You’ve heard the commercials for antidepressants promising to help treat depression, but they never specify what type of depression. And the way that many people talk about depression, you would think it’s just one mental disorder that affects everyone at some point. Does this seem confusing? How can it affect everyone if it’s a disorder? You’re not alone, and there needs to be a reconceptualization of what depression really is because of this confusion.
Doug Haymaker, a clinical psychologist, said in an email that many of his patients seem to be misinformed about the true meaning of depression.
“One of the most common reasons people come to see me is because the ‘have’ depression,” Haymaker said. “Usually, what they mean is they have a vulnerability to depression -- not constantly depressed, but under the right (or wrong) circumstances, they can become depressed.”
Depression is currently used by many people to describe any state that has some depressive symptoms, although this is inaccurate.
“I agree that depression is overused, meaning anything from seriously disabling (can't get out of bed) to a personality that tends to be pessimistic and glum,” Haymaker said. “When I see people, I make a distinction between how they feel (sad) and how they function, among many other things.”
Rebecca Cagle, a certified advanced professional life coach, said in an email that she separates depression and sadness, which can sometimes be confused with each other.
“Sadness is usually attributed to specific events,” Cagle said. “In most cases of sadness, you do not lose hope all together. You may even feel immediate despair when a loved one dies but you eventually regain your hope ... Sadness generally does not require medication, except in short term cases such as the first few weeks following the death of a close loved one.”
Although she doesn’t differentiate between different types of depression, she said that depression should be separated from sadness in its definition.
“Depression is like a black hole that you are in and there seems to be no way out. You feel unfathomable despair,” Cagle said. “You completely lose hope and think that nothing will ever be OK again for a prolonged period of time. There may or may not be a triggering event. Depression is more about a chemical change in the brain that may be alleviated with anti-depressant medication on [a] long-term basis.”
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) is used to define mental disorders, including different types of depressive and mood disorders. When people refer to clinical depression, in the DSM this would most likely include any depressive disorders like dysthymic disorder and major depressive disorder. There isn’t even an entry referred to only as “depression.” And websites never seem to have the same definitions or types of "depression" as well. Sometimes mental health professionals who use these definitions don’t even follow them fully.
Melody Brooke, a licensed professional counselor, said in an email that lack of communication about definitions can contribute to issues.
“The problem is that the clinicians don't communicate the differences in the conditions very well, and prolonged grief is a ‘V’ code (not really a disorder) but is proposed for the next edition,” Brooke said. “It’s also difficult for a lay person to differentiate between generalized anxiety disorder and depression.”
Some people are just experiencing normal emotions and don’t actually have depression.
“Depression is not just ‘feeling blue’ for a few days or weeks,” Brooke said. “It's a debilitating experience that significantly interferes with functioning in all areas of our life. Thoughts of suicide, self harm, psychotic episodes, significant weight loss and a marked absence of emotional expression characterize depression. Prolonged grief can turn into depression, but is not depression by itself. Grieving is normal, depression is not.”
Tara Kennedy-Kline, the CEO/President of TK’s Toy Box, said in an email that she herself has been uncertain as to what type of depression or mental disorder she actually has or had. She was diagnosed first as having depression anxiety, then manic depression, ADD and PTSD. She eventually realized that at least for her, these definitions weren’t helpful.
“What I didn't realize was that many of the problems I was having as a result of my circumstances were problems I created,” Kennedy-Kline said. “I didn't learn this until I went through my coaching training, but I was actually compounding my own troubles by burying them under all the labels I was given to excuse them.”
Stephanie Adams, a licensed professional counselor, said in an email that situational depression is sometimes interchanged with clinical depression.
“You can have the exact symptoms of clinical depression, but not be clinically depressed, because you have a reason to feel that way,” Adams said, referring to situational depression. In clinical depression, there are also cognitive difficulties experienced.
Even among experts and sufferers of depression, it appears that there is no concrete concept of what depression is, but it is clear that there is an issue with pathologizing normal emotions and reactions (and maybe even normalizing actual mental health problems in some cases), as well as simplifying complex mental disorders into one word.
Haymaker, Doug. Email interview. August 15, 2011.
Cagle, Rebecca. Email interview. August 15, 2011.
Brooke, Melody. Email interview. August 15, 2011.
Adams, Stephanie. Email interview. August 15, 2011.
Kennedy-Kline, Tara. Email interview. August 15, 2011.
Reviewed August 17, 2011
by Michele Blacksberg R.N.
Edited by Jody Smith