What is Depression?
Depression is broadly defined as “a mental state of altered mood, characterized by feelings of sadness, despair, and discouragement.” (The Free Dictionary) Technically classified as a mood disorder, depression ranges in severity from more mild but persistent forms such as Dysthymia to more severe forms such as Major Depressive Disorder (MDD) with suicidality or psychosis. Symptoms of depression include: lethargy, sadness, apathy, despair, thoughts of death, a sense of worthlessness, fatigue, irritability, insomnia or sleeping too much, weight loss or weight gain, excessive guilt, difficulty concentrating, and diminished interest in activities. Depression is one of the most frequently diagnosed psychiatric conditions and many consider it the “common cold of mental health.”
Depression vs Low Mood
Unfortunately, the commonality of depression has led to widespread misuse of the term in the vernacular such that the word can refer to almost anything from having a bad day, to a response to the death of a loved one, to a low variation in mood, to suicidal thoughts. What distinguishes all forms of depression from a low mood is that low moods typically correlate with stressful circumstances. Part of being a member of humanity includes the capacity of a wide range and depth of feelings—sadness, joy, frustration, anger, or fear, in response to life events. While feeling low for no apparent reason more often coincides with a diagnosis of depression. Another often distinguishing feature of depression is a tendency for the state to persist longer than a typical low mood. The exception to this pattern occurs in rapidly cycling depressions, such as in Bipolar Disorder.
Depression vs Grief
Depression and grief are not the same thing though the two are often confused with one another. Grief can exacerbate an underlying depression. But ultimately, grief is a normal response that enables the profound adjustment to take place in processing death or other significant loss. Indeed, the absence of the need to adjust to death would be a more abnormal response to loss. While variable over time and the nature of the unique relationship lost, the grieving process can be complicated by cultural expectations. These expectations can be inadvertently pushed onto the griever by society (sometimes even by health professionals) and often dictate particular time frames (Why aren't you finished grieving, yet?) and methodologies, even though every loss is as unique as the individual lost. As culture has grown increasingly more modern and technological, grief rituals and symbols have eroded, stripping grievers of acceptable venues for processing. All the while modern technologies such as social media sites like Facebook have generated a surface sense of connectivity, without delivering true community. All of these factors have contributed to a greater sense of isolation and increased likelihood for complications in the modern grief process. For more practical information on the Do's and Don'ts of how to respond to someone who has experienced loss, consult the M.I.S.S. Foundation website in Phoenix.
Depression vs Bipolar Disorder
Both Depression and Bipolar Disorder are classified as mood disorders. Sometimes depression is referred to as "unipolar" depression. Bipolar disorder is a condition where mood episodes swing between the highs of mania and the suicidal lows of depression. The features of mania often include: heightened mood, insomnia, rapid speech and thought, irritability, greater energy, impulsivity, and increased acuity in perceptions. Upon first glance, one might ask, “How on earth could these two dissimilar diagnoses ever be confused?” But the problem is that patients with Bipolar disorder sometimes first experience an episode of depression. Typically, this episode is treated with an antidepressant pharmaceutical. Complicating matters further, numerous treatments for depression including many of the antidepressants are known to cause mania or hypo-mania and often exacerbate a Bipolar condition, leading to rapid cycling and a worsening outcome (prognosis).
Typically, the first line treatment for depression is an SSRI, a pharmaceutical antidepressant, which might be a bit of a misnomer according to a recently published article in Scientifica by David Antonuccio, PhD and Psychiatrist, David Healy, MD. Unfortunately, this category of drugs is grossly over prescribed in the U.S. sometimes given by primary care providers without an appropriate diagnosis or for a normal state of grief. Complicating matters further, the side effect profile of this class of drugs is lengthy and serious. Perhaps most concerningly, the SSRIs increase the risk of suicidality upon initiation, potency changes, and cessation of treatment even in patients with no previous history of suicidality. Additionally, Pharmaceutical companies have created branded cultural movements that have ensured a certain familiarity with designer drugs names like Prozac, Paxil, and Zoloft, which has led to more patients feeling too comfortable with this class of prescription drugs such that they do not take seriously the risk of serious side effects. Given the number of risks associated with these drugs, patients need to receive adequate information so that they can decide whether or not to even initiate treatment. Even well meaning physicians sometimes fail to inform. Strained by a system herding patients through like cattle, manipulated by drug reps and poor academic integrity, doctors sometimes seem to have their hands tied by Big Pharma.
Though it may come as a surprise to many, regular exercise functions as a powerful antidepressant. In a study conducted on patients with Major Depressive Disorder (MDD), exercise was found to be as effective as Sertraline (aka Zoloft) and the effects of exercise lasted longer even after discontinuing treatment. Additionally, exercise has numerous physical benefits including cardiovascular and skeletal, and no side effects. Psychiatrist and mood disorders specialist, Jim Phelps, MD, has more extensive information regarding the mood-exercise connection.
The sun is a natural antidepressant. In the presence of sunlight, skin synthesizes fat soluble Vitamin D out of cholesterol. While Vitamin D is still the subject of much research, deficiencies have been correlated with many of the most common forms of cancer: including breast, colon, and prostate. Additionally, other common diseases have been linked to Vitamin D deficiencies including osteoporosis, depression, hypothyroidism, insulin resistance & Diabetes, and autoimmune conditions.
Sunlight also plays an important role in regulating circadian rhythms in the body. Understanding the influence of sunlight stands as an important piece of the puzzle in the treatment of both unipolar (MDD) and bipolar depression.