Depression Explained

Depression is a frequently used word, but what exactly does it mean? Since October 7 is National Depression Screening Day and October 10 is National Mental Health Day (see NAMI learn more about Mental Illness Awareness Week that Congress initiated in 1990), I thought I would take this opportunity to delve deeper into the diagnoses and symptoms of depression and some of the most compelling research to treat depression and enhance mental (and physical) health.

Depression affects more than 264 million people worldwide. Of those impacted, 76-85% of people with mental health disorders in the middle to lower-income countries lack access to treatment. While depression is decreased with higher incomes, it is essential to recognize that the leading cause of death among non-Hispanic white, middle-aged adults in the U.S. was due to poisoning, with the third leading cause of suicide. This reveals the gravity of depression and its associated costs even among people in a higher-income country with broader access to care. Unfortunately, it also highlights one of the biggest challenges in treating depression, as one of the main symptoms of depression is the tendency to withdraw and isolate. It’s also a biological norm because the body naturally withdraws to conserve energy and heal when it feels sick. However, untreated depression is less likely to recover in a state of isolation and depression-driven behaviors.

What are the depression diagnoses?

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), depression has various physical and non-physical symptoms, with depressed mood and anhedonia (inability to feel pleasure) being primary symptoms. That is why you cannot coax someone into looking at the bright side, trying to get them to laugh, or telling them to get over it. (All bad ideas that only serve to reinforce the depressed person’s emotional and physical isolation from you.)

Physical symptoms of depression may include sleep difficulties, weight changes (gain or loss), trouble concentrating, fatigue, and accelerated or decreased psychomotor activity. In contrast, non-somatic symptoms can be depressed mood, lack of pleasure, hopelessness, worthlessness, guilt, and suicidal thoughts.

Not all of the listed depression symptoms have to be met to attain a depression diagnosis, yet having a cluster of the described symptoms combined with onset, length of time, and accounting for other existing medical conditions can result in the diagnosis of depression (based on the severity of mild, moderate, or severe). Some depression diagnoses are disruptive mood dysregulation disorder, major depression disorder (MDD) (with episodes and features), persistent depressive disorder (dysthymia), premenstrual dysphoric disorder, postpartum depression, and depressive disorder due to another medical condition.

Systemic Consequences of Depression

Depression can lead to trouble concentrating, making one withdraw from social and physical activities (including work and/or school), and can have the reinforcing isolating impacts of being socially rejected, losing essential relationships, and/or getting let go from a job. Social isolation increases depression, so it’s a vicious, mutually reinforcing cycle.

Depression can also have devastating effects on a newborn when their mother is unavailable and disinterested. Ahmed et al. (2021) found mothers who had poor mental and physical health during the pregnancy and up to 15 months after the baby’s birth resulted in their infants having significantly poorer health scores and decreased functioning.

Unfortunately, numerous studies reveal that neglect and mistreatment in childhood have long-lasting harmful effects on health and often result in depression. Duprey et al. (2021) found neglect and childhood maltreatment to result in internalized shame, cognitive distortions. They blunted cortisol production (like in Addison’s Disease, where the body cannot produce cortisol and features a flat effect). Liebermann et al. (2018) showed that women with childhood maltreatment had higher depression, pelvic pain, and endometriosis rates. Zarse et al. (2019) identified a long list of early-onset health conditions and mental disorders among people with adverse childhood experiences (ACEs), including high rates of depression, substance abuse, and reduced lifespans.

Depression becomes reinforced through the generations as depressive parenting creates depressed adults combined with a depressive culture that often employs unhealthy habits for coping (like poor sleeping habits, excess nervousness and anxiety, alcohol and substance abuse, junk food preferences, lack of exercise, and poor self-care). Additionally, the inability to concentrate in school can lead to higher school drop-out rates, job instability, difficult relationships, trouble maintaining household chores and bills, reduced income, and reduced use of medical check-ups and healthcare. Consequently, it is not surprising that many studies have shown increased inflammation and diseases in chronically stressed and depressed people.

Depression Essential Reads

Not Just Sadness: Decomposing Depression

Vigorous Workouts Alleviate Depression Better Than Easy Ones

Recommendations for Treatment

One of the consistently researched and recognized interventions for treating depression (and chronic pain) is cognitive-behavioral therapy (CBT). This may help because it reduces distorted thinking patterns that pervade depression. Depression is akin to wearing blurry glasses, and one’s perceptions about the world and other people are not always correct. CBT helps to regain more accurate perceptions and overcome rumination, catastrophic thinking, fear, and self-abuse. It should be noted that CBT works best when it is with a trusted therapist. As so many studies and theories echo, good therapy outcomes result from a good therapeutic relationship. People often report improved relationships in other areas of their lives due to therapy, which aids in overcoming depression and sustaining mental health.

Other lifestyle practices include a healthy diet that replenishes the healthy bacteria in the gut (microbiome). Antibiotics, fast foods, sugar, and trans fat destroy healthy bacteria, and research continues to find a direct relationship between the microbiome and immune system and mental health. This can feel especially challenging for people who reach for chocolate chip cookies with fond memories of a grandparent who made homemade cookies. Choosing a sweet potato instead may not seem as appealing yet can have more positive impacts on your health and mood over the long run.

Exercise is another way to restore healthy balance to the body. Running, dancing, walking, hiking, or jumping jacks can release the stress hormones that feed depression. Soothing stretching and mindful exercise like yoga can release stress hormones while simultaneously enhancing feel-good chemicals and moving the body into the healing rest and digest nervous system. Another secret is spending more time outdoors. Not only does the vitamin D from the sunshine help (just not too much), trees emit natural neurochemicals that treat depression. All people could benefit from more recess play-time outside.

Another overlooked necessity is sleep. It has been reported that adults in the 1950s reported 8-9 hours of sleep per night. Today’s adults sleep 6-7 hours on average. They need more sleep. Growing adolescents need around 10 hours of sleep per night. Sleep is huge for memory consolidation, learning, immune repairing, mood neurochemicals, and a host of molecular processes needed for the body to optimally function. Sleep deprivation is a massive public health issue and underlies many accidents, poor decision-making, and mood states. Sleep deprivation has been associated with numerous illnesses, and one night’s sleep loss has shown increases in brain chemicals associated with Alzheimer’s Disease. The grimmest result of sleep deprivation is death. To restore sleep, stay off electronics before bedtime and try to keep electronics out of the bedroom. Beware of blue lights as they activate our serotonin-induced wake-state. Instead, we want to enhance our night-time natural melatonin. Deep breathing and conscious muscle-relaxing help and consciously seek things that inspire grateful feelings, even if it is only the ability to breathe.

I realize these tips are easier said than done. I deeply understand the burden of depression and its associated feelings of isolation and despair. I came into this field as a wounded healer. My young teenage mother was depressed, estranged from her family, and she even fell off the delivery table while giving birth to me (this has been corroborated). I watched my mother cry most of my life. Sometimes she would laugh. Other times she was ridiculing and angry. My father responded to me with old-fashioned physical punishment. I was often told I bruised easily and was too sensitive. I had experienced being in a foster home when the state charged my parents with child abuse. I lived with great shame about that for years. My mother passed ten years ago. She was far too young, and I cannot help but view the toll that untreated depression took on her.

Depression is a multifaceted, systemic disease, and treating it takes time and help. Please know you are worth it—and when you rise from it like a beautiful cresting wave greeting the sunlight, you inspire the rest of humanity that they can do it too. Be compassionate with yourself and those around you because so many people struggle from invisible wounds and are often reacting from a place of darkness and pain.