JUST SAD OR CLINICALLY DEPRESSED — How to Know the Difference? How to Treat Depression?


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   To me one of the great questions of the day is understanding the difference between being sad and clinical depression. A lot has been written on this recently. An excellent article in the Washington Post today discusses this topic and treatment for depression. Here are few of its observations. 

  • To say that we live in stressful times is an understatement. Covid. The climate crisis. A country riven with tension and political discord. What’s clear is that the world we live in has taken a toll on our collective mental health. 
  • But it is never too soon for people to wonder whether they are just stressed and sad — or clinically depressed. 
  • Feeling sad is normal, but depression is not. It’s a critically important distinction. Feeling distressed and sad is a normal and expected response to what we’ve endured these past several years, including the social isolation and loss of human life brought about by the pandemic.
  • But unlike everyday sadness, clinical depression is never a normal response to stress or trauma; it’s a serious medical illness that is associated with significant impairment in our ability to function in major areas of our life — in relationships, at home and at work. 
  • So how can you tell if you are depressed or just plain sad? 
  • To start, depression is a syndrome that involves far more than sadness. Aside from a sad or flat mood, depression typically causes insomnia, loss of libido and appetite, social withdrawal, low energy, feelings of hopelessness and suicidal thoughts, feelings and actions. 
  • Sad people are unhappy about a specific event, while depressed people feel bad about themselves and have a loss of self-confidence. 
  • There is abundant scientific evidence that clinical depression is associated with distinct brain changes in circuits that regulate mood, sleep, energy and appetite.
  •  Brain-imaging studies have identified multiple regions where there is altered activity or structure in people with depression. 
  • The notion that depression results from a chemical imbalance of any neurotransmitter such as serotonin is simplistic and wrong. 
  • Depression isn’t a disease of a single neurotransmitter or brain circuit, but more likely a system-level disorder involving multiple pathways and their related neurotransmitters. 
  • We don’t yet understand what causes the biological abnormalities in depression to come about in the first place, but we think it results from a complex interaction between genes and environmental stress. 
  • Still, we know a lot about how to treat depression. Both psychotherapy and antidepressants are highly effective for depression. 
  • Therapy and antidepressants are most effective. Psychotherapy is a first-line treatment for people with mild to moderate depression, but when depression is severe, meaning either the presence of psychotic symptoms or suicidal thoughts and feelings, then a combination of therapy and antidepressant medication is the safest and most effective approach. 

                    “Stress and Sad.” Washington Post (Oct. 18, 2022).

COUPLES AND MARRIAGE — Do They Change? Yes, But how?

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A new research study was published recently that discusses how marriage transforms couples in their relationships. Very interesting. Here are a few conclusions from that study:

  • Since newlyweds have to find ways to get along on a daily basis, it’s perhaps not surprising that they experience changes in personality as they adapt to partnered life.
  • Wives tended to show decreases in openness to experience, perhaps reflecting their acceptance of the routines of marriage.
  • Husbands increased significantly in conscientiousness, while wives tended to stay about the same. Since women tend to be higher in baseline conscientiousness than men, the increase for men probably reflects their grasping the importance of being more dependable and responsible as a spouse.
  • Husbands also became more introverted over the first year and a half of marriage. Other research has shown that couples tend to shrink their social networks after they wed, so this decline in extraversion reflects that trend.
  • Husbands showed a slight increase in emotional stability, but it was not statistically significant. Wives, however, showed a much greater increase. In general, women tend to report higher levels of neuroticism (emotional instability) than men, so it appears that the commitment of marriage had a positive effect on the wives’ emotional stability.
  • As husbands and wives negotiate life together, the best predictor of whether their marriage will thrive is the personalities of the two individuals as they enter the relationship. Emotionally stable partners make for emotionally satisfying marriages; for others, the journey is much more likely to be bumpy.

                          “How Marriage Transforms Us.” (October 2022).