If you've turned on the TV anytime in last decade you've seen the commercials where pharmaceutical companies tout their pills as miracle cures that prevent feeling sadness. There's a huge market for easy cures that make people feel better right away. But when is sadness a feeling that we should experience and when does it become an illness that may require additional treatment? If you can no longer tell depression as an illness apart from normal unhappiness, you are not alone.

The debate over "normal reactions" vs. "disorders" has become a huge argument between the American Psychiatric Association and many other mental health professional organizations. The dispute surrounds defining mood disorders and other major mental illnesses in the upcoming Diagnostic and Statistical Manual. This manual is used by doctors to diagnose psychiatric illness and determine where adaptiveness ends and a disorder begins, hence, what type or level of sadness needs professional treatment.

According to the National Institute of Mental Health, more than 20 million people in the US, or around 7% of the population, have some degree of depression. Outside this group are the people who react appropriately to manageable stressors in their lives. In other words, they can experience sadness and recover quickly. It's easy to contrast the two ends of the scale: one side is characterized by temporary discontent while the other sees never-ending distress and severe depression. However, it's in between these two extremes that there is tremendous "grey area" and controversy about where the line should be drawn.

When is the social support of friends enough to overcome trauma and when are additional psychotherapy and/or medication necessary? When is the blues a normal reaction to what is going on in your life and when is it something else?

Here are two critical distinctions to make:

Sadness is just one symptom of Major Depression. For Major Depression, there are usually multiple other symptoms (at least 4 of the following much of the day, most days) such as trouble sleeping or sleeping too much, fatigue, weight gain or loss, feeling worthless, poor concentration, diminished interest or pleasure in normal activities, body movements that are agitated or slowed down, and suicidal thoughts. This type of depression requires professional assistance.

Intensity, frequency, and length of time are also key differences between sadness and Major Depression. Grieving is a normal and healthy reaction when having gone through a traumatic experience or losing a loved one. However, when sadness is felt throughout entire days for a period longer than two or three weeks, there are other depressive symptoms, and it is affecting daily functioning, then it may be a more serious problem. It is the grey areas in between the extremes of sadness and depression that cause controversy and confusion. It requires careful thought and a professional opinion.

With these two distinctions in mind, sadness is generally treated differently than depression. If a person is dealing with sadness, that is minor and temporary, self-help and social support can be very effective. The healing process can be sped up by embracing the emotion. People can plan some time to allow themselves to acknowledge their feelings and to be sad. Getting social support by talking to friends and relatives will help, too. Overall, people need to remember that sadness can be a healthy experience that allows for personal growth, even when it does not feel good.

Major Depression is different. It is more severe, intense and lasts longer than everyday sadness. There is no easy way to beat depression. When it interferes with a person's daily functioning, he or she may need assessment and treatment by a professional.

Psychotherapists can help reduce negative thoughts, build coping skills, and reframe a person's view of the world. If depression is severe enough, medication and therapy together may be the most effective intervention for a major depressive episode. The medication can provide alleviation from symptoms and rebalance neurochemicals in the brain. In combination, therapy addresses, explores, and processes the source of the depression and helps solve the problems. This kind of treatment takes time and requires professional expertise.


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