Facts About Depression - A. Symptoms

Depression is a complicated illness that can involve a number of contributing factors – genes, environment, diet, lifestyle, brain chemicals, and personality.  One of the basic keys to beginning to overcome this potentially debilitating disorder is to be educated about it. That applies whether it’s you who have depression or a loved one.  

There’s so much information available nowadays, particularly through the net, and people are accessing it more readily and easily than ever before. However this has a downside - sometimes there’s so much out there, it only confuses rather than clarifies. Hopefully this series of posts will serve to inform the reader of the basic knowledge about depression and will explain some of the terms which are sometimes used interchangeably as they mean the same things. Being informed about this illness is not about being self-focused and self absorbed; for people to whom depression has taken over their life, it’s a way of managing it so that they can have a meaningful and fulfilling life while living with depression. So through intense research of reliable sources, I have here condensed the professional jargon into something that we, as 'laymen', can understand.

These posts (About Depression - Symptoms; Causes & Treatment) are focused on factual information. Of course as Christians we cannot minimise the spiritual, but even though we believe in healing and know that God can and does heal, what do we do if we or a loved are diagnosed with a chronic or major disease and we wish to help them? We will learn all we can about it, including what the secular medical community have discovered. Lets not be afraid to do the same with this illness that affects many and devastates the lives of both Christians and unbelievers alike. Doing this does not diminish our faith or reliance on God, it just helps us to understand what we are dealing with.

The three most widely quoted sources of information on depression are the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the World Health Organisation (WHO) and the International Classification of Disease (ICD). All three differ to some degree in some of their interpretations, but do agree about the most basic facts of depression.

The two most popular Australian organisations for help with depression are Beyond Blue and the Black Dog Institute. These differ somewhat in their classifications of depression, possibly because they recognise it can be confusing and each is trying to make it easier for the general population to understand. There are also some differences between countries. I have tried to include the most commonly used terms here and have given examples of the many different labels and names used.

You may read or hear depression described as an ‘affective disorder’. This is an overall term meaning a mental disorder characterised by consistent and pervasive changes or extremes of mood, affecting thoughts, emotions and behaviours. Both depression and bipolar are considered affective disorders.

There are several different types of depression which have both similar and differing symptoms, as well as additional symptoms such as in bipolar, or with fewer signs as in dysthymia (a milder, chronic form of depression). These and other different types of depression will be examined in the next post. And then, in a third post we’ll go through the causes. It is important to know what kind of depression you have as the symptoms may vary and there are different treatments more suitable for different types of depression. Different types of depression can have different causes. Knowing this also aids in the treatment. Hopefully I will have reduced the gobbledygook into simple terms that are easy to understand and relate to.

Symptoms

To begin we will look at the symptoms described in the ‘bible’ of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association, 4th Ed,  Washington, D. C.,1994, p 327). It describes a “major depressive episode” as:

Five (or more) of the following symptoms have been present during 

the same two week period and represent a change from previous 

functioning; at least one of the symptoms is either (1) depressed 

mood or (2) loss of interest or pleasure:

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful),

(2) markedly diminished interest or pleasure in all or almost all activities most of the day, nearly every day,

(3) significant weight loss or gain when not dieting or specifically trying to increase weight (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day,

(4) insomnia or hypersomnia nearly every day,

(5) psychomotor, agitation or retardation nearly every day (observable by other),

(6) fatigue or loss of energy nearly every day,

(7)feelings of worthlessness and/or guilt that is excessive or inappropriate nearly every day,

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day,

(9) suicidal tendencies including: recurrent thoughts of death, recurrent suicidal ideation without a specific plan, a suicide attempt or a specific plan for committing suicide.

The symptoms must not be a physiological effect of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

That is the official criteria that your doctor will use to diagnose depression. They will usually use a questionnaire or rating scale to help them with the diagnosis. When diagnosing depression, anxiety, grief and sorrow are regarded as ‘normal’ reactions to tragic life events and as such are not deemed ‘clinical depression’ although it sometimes happens that negative life events will trigger clinical depression and this is usually diagnosed if the symptoms have lasted longer than is thought ‘normal’ after a negative event in a person’s life.

Now we’ll explore what these symptoms may look like in everyday life.  Some of these will vary depending on the type of depression, which will be discussed in the next post. But while there are many general signs that will apply to most people with depression, it is a very individualistic illness.  (Although as stated in the DSM-IV quote above, a depressed mood and/or a loss of interest or enjoyment in activities is present in anyone with clinical depression.) What one person feels strongly may not be much of a problem with another person. These symptoms lie on a continuum that ranges from the less severe to very severe. For example, someone with mild to moderate depression may feel sad but be able to cover that feeling to all but the closest to them. (This even has a name – smiling depression or may also be called concealed or hidden depression) they may have low-lying symptoms, that seem to be just beneath the surface . . . not felt severely, but obviously there; while at the other end of the spectrum someone with a very severe depression may experience such an all consuming and deep sadness that it immobilises them. They may not be able to cope with everyday life due to the severity of their symptoms. These symptoms affect all areas of a person - body, mind and spirit. 

Below is a list of common symptoms that person with depression may experience:

Mood

·       * Feeling sad
        * Crying, or may want to cry but can’t
        * Loss of pleasure or interest in ordinary activities
        * Feeling empty
        * Hopelessness
        * Profound and utter despair
        * Feeling worthless and inadequate
        * Low self esteem
        * Feeling numb
        * Emotions ‘hurt’
        * Feeling a deep sense of guilt
        * Lack of motivation
        * No emotional reserves
        * Feeling despair

Thinking

·       * Hard to concentrate
        * Ruminating – going over and over the same thing in your mind
        * Mind may seem empty of thoughts
        * Thoughts may become muddled and broken, hard to think clearly
        * Lack of self confidence and self esteem
        * Introspective – in a self derogative way, preoccupied with own failings
        * Worry a lot
        * Feeling unable to give to others
        * Isolating yourself
        * Impaired memory
        * Altered perception – negative interpretations of events or conversations                     

        * Negative self concept
        * Thinking others are watching or talking about you behind your back
        * Exaggerated negative view of your problems
        * Blaming yourself and believing with all your heart that you are to blame for anything that 
          goes wrong and for feeling the way you do

        * Self pity

·       * Pessimistic
        * Mental pain – hurts to think
        * Difficulty in making decisions
        * Thinking centres around deep guilt feelings, even when the guilt is not deserved, you 
           sincerely believes it is
        * Believing that you are inadequate and worthless
        * Irrational thinking 
        * Obsessive behavior
        * Difficulty in contributing to conversations
        * Thinking about of suicide, or having a fear of committing suicide
        * Thinking about death
        * Delusions, hallucinations, psychosis may happen but only to a       

               minority of people

Physical

·       * Slowed body movements
        * Change in facial expression, sad, eyes cast down, looking tired 

          and dejected
        * Looking and feeling exhausted all the time
        * Sleeping affected. May sleep too little or too much, often having 

           trouble falling asleep at night or waking in the early hours and unable to get back to    
           sleep.

·       * Eating too much or too little
        * Menstrual periods stop or become irregular
        * Loss of libido
        * Tension headaches
        * Rapid heart beat, palpitations
        * An ache, knot or butterflies in the pit of your stomach
        * Increase in symptoms of other medical problems, i.e. if you have   

           irritable bowel syndrome or migraine, these may become worse 

           when depressed.

·       * Fatigued, lack of energy or stamina, small task seem like major 

           ones. May take 4 hours to do what normally takes only 2, then you 

           will feel very tired after.
        * Lethargy, exhaustion
        * Can have aches and pains in body and/or sweating
        * Diarrhoea, constipation,
        * A feeling of a lump in the throat, difficulty swallowing
        * Agitation
        * Catatonic
        * Withdrawing from social activities
        * Gastrointestinal disorders
        * Neglecting appearance

Anxiety Disorders (depression is associated with a high frequency of anxiety    

    disorders)

·       * May become irritable
        * Angry outbursts, short fuse
        * A feeling of running on empty
        * Agitation, may feel as though you are ‘jumping out of your skin’
        * Feeling of having lots of adrenaline
        * Panic attacks
        * Phobias
        * Obsessive compulsive symptoms
        * May feel that every one is looking at you so having to socialise 

           may overwhelm you

·       * Feeling nervous when there is no reason to be
        * Fear of meeting people, talking on the phone

Spiritual

·       * Pulling away from God
        * Feeling as though God is rejecting you (triggered by excessive 

           and false guilt)

·       * Feeling that God is punishing you

·       * Becoming overly involved in spiritual things in a desperate attempt 

           to compensate for the feelings of guilt
        * Christians may fear they have committed the unforgivable sin.
        * Feeling deeply guilty over any sin you think you may have 

           committed and may become very focused on your sins
        * May doubt your salvation

As you can see this is a large list and is not exhaustive. Someone may suffer only a few from different categories or they may experience many of these symptoms. If you thought it was tiring reading about them, imagine living them. Depression, if nothing else is emotionally draining.

Relationships often suffer when someone is depressed. Often the depressed person will not open themselves to another person as they feel that if someone really knew them in that state there is no way they would like them, let alone love them.

There are also some atypical (not typical) forms of depression that have their own diagnostic criteria. Many people who have mild to moderate depression do not know they are actually sick, they just know they feel awful and do not know why. Having a doctor diagnose depression can almost be a relief in this situation. 

Many things can influence depression. Hormones may cause it to be worse around menstrual time or during menopause. Drugs, medications, alcoholism, or other medical problems may also cause similar symptoms and may complicate the issue and also, depression can be a symptom of a totally different disease. This is why it’s important not to just self diagnose but to get a professional opinion.

The emotional pain of depression can actually be more severe than the physical pain of a broken leg. This may be hard to understand if you have never suffered in this way, but it’s true... just ask anyone who has suffered from moderate to severe Major Depression. Emotional pain can be felt in a physical way. Often as a deep pain in the pit of your stomach, or as though you have a heavy cloud pressing down on you – physically. It is very real. Its been described as feeling like you’re being kicked in the guts – continually. Conversely for some people it can involve a severe numb feeling, where they lose the deep sadness and just feel nothing.

Sometimes people may experience some of these symptoms at different times in their life, perhaps as a result of a life event and/or through grief. They may think that because of this they understand depression and may offer suggestions of things that worked for them. Similarly I’ve known people who have experienced mild depression who offer solutions (often lifestyle changes) to someone who is moderately or severely depressed and wonder why their advice doesn’t work.  Depression is different for everyone and it’s so important to not be judgmental. Just because something worked for one person doesn’t mean it will work for someone else. And just because a person has experienced depression doesn’t mean they automatically understand what depression is like for someone else.

Knowing your symptoms is the first step in treating depression. This is how a doctor will diagnose what type of depression you have, and knowing what type of depression you have helps to know how to treat it. We’ll look at the different types of depression in the next post.