Feeling sad or unhappy at times is normal – especially during the COVID-19 pandemic. Many of us are doing our best to cope with anxiety and isolation.
But at what point does that sadness progress into depression?
“You can usually think about clinical depression being clinical when it lasts for two or more weeks, with most days or most of the time being down in the dumps or blue, or unable to enjoy the things you usually enjoy,” said Mark Bauer, who is professor emeritus of psychiatry at the Harvard Medical School and an investigator with the Department of Veteran Affairs’ Center for Healthcare Organization and Implementation Research.
Symptoms of depression
Depression can have many symptoms:
- Loss of interest or pleasure in activities or hobbies you once enjoyed
- Lack of energy or tiredness
- Changes in sleep – too much or not enough
- Changes in diet – reduced appetite or overeating
- Slowed thinking, speaking or movement
- Trouble thinking or concentrating
- Feelings of worthlessness or guilt
- Unexplained physical aches or pains
- Prolonged feelings of sadness, hopelessness or emptiness
- Unexplained crying spells
Some of the most severe symptoms involve thoughts of suicide or death. These require immediate attention. If you or someone you know is having these thoughts, seek medical help right away or call the National Suicide Prevention Lifeline at (800) 273-8255.
Steps to start treatment
The first step in dealing with depression is to check in with yourself on how you’re feeling, said Vivian Pender, president-elect of the American Psychiatric Association and a clinical professor of psychiatry at Weill Cornell Medical College in New York.
“If you spotted a cut on your arm and it was bleeding, what would you do?” Pender asked. “You would take care of it. You wouldn’t ignore it. It’s the same thing with feelings. Don’t ignore them.”
Next, look at the severity of your symptoms. If you feel they’re mild, Pender said positive actions such as talking to friends and family, exercising regularly, or improving your sleep may help.
If these don’t work, Pender recommends a “triage” approach. First, talk with your primary care doctor to rule out any potential medical conditions that may cause depression, including thyroid issues.
Your doctor then can refer you to a mental health professional, who can provide a number of treatment options, including talk therapy, medications or a combination of the two.
If you’re prescribed medication for depression, don’t stop taking it without consulting your mental health professional first, Pender said, adding, “It’s most important not to do that.”
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If you have depression, a number of resources and organizations are available to help. The National Alliance on Mental Illness has a series of personal stories on its website, including one titled, “I Have Depression And It’s OK.”
The anonymous author writes, “Depression is not weakness. I know I’m not alone. You’re not alone. We’re all in this together.”
Working it out
During a July 28 webinar hosted by the Anxiety and Depression Association of America, Zachary Cohen, a clinical psychology researcher at the University of California, Los Angeles, said treatment for depression likely will involve trial and error. This means doing your best to be patient as you and your mental health professional work out the right treatment for you.
“There’s really a wide spectrum of different treatments, all of which work for some people and some of which work better on average than others,” Cohen said. “There are a lot of things we can try.”
| Types of depression and risk factors |
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Someone who experiences repeated depressive episodes over a period of at least two weeks may have a condition known as recurrent depressive disorder, according to the World Health Organization. Another significant type of depression is bipolar affective disorder. “This type of depression typically consists of both manic and depressive episodes separated by periods of normal mood,” the WHO says. “Manic episodes involve elevated or irritable mood, overactivity, pressure of speech, inflated self-esteem, and a decreased need for sleep.” Some symptoms of depression, such as insomnia, irritability or agitation, are more commonly linked to anxiety. “We know there’s some neurological connection,” said Mark Bauer, who is professor emeritus of psychiatry at the Harvard Medical School and an investigator with the Department of Veteran Affairs’ Center for Healthcare Organization and Implementation Research. “We know that some people who get depressed can feel very anxious and agitated, while others feel more sad and turned inward.” Other types of depression include postpartum depression (after childbirth) and seasonal affective disorder, also known as SAD. According to the Depression and Bipolar Support Alliance, risk factors for depression can include having a family member with a mood disorder or other mental health condition. Specific genetics or brain structures, trauma or stressful life events, and excessive drug or alcohol use are some of the other risk factors. |
