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Updated on June 9, 2008

Beyond the Blues: Sadness or Depression?


by Helen Borel, PhD

Depression, a worldwide challenge to psychiatrists, afflicts15 to 19 million Americans. Untreated or undertreated, it accounts for the daily disability and suffering of these millions, but suicide is its major danger.

Common Sadness and Ordinary Grief are Not Depression Never confuse depression with common but fleeting down-moods like sadness due to loss of a job. Or like that "bad mood" caused by insomnia or hunger. And not even the pain of grief over a death. These latter are typically time-limited. Moreover, although the duration of grief varies in different people, in contrast to depression grief generally follows a four-stage course. These 4 stages proceed, respectively, as Shock, Bargaining ("If I do so-and-so, the person will return to me"), Anger, and Letting Go. Depression does not include this very specific experiential quartet.

Actual Depression is Unbearable and Seems Never-Ending True depression is tenacious and prolonged; its symptoms, to the depressed person's life, devastating. So emotionally painful that the depressed person may feel that the only way out of the blackness is suicide. It is this danger, in addition to the joy-robbing symptoms, that makes the rapid diagnosis and immediate treatment of depression so essential.

Kinds of Depression Occurring on a continuum, depressive mood states can be relatively moderate, others prolonged and severe such as Major Depressive Disorder (MDD) and the depressive phases of Manic Depression (otherwise known as Bipolar Disorder). It's important to note that Bipolar Disorder tends to run in families.

All too often, depression goes unrecognized since it can seem to be a physiologic illness, such as pain of unknown etiology (cause), or progressively deteriorating hygiene, or as a forced, painted-on smile in spite of marked internal suffering. These confounding symptoms and family-upsetting behaviors are too often not viewed as typical depression. Unfortunately, in such cases, essential therapies are delayed due to absence of a swift and accurate diagnosis of depression.

Swift Depression Diagnosis and Treatments Improve Mood and Can Prevent Suicide Biochemically, emotionally and psychosocially, depression is a serious disorder. To recover from it, or at least sustain a full remission, it requires long-term treatment - and sometimes a lifetime of treatments. The earlier a depression diagnosis is made, the better in order to lift the depressive's mood state and prevent suicide. Then, ideally, a prescription drug and/or psychotherapy begins immediately; upon prompt diagnosis, the optimal regimen for each particular patient is prescribed. This means that one or another antidepressant drug and/or psychotherapy will begin right away.

Behaviors and Feelings Pointing to Depression At its worst, depression is a shutting down of feelings and a retardation of physical motion. In the depressed state, a patient's activity is markedly slowed, eventually to a halt. So much so that the patient's appetite can vanish resulting in refusal of food and liquids, with dehydration an added risk. So too, such patients in such severe depression may remain in bed all day. But not only is oversleeping common. In some cases, inability to sleep enough is paradoxically present and can result in irritability and agitation.

Look for the Following Indicators When You Suspect Depression: (1) Feelings of Lethargy, Hollowness inside and Worthlessness; (2) Feeling and exhibiting Irritability, Anxiety and Agitation; (3) Insomnia or Oversleeping; (4) Anorexia or Overeating; (5) Indecisiveness and Poor Concentration; (6) Anhedonia (incapacity to feel pleasure or to have an interest in a sexual or social life; (7) Copelessness (can't cope due to lack of hope); (8) Unrelenting Sadness; (9) Physical Complaints unrelieved by medical interventions; and finally (10) A paramount risk in depression is Suicide. Suicide itself can proceed from thoughts of suicide to attempts to kill oneself, to completion of one's suicide.

Varied Therapies Decrease Depressive Suffering and Often Prevent Suicides

PSYCHOTHERAPY is the first-line intervention for intransigent dark mood states and moderate levels of depression. Cognitive-Behavioral Therapy (CBT) is one approach that helps redirect a depressed person's negative beliefs toward positive thoughts and attainable goals. Thus, CBT teaches and helps the patient maintain personal behaviors and interactions that restore normal moods and awaken enthusiasm for life.

PSYCHOANALYTIC APPROACHES are useful, too, because these techniques help depressed individuals face and handle their critical problems arising from childhood events. Particularly those that are dysregulating current relationships and that can complicate recovery from depression.

ANTIDEPRESSANT DRUGS may be needed along with psychotherapy in some moderately affected patients. However, all severely depressed patients require antidepressant medication. Such prescription drugs include the chemical class known as the tricyclics, of which Elavil (R) (amitriptyline) is an example.

Or the depressed patient may be given one of the "newer generation" antidepressants known as serotonin selective reuptake inhibitors (SSRIs). Examples of this chemical class include Prozac (R) (fluoxetine), Zoloft (R) (sertraline), and Paxil (R) (paroxetine). Somewhat more side-effect-free than the tricyclics of yesteryear, the SSRIs intervene in serotonin brain chemistry, thereby delivering their antidepressant effects.

Other prescription agents, particularly Lithium carbonate and anti-epileptic medications are also used to treat the episodic mania-depression cycles of bipolar disorder.

ELECTROCONVULSIVE THERAPY (ECT) is sometimes unavoidable to quickly reverse severe depression that is, too often, medication-resistant. ECT is necessary in such dire circumstances because this only minutes-long procedure - performed with the patient under anesthesia - is a safe and rapid way to resolve depressive symptoms unresponsive to antidepressant drugs.

ECT's one inconvenience of temporary memory loss is a small price to pay to get better and not end one's life.

To sum up, ECT is administered in unrelenting, drug-resistant depression because it is the surest method for quickly combatting depressive pain and obviating suicidal actions. It thus can save many lives.

A key fact is that ECT can more rapidly accomplish what drugs and psychotherapy take measurably longer to bring about. Basically, ECT shakes up the patient's neurotransmitters (brain chemical messengers), shifting them toward homeostasis and elevating mood states toward more optimistic frames of mind by effectively "balancing the brain."

Getting Help for Depression If you suspect you are (or a loved one is) depressed, get psychiatric help immediately. Remember that the earlier your diagnosis, the swifter your treatment regimen can begin. You don't have to suffer any longer now that you know depression is substantially treatable. You can feel better. You'll be able to get back your pleasure in life. Don't wait. Reach out for help right now.

(c) copyright 2008 Dr. Helen Borel. All rights reserved.

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To read more of my articles on other mental health issues and psychotherapy, feel free to visit


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    • pjdscott profile image


      10 years ago from Durham, UK

      Very interesting since my father suffered from depression. In his day it was not really understood but as your article shows, the medical profession are beginning to treat it appropriately. Psychotherapy is a great modern option - non-invasive, as opposed to dosing someone with Prozac.


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