Things Everyone Should Know About Depression

Foreword

This post is a lot to take in, so if you choose to not read it right now, I would recommend you at least watch this 4 minute video:

You can also choose to watch this video version instead of reading:

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“In 2017, an estimated 11 million U.S. adults aged 18 or older had at least one major depressive episode with severe impairment. This number represented 4.5% of all U.S. adults. … Approximately 35% of adults with major depressive episode did not receive treatment.”
—National Institude of Mental Health

“Overall, male university students exhibited low overall mental health, limited mental health knowledge, weak mental health beliefs, poor mental health attitudes, high self-stigma to seek help, significant impacts of help-seeking on self-confidence, and low intention to seek professional help. “
—Mental health literacy, stigma, and help-seeking behaviors among male college students

Help starts with understanding. Though false stereotypes about people with depression¹ certainly persist, another important issue is that many people just don’t know much about it. If your knowledge about depression amounts to “it’s a mental health thing where you feel terrible, sometimes to the point of being suicidal, and there are a lot pills for it”, you are not equipped to help yourself or others when faced with this disease. And yet, based on the above statistics it’s clear that just about everyone needs to be ready to do just that.

“Based on data collected by the Centers for Disease Control and Prevention in 2007, approximately 25% of adults with mental illness believed that others are sympathetic toward patients diagnosed with these conditions.”
—Evaluation of perceptions and knowledge of mental illness in the United States through crowdsourcing

“Mental health literacy seems to have a promising effect on care seeking. Individuals who better recognize their mental illness and its manifestations, as well as treatment options to address its varied impressions, might better avail themselves of those options (Jorm, 2012).”
—“The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care”

There are already many resources aimed at assisting with that, such as “What People With Depression Wish You Knew”, “7 Facts You Should Know About Depression”, and many more. Much of their content is focused on explaning what depression is not with statements such as “Depression Is More Than Ordinary Sadness” and “It’s a real disease”, which is commendable but also results in them not discussing many aspects of what depression is. This is going to be the aim of this piece; more specifically, the intent is to make it easier for anyone to empathize and help others dealing with depression or to face it yourself². More concretly, I will address the following:

• Foreword
• What Is Depression
• What Causes Depression
• What Is It Like To Have Depression
• How Can You Know You Have Depression
• What To Do If You Think You Have Depression
• Are Antidepressants Necessary to Heal Depression
• How To Help Someone Who Has Depression

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.
For more mental health resources, see our National Helpline Database.

What Is Depression

Clinical depression is a diagnosable health condition with the following diagonostic criteria³:

“Depressed mood and/or loss of interest or pleasure in life activities for at least 2 weeks and at least five of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning almost every day:
1.Depressed mood most of the day.
2.Diminished interest or pleasure in all or most activities.
3.Significant unintentional weight loss or gain.
4.Insomnia or sleeping too much.
5.Agitation or psychomotor retardation noticed by others.
6.Fatigue or loss of energy.
7.Feelings of worthlessness or excessive guilt.
8.Diminished ability to think or concentrate, or indecisiveness.
9.Recurrent thoughts of death (APA, 2000, p. 356).”

This period of 2 or more weeks of “depressed mood and/or loss of interest or pleasure in life activities” is known as a major depressive episode, and many people with depression experience more than one such episode in their life:

“Major depressive disorder is one of the most common forms of psychopathology, one that will affect approximately one in six men and one in four women in their lifetimes (Kessler et al., 1994). It is also usually highly recurrent, with at least 50% of those who recover from a first episode of depression having one or more additional episodes in their lifetime, and approximately 80% of those with a history of two episodes having another recurrence (American Psychiatric Association, 2000; Kupfer, Frank, & Wamhoff, 1996; Post, 1992). Once a first episode has occurred, recurrent episodes will usually begin within five years of the initial episode (Belsher & Costello, 1988; Lewinsohn, Clarke, Seeley, & Rohde, 1994), and, on average, individuals with a history of depression will have five (Kessler & Walters, 1998) to nine (Kessler, Zhao, Blazer, & Swartz, 1997) separate depressive episodes in their lifetime.
—Risk for Recurrence in Depression”

Another important thing to note about episodes is their length. Depression is not a temporary mood:

“It is natural to temporarily feel ‘down in the dumps’ from time to time, especially if you are going through an upheaval, loss or stressful situation. Some people refer to this as ‘feeling depressed’. However, if these feelings are intense and persist over weeks or months and if they stop you enjoying or even doing your normal activities, it’s likely that you have depression. Depression is a serious illness that can have a great impact on your everyday life. It’s not something you can normally ‘just snap out of’.”

In fact, this is precisely what makes it so bad; generally, even with treatment it’ll take weeks or months to get better.

What Causes Depression

The science is still unclear on the balance of genetic and environmental causes for depression, so it’s generally correct to understand that it is caused by a combination of the two. According to Genetics Home Reference:

“Depression is known to run in families, suggesting that genetic factors contribute to the risk of developing this disease. However, research into the genetics of depression is in its early stages, and very little is known for certain about the genetic basis of the disease. … Nongenetic (environmental) factors also play critical roles in a person’s risk of developing depression. The disorder can be triggered by substance abuse, certain medications, or stressful life events (such as divorce or the death of a loved one). … It is likely that environmental conditions interact with genetic factors to determine the overall risk of developing this disease.”

It is however important to note that if you have a close relative who had dealt with depression, you are more likely to experience it as well:

“People who have a first-degree relative (for example, a parent or sibling) with depression appear to have a two to three times greater risk of developing the condition than the general public. However, many people who develop depression do not have a family history of the disorder, and many people with an affected relative never develop the disorder.”

It’s also the case that for some people depression is at least partially caused by seasonal changes in weather, and especially lack of sun. Lastly, different occupations and socioeconomic conditions of course have different risk levels for depression:

“Rates for clinical depression in 55 industries ranged from 6.9 to 16.2 %, (population rate = 10.45 %). Industries with the highest rates tended to be those which, on the national level, require frequent or difficult interactions with the public or clients, and have high levels of stress and low levels of physical activity.”
—Prevalence rates for depression by industry: a claims database analysis

“Our results show that graduate students are more than six times as likely to experience depression and anxiety as compared to the general population … 39% of graduate students scored in the moderate to severe depression range in our study, as compared to 6% of the general population measured previously with the same scale “
—Evidence for a mental health crisis in graduate education

What Is It Like To Have Depression

The above definitions are somewhat formal, and I suspect do not help very much with understanding what a person dealing with it is going through. Speaking less formally, there are at least three parts of the subjective experience of depression one needs to understand:

1. Emotional: Your baseline enjoyment of life decreases. In other words, you start constantly feeling a sense of suffering, or emotional pain, for no clear reason. Your are more negatively impacted by set-backs, and find it harder to enjoy the things that bring you pleasure and joy.
2. Physical⁴: You have less energy. Just about anything feels like a tiresome undertaking, and you often feel like just lying down and doing nothing. It may seem impossible to do the smallest of tasks⁵.
3. Mental: Your thinking becomes distorted and negative. Your self esteem decreases, so that you feel worthless. Thinking and concentraing becomes harder, as if trying to see something through a fog. It’s hard to imagine things becoming better, or to form a positive idea of the future in general. You have a variety of intrusive negative thoughts, which at the worst often deal with self harm of even suicide; these thoughts can happen regardless of however much you believe or agree with their content.

This is still somewhat abstract and hard to empathize with, so to further understand this condition I recommend listening to this song:

So, as you can imagine it’s a difficult and highly painful condition to be in. The above is what you really need to understand, though it only starts to describe it.

How Can You Know You Have Depression

One of the tricky aspects of depression is that the above stated symptoms can often happen to varying degress as part of normal life, without reflecting a mental health condition. So how do you know whether you are going through a rough patch, or are dealing with depression?

The obvious answer is that you should consult a mental health professional, if you think depression is a possibility. But that’s also not an easy thing to do. So, an easy alternative is to start with a a short multiple choice quiz, which can inform you on whether it is time to seek professional help. There are also many apps that serve a similar purpose.

What To Do If You Think You Have Depression

These are my personal and subjective recommendations on things to keep in mind and do if you think you may be dealing with depression.

First, try to understand that however bad things may seem, your perception of how bad things are is distorted by this condition, and objectively things are probably not as bad as they seem. One thing I found helpful was to think of there being two of me - the “depressed Andrey” and the “healthy Andrey”, with the former thinking quite unlike the latter; it was important to remember that what I considered my true self, with the beliefs I agreed with, was the healthy Andrey. Keeping that in mind may not make you feel better, but it’ll make it easier to motivate yourself to take the following steps to get better.

Second, do your best to continue living your life as before. Keep waking up, showering, going outside, seeing friends, excercising, etc (to the extent that you can; do not feel guilty about things you cannot do). The more you keep moving, keep believing if you put in the work things will get better, the less painful it will all be. It may not be easy, but the important thing is to not give up, and to keep making the effort. One thing that helped me is an unwavering belief in “this too shall pass”; if you truly believe the above facts about depression, you should also believe that it will pass with treatment, so it’s only a matter of time and perseverance.

Third, try to reach out for help. First and foremost, try and confide in your close friends and family, who can help you in this difficulty time. If it is an option, a therapist, or at least a support group, is an ideal first option to help you cope with this. Depending on their recommendation, you may also want to see a psychiatrist and consider taking antidepressants. Although you may be uncomfortable with this course of action, you really ought to go through with it:

“Up to 80% of those treated for depression show an improvement in their symptoms generally within four to six weeks of beginning medication, psychotherapy, attending support groups or a combination of these treatments. (National Institute of Health, 1998). Despite its high treatment success rate, nearly two out of three people suffering with depression do not actively seek nor receive proper treatment. (DBSA, 1996)”.

Fourth, if there are external/environmental causes for your depression, do your best to remove them. For instance, if you are stressed by work, try and put it on pause. This too is likely not easy, but if it is doable it is definitely beneficial. At the very least, it’s a good idea to have things to look forward to, such as a vacation or a trip to be with family.

Fifth, if things are getting really bad and seem to just be getting worse, be cautious with making life altering decisions at this time. As described above, your thinking and by extension your decision making becomes distorted and therefore unreliable. I personally almost called off applying for PhD programs while depressed, and am very glad in hindsight that I did not. One thing that helps is to try and remember this notion of the “healthy you”, and what that version of you would think of this course of action. Consulting with others is a great idea, as well.

Needless to say, this especially applies to any thoughts of self harm; if things are getting to the point of getting concerning, try and make ahead of time what you’ll do when in a really tough place to survive it, such as calling the National Suicide Prevention Lifeline. One thing I found helpful was to just promise to myself that no matter how things got, no matter how many thoughts about it I had, I would not really consider or attempt suicide; to be honest, you may think about it a lot, but knowing that these are just thoughts and you don’t truly consider that an option makes them more bearable.

Are Antidepressants Necessary to Heal Depression

It’s easy to feel uncomfortable about the idea of antidepressants, but the fact is that they are often an effective treatment for depression:

“The various antidepressants have been compared in many studies. Overall, the commonly used tricyclic antidepressants SSRIs and SSNRIs performed equally well. Studies of adults with moderate or severe depression showed:
Without antidepressants: About 20 to 40 out of 100 people who took a placebo noticed an improvement in their symptoms within six to eight weeks.
With antidepressants: About 40 to 60 out of 100 people who took an antidepressant noticed an improvement in their symptoms within six to eight weeks.”
—Depression: How effective are antidepressants?

“All antidepressants were more efficacious than placebo in adults with major depressive disorder. … Our literature search was as comprehensive as possible, including the largest amount of unpublished data to date, which are associated with less favourable effect sizes for antidepressants.”
—Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis

However, they are not the solution for everyone: “But a report recently published in The Journal of the American Medical Association showed that the drugs work best for very severe cases of depression and have little or no benefit over placebo (inactive pills) in less serious cases.” Certainly mild to moderate depression can be healed without medication, and in fact that has worked for me in the past, but in a severe case such as mine it should really be considered. This is really a case where talking to a therapist or psychiatrist is ideal, to understand your needs.

Antidepressants do have side effects, and some people struggle with finding the right medication for them. In my case, my psychiatrist asked me to ask my relatives what worked for them, and that indeed proved very effective for me (after months of excercise, therapy, talking to friends, and other measures did not improve my condition). So to conclude, while they are not necessary, antidepressants are an important option that should be considered with the consultation of a mental health professional for serious cases of depression.

Antidepressants are not meant to make you happy (they are not ‘happy pills’), so much as to heal you of depression and just make you normal. In my case, I did have a brief period of time after starting on them in which I was unusually cheerful and energetic, but this soon subsided and I just started to feel like my regular self. One thing to know is that you will need to continue taking them for some time after your depression improves, and it may take a process of gradual reduction to be able to stop. In my case this slight lack of freedom has certainly been worth it, but it is something you should be aware of.

How To Help Someone Who Has Depression

This one is tough, but boils down to the same one always needs to do to help someone: have compassion, care for them, and just be there. Beyond that, many lists out there provide good further recommendations. One thing I will personally emphasize is that you should try and be direct about asking if someone is doing well. If they seem to be having many of the symptoms of depression, don’t hesitate to follow up a simple “how are you doing lately” with “are you sure things are alright? it’s just that you seem more down than usual lately”, or the like.

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Feedback If you think there are other essential bits of information I should add to this, or have other feedback, feel free to reach out to me at my email andreyvkurenkov at gmail dot com .