ASK A DOCTOR: How does clinical depression differ from sadness?

By Dr. Jennifer Braden,
Valley Medical Center

What is clinical depression and how does it differ from feeling sad?

It is normal to have feelings of sadness in response to certain events or circumstances in your life. What differentiates “normal” from “clinical” is the severity and persistence of the depression, the presence of other associated symptoms, and interference of these symptoms in your ability to function in your day-to-day activities.

By definition, a “major depressive episode” lasts at least two weeks and can include any of the following symptoms:

• Depressed mood;

• Loss of interest in activities that are normally enjoyable for you;

• Difficulty sleeping or sleeping too much;

• Loss of appetite or eating too much;

• Difficulty concentrating;

• Feeling tired, feeling anxious or restless; or

• Having thoughts of death or suicide.

Some people don’t feel sad, per se, but rather may feel angry, irritable or apathetic. In severe depression people can sometimes have unusual experiences such as hearing voices or seeing strange things (hallucinations).

What causes clinical depression?

Depression results from an imbalance of chemicals in the brain. It is often a combination of factors in an individual that causes this imbalance. Some people have genes that put them at risk for depression (just as one may be genetically at risk to develop diabetes or high blood pressure) and may become depressed even when situations and circumstances in their life are good.

Stressful circumstances in childhood and/or adulthood can also put one at risk of developing depression. Individuals with chronic medical conditions such as diabetes, chronic pain and heart disease are at higher risk for developing depression.

How is depression treated?

Depression is typically treated with medications and/or counseling. Medications aim to correct the imbalance of chemicals in the brain responsible for the depression. Counseling may include examining thought patterns that contribute to feeling depressed, gaining insight into factors in your life that play a role in the depression, learning coping strategies, changing behaviors or improving relationships.

Is there anything I can do on my own to help with depression?

Absolutely. For starters, get plenty of exercise. Regular aerobic exercise has been shown to help improve mood. It is also helpful to schedule one enjoyable activity into your days, even if you don’t feel like it. When depressed persons become isolated and inactive, that can only serve to worsen the depression. Believe it or not, light therapy, or sitting in front of a special fluorescent light box (10,000 Lux intensity) for about 30 minutes each morning has been shown to be helpful for seasonal depression.

Meditation, good sleep habits and avoiding alcohol or drug abuse are also good methods of curbing episodes of depression. Adopt good sleep habits: Establish a relaxing routine before bedtime, have a regular schedule for going to bed and waking up, allow yourself a sufficient number of hours for sleep at night, and avoid excessive napping during the day.

Where do I go for help?

If efforts on your own to shake the feeling and symptoms are unsuccessful, see your primary care doctor or a mental health professional for further evaluation and a discussion of treatment options.  If you are having thoughts of harming yourself, please go to an emergency room or call the crisis line (1-866-427-4747), which has trained counselors who can talk with you by telephone 24 hours per day, seven days per week.

Dr. Jennifer  Braden is a psychiatrist at Valley Medical Center in Renton. She has a particular interest in mental health problems in individuals with chronic pain and other chronic medical conditions, and those in recovery or in treatment for substance abuse.

This column is for general information, and any specific questions or concerns regarding this topic should be brought to your physician.
