pattern for a while,
increased rumination, and low energy level. Again with the vast majority of
individuals, these pass without serious repercussions.
However, there are times when the depression posses a
greater and more serious threat to the integrity in the life of an individual.
When the depression is significant and appears to last for more than at least
two weeks, this is something that should be taken note of. Sometimes with a
significant depression there is a serious sleep interruption. This might be that
the person experiences difficulty falling asleep for more than an hour at a
time. There may be mini awakenings at night. There is sometimes difficulty
getting out of bed in the morning and getting to classes. In some individuals
there is the phenomenon of hypersomnia, which is excessive sleep. This would be
gauged by the need for more than ten hours of sleep. When there is an appetite
loss of ten or more pounds, this is also a significant factor. In cases of
significant depression these is a decrease in concentration and periods of time
in which a person can feel unfocussed. There is often associated this a loss of
motivation for school work or other forms of work. This is associated with a
sense of fatigue and heaviness. Others may a notice a sense of social withdrawal
and isolation by the individual accompanied by sometimes increased irritability.
In some extreme cases there is even what is referred to as "psychomotor
retardation". This is when the person literally begins to physically move slower
and seems to be experiencing a significant decrease in their capacity to move
and conduct themselves through the day. Also with depression that is significant
there are increased feelings of guilt, sense of uselessness, and loss of
pleasure or anhedonia. These are all signs that the depression has moved beyond
a mild or moderate stage into something more serious and deserves the attention
of those around them.
The forms of serious depression however are many. Some
of these are reactive to a situation. This includes a major depressive episode.
A person may require to be removed briefly from the life context in order to
overcome this depression. Some depression, however, appear to be cyclical to the
persons personality style. In other words, there is a condition called
cyclothymic disorder. This is where a person literally has significant ups and
downs in their personality during the year. Another condition is referred to as
bipolar disorder. There are two forms of this. It is essentially where a
person's moods are significantly altered that it requires attention. There are
several other mood disorders that are associated with depression. There is a
form of depression also associated with personality "style" that is deferred to
as dysthemia. This refers to a person who may feel themselves to be low in
energy and mildly depressed for long periods of time without any clearly
stimulating factors. A variation on this is SAD or seasonal affective disorder.
However, seasonal affective disorder occurs primarily on the wintertime and is
significantly altered by the change of seasons. Seasonal affective disorder is
also know to respond to different forms of light therapy. Many forms of
depression also respond well to brief medication.
A form of depression that is unique to women is
referred to as post-partum depression. Sometimes after the birth of a child,
there is a significant depression on the part of the woman for several months.
This is related to biological and hormonal changes as opposed to primarily
psychological factors. Clearly psychological factors are involved, but it is
primarily a medical disturbance.
Another form of serious depression that is normal is
the bereavement response. This is when someone very close to us, usually in our
family relationships, but also in our other intimate circumstances dies. We have
a painful but normal and prolonged grieving process. In most individuals this
generally lasts about a year. Many cultures and societies naturally address this
with various rituals and patterns of response to help the individual move
through these difficult times. This again is a normal response. When it moves
beyond a normal response to one that is a clinical response, it is referred to
There are forms of depression that are brief and
reactive that are initiated not by the personality but by substances. These
substance induced mood disorders are many. Also occasionally there is an intense
form of depression referred to as psychotic depression. These can occur with
intense manic episodes and with other major depressive episodes.
It is important to know when to seek help for one's
self and others. When the depression occurs for more than a month, it is
important to address that depression. Also when the depression appears to be
continuous, it is important to address it in yourself or to others. If
significant changes in habits such as sleep, appetite, concentration, mood,
subjective negativity and isolation are all signs that the depression should be
taken seriously. In extreme situations suicidal ideation, whether it be
recurrent or fleeting, can attend depressive episodes. These brief suicidal
thoughts can occur in one's self and sometimes be observed in others. When they
are fleeting, they may occur to a person for the first time and actually be
quite frightening for an individual. Others however, have experienced suicidal
ideation off and on many times and are not as frightened by them. However in
either case they should be taken seriously. When there is a sense of finality
and a sense of severing of ties, of unrelenting guilt, remorse and feeling of
worthlessness, this is when depression is associated with suicidal ideation that
should and must be taken seriously. Verbalized statements of self injury to self
or others are also to be taken quite seriously. When messages are left to others
in various ways symbolic or other, this is a sign that the person's behavior
should be taken quite seriously. This is not the time to abandon a friend. It is
better in circumstances like this to be nosy and intrusive with someone that to
abandon them. Also when there is an increased fixation on (exit) options, this
is sign that the person is entertaining destructive thoughts beyond the fleeting
It is extremely important to take such subjective and
behavioral signs seriously. When this occurs to one's self, even if it's for the
first time, one should seek help or if it occurs with someone else, one should
gently urge the others to seek help. One should be aware of the emergencies
operation. Here at the university, you have available the University Health
Services Mental Health Division, which is a 24 hour on-call service. There is
also Emergency Services in Northampton. There is also the police and other
Help for someone with a significant depression that may
be associated with a suicidal ideation can take many forms. Sometimes brief
counseling or even longer term therapy is important after there is an assessment
by an appropriate clinician. Sometimes brief counseling may be associated with
appropriate medication. There are a number of very effective medications that
significantly decrease the pressure that is created subjectively with depression
and suicidal ideation. Sometimes leaving school or one's job can actually be a
positive step in decreasing one's immediate life stresses. Under certain
circumstances hospitalization, voluntary or involuntary, is the path of choice.
Again it is more important to be persistent and even nag the person rather than
to isolate them and leave them alone. Better safe than sorry. Compassion is
significantly less expensive than grief.
Diagnostic and Statistical Manual of Mental Disorders (DSM IV), 4th edition,
American Psychiatric Association
Alfred Friedman, MD, Harold Kaplan, MD, & Benjamin Sadock, MD, Modern
Synopsis of Psychiatry II