What is clinical depression?

As a matter of course for this site (or the accompanying podcast) to make sense, I suppose it’s prudent to determine what clinical depression is. Yet before that, identify a few misnomers.

Technically, everyone feels a little depressed or down when they get bad news or things just aren’t going right.In some cases, you may also experience lowered self esteem, feel more self-critical, and feel pessimistic about the future. However, if any of these pick up again within two days to two weeks, then you are undergoing a normal response to difficult or sad situations – ‘normal depression’.

Almost everyone has had a situation like this in their life. It’s probably because of this that people assume that those with clinical depression are over-indulging in their darkness and should “just get over it”.

Clinical Depression is a little more than a period of ‘the blues’.

  • Clinical Depression can be incapacitating – In fact, impaired work performance is often an early manifestation.
  • Clinical Depression is a distinct break from a person’s usual pre-morbid self.
  • The sufferer experiences clinical depression as qualitatively distinct from grief or other understandable reactions to loss or adversity.

The WHO maintains a number of definitions on defining Clinical Depression.

  • Two weeks of an abnormal depressed mood
  • loss of interest or pleasure in activities that used to be enjoyable
  • Reduced energy, or feeling tired
  • Loss of confidence and self-esteem
  • Feeling guilty and unworthy
  • Recurrent thoughts of death or suicide, or any suicidal/self-harming behaviour
  • Reduced ability to think or concentrate
  • Agitated or slow movements
  • Disturbed sleep (not enough/too much/poor quality)
  • Change in appetite (increase or decrease) with weight change
  • Decreased libido
  • Unexplained physical symptoms

Further, clinical depression is generally categorised as:

  • Minor depression
    includes 2 of the first three (italicized) symptoms and at least 2 others.
  • Moderate depression
    includes 2 of the first three (italicized) symptoms and at least 4 others.
  • Severe depression
    includes all 3 of the first three (italicized) symptoms and at least 5 others.

Part of the problem is that we don’t know everything about the mind, it’s function and thus it’s dis-function. We don’t know all of the whys and therefores – but we do know there are many different causes and factors that contribute to depression. Each is unique to the individual who experiences it.  Sometimes, the cause simply isn’t clear.

Some identified causes of depression include:

  • Lifestyle factors
    • stress,
    • nutrition,
    • sleep and
    • exercise
  • Genetic predisposition
  • Personality
  • Traumatic event/s
    • losing a loved one
    • Childhood Trauma
  • Medical conditions
    • hormonal disorders (e.g. SDS)
    • Vitamin D deficiency
    • Chronic infections
  • Medications/Drugs

The issue is complex, hell, let’s be honest, we’re still in the relative dark ages of mental health practitioning. So, while this is in no way meant to be a conclusive explanation, hopefully it provides you with some guidance and a better understanding of what it is we are dealing with.

So, how about me? Well, I have Dysthymia – a.k.a. Chronic Depression.

The symptoms of dysthymia are the same as those of severe depression but may not be as intense in some areas. Those with Chronic Depression may still seem to be adequately functional – however the depression symptoms can linger for periods of two years or longer. Just like other forms of sever depression,  the symptoms include:

  • Persistent sad or empty feeling
  • Difficulty sleeping (sleeping too much or too little)
  • Insomnia (primarily early morning awakening)
  • Feelings of helplessness, hopelessness, and worthlessness
  • Feelings of guilt
  • Loss of interest or the ability to enjoy oneself
  • Loss of energy or fatigue
  • Difficulty concentrating, thinking or making decisions
  • Changes in appetite (overeating or loss of appetite)
  • Observable mental and physical sluggishness
  • Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
  • Thoughts of death or suicide

This form of chronic depression is thought to be related to SDS. Serotonin is a chemical (neurotransmitter) that helps your brain to cope with emotions (among other things). Major life stressors, chronic illnesses, certain medications, and relationship or work problems may also further increase the chances of Chronic Depression.

References and further reading:

The ICD-10 Classification of Mental and Behavioural Disorders
World Health Organization

Facts and Figures – Conquering Depression
World Health Organization

Dealing with Depression
Gordon Parker
ISBN-10: 1741142148

Causes of depression
Blackdog Institute

Depression Causes
eMedicineHealth (USA)

Chronic Depression (Dysthymia)

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