I came across the idea of the “Black Dog” to personify depression years ago. I loved the illustration as I feel it captured well how depression feels in a way others may somewhat understand. You can watch the video here:
Depression is much more than feeling sad. People will often say they feel depressed or have felt depressed over a situational sadness. Everyone feels sad. Everyone has experienced grief. Not everyone knows the dark pit of depression.
Depression is a dark hole that a person falls into and seems to never be able to crawl out of. Depression is an all consuming fire burning the person alive. Depression is a large wave drowning you as you fight for your life. Depression is NOT a choice. One cannot simply “snap out of it”. “Just think about all the good thing you have”. “How can you be depressed, your life is so good”. “You’d feel better if you strengthened your relationship with God”. “You’re letting the devil control your life”. “You just need to ______”. Words I’ve heard over and over, and words that are so very far from helpful.
Depression is beyond situations…granted situations can make depression feel worse and situation grief or sadness can evolve into depression, but often it persists despite what is going on in a person’s life. Research into the cause of depression has shown it is a very complicated disease created from genetic dispositions and the way a persons brain is wired. I could go on and on about the neuroscience behind depression, but rather I’ll provide a link if you’re interested:
Depression is defined in the DSM-V (psychology diagnostic manual):
Depressed mood or irritable– A person must feel depressed the majority of the time and can be subjective (reported by person) or objective (observed by another).
In my life I become very tearful and feel very empty. This is a consuming feeling and persists for days, to weeks, to months…to years.
Decreased interest or pleasure– A substantial loss of interest in what a person used to like to do.
One of my warning signs for heading into a depressive episode is that I start to lose interest in doing thing I normally love. I quit reading, I quit working out, I quit cooking, I start to just stay inside, I limit social contact, even my job seems difficult to enjoy.
Significant Weight/Appetite Change- Generally a change of 5% of body weight in 3-4 weeks.
For many eating is a coping mechanism. For me, I quit eating. I completely lose interest in food and things I normally love to eat taste bland and unappealing. In nursing school I lost 30lbs in three months because I couldn’t eat. I try to force myself when this happens, but with food not tasting well it’s hard to do.
Change in Sleep- Insomnia or hypersomnia. Can’t sleep or sleep way too much.
Mine shows up as insomnia. I cannot fall asleep and once I do I wake up constantly. However I’m always exhausted. Others sleep too much and struggle to stay awake.
Change in Activity- Psychomotor agitation or retardation. Think fidgeting too much or unable to move.
My depressive episodes are definitely mixed with anxiety so I will experience both. At times I cannot sit still. Other times I cannot move or move very slowly. I’ll walk slower and respond slower…sometimes it takes all day to take a shower.
Fatigue or loss of energy- I feel this ties in with the previous one. However the loss of energy is more than feeling “blah” or a normal “tired”.
At it’s worst I have to remind myself to breath. The loss of energy is so severe that breathing seems “too much”. Moving seems impossible…I’ll sit or lay in one position for hours…the entire time trying to convince myself to move. It’s as if your body is made of lead.
Guilt/Worthlessness- Excessive or inappropriate feelings of guilt and worthlessness.
Note: “Inappropriate”. Meaning irrational. Meaning the thought process and perception of the person is affected and you cannot reason a depressed person out of depression. Instead they often find themselves feeling very guilty for feeling the way they are. I will feel like I’m letting everyone down around me…I will feel useless, worthless. A burden.
Concentration- Indecisiveness, diminished ability to think.
Talking is difficult for me, I’ll struggle with expressive aphasia. Meaning I can’t get words out and I can’t get them out in the right order at times. When severe I can barely drive…I’ve almost wrecked my car many times because of this. It’s worse than driving drunk…you just cannot think right.
Suicidality- Thoughts of death or suicide. Has a plan.
If you’ve been following me at all it’s no secret this has been something I’ve definitely struggled with. And suicide deserves a post to itself. It’s a very complicated topic. For now I’ll explain that in these pits of darkness death seems to be the only way out. It’s not necessarily that the person wants to die, but rather escape.
To be diagnosed with Major Depressive Disorder one must possess 5 of the 9 symptoms listed above nearly every day for more than 2 weeks. The symptoms need to interfere with daily living-jobs, social life, relationships, etc.
Depression is often a co-morbid diagnoses most often with anxiety and addiction. Both of which I will touch on later.
Treatment for depression involves psychotropic medications such as SSRIs (Zoloft, Prozac, Celexa, Lexapro, etc) and therapy. I often tell people treatment is much like dating–you have to go through a lot of bad apples before finding “the one”. Not every medication is for everyone and neither are therapists.
If you haven’t had luck with therapy I’d encourage you to try again. Being able to connect with the person is very important and often therapy is unsuccessful because the relationship between the therapist and patient doesn’t mesh well. Therapy can help identify precipitating factors that cause depressive symptoms and help you rework the mis-wiring of your brain. It’s not a short term process nor a quick fix. Medications aren’t either. They can help, but do not cure. Ultimately you learn to live with your symptoms, learn to lessen them, and cope with them.
Anxiety and Substance Abuse/Addiction are next. Then we’ll finish of Mental Health Awareness Month with the difficult subject of Suicide and an overall discussion of coping skills, therapies, and resources.
If you are feeling suicidal please call 911, go to the ER, or go to your nearest behavioral health facility for an assessment. Your life is worth it. I promise.
Helpline 211 is also available 24/7 to chat or talk on the phone, they are here to help.