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).