Are we depressed, or do we have a mental illness called ‘Clinical Depression’?

There can be some confusion over this at times. Another word for depression is melancholy and this might prove to be the best way to help distinguish between mental illness and simply feeling very sad, by re-naming it. If you are melancholic and sad, you can still have a range of physical symptoms associated with this like lethargy, poor appetite, poor sleep and loss of motivation. It usually accompanies a life event which entails some form of loss.

This may be loss of health, choices, loss of a loved one, a job, an identity, money. There are many such events entailing loss, and it is normal to feel unhappy about it. The melancholic period has a beginning and an end. It doesn’t continue indefinitely.

When normal sadness does not resolve…
‘Clinical Depression’ may come about when normal sadness following an event does not resolve, but deteriorates into a prolonged period of depression with more significant symptoms. Alternatively there may be no particular event immediately identifiable that plunges you into this state of mind. It can be related to Post Traumatic Stress Disorder, or be associated with another form of mental illness. It can develop when someone is suffering through a protracted period of physical illness with significant disruption to normal life. It can occur seemingly as a random occurrence and yet causes may be discovered during the course of professional intervention.

The difference is that the symptoms do not have an end, the lethargy and poor appetite extend and worsen. Poor sleep is significant, and not just the odd night. You may be able to fall asleep but be wide awake up at 3 am with racing thoughts, unable to return to sleep until dawn. You may not be able to fall asleep easily and resort to medication and alcohol to fall asleep, only to wake up four hours later. Lethargy, malaise and poor concentration are all associated symptoms. In clinical depression this isn’t a one off, it occurs regularly over a long period of time and requires professional intervention.

Appetite may be spasmodic, sometimes non-existent, picking at food, not feeling motivated by hunger, not wanting to cook anything. Weight loss is often an associated symptom, or alternatively weight gain due to comfort eating and binge eating.

The combined effects of poor sleep and inadequate nutrition lead to irritability, angry outbursts, inability to read situations well, poor choices in communicating with others and general lack of coping mechanisms with everyday life. There is no joy to be found anywhere.

Persistent sad, anxious or ’empty’ feelings are common. Feelings of hopelessness and pessimism are not overcome by activities which might normally cheer you up.

Thoughts of suicide may pass in and out of your head, sometimes randomly, sometimes regularly. These thoughts may evolve into ideas about how you might carry it out. At worst these ideas may be acted upon, and result in failed attempts or be successful.

Nothing seems to help, and there is a distinct lack of motivation to embark on a path of getting well. There seems to be no valid reason to try.

When is medical intervention required?
As you can see, this is not just being melancholic or very sad. It is clinically abnormal thought process associated with physical symptoms.
It requires medical intervention which may take the form of anti-depressants and counselling, or in the first instance sometimes the Doctor will just start with the medication to re-establish normality within the chemistry of the brain function.
It takes time to find the right fit as some anti-depressants won’t suit you, everyone is different in this regard. It is a good idea to persevere because eventually the right medication and dose will be found and this will literally change your life. When you go to the Doctor it is very helpful to take with you a list of all your symptoms and thoughts, and how long you have felt like this.

Once your outlook has improved with the right medication, sleep and nutrition have improved, then it is often a good time to start counselling to work out abnormal thought patterns. Cognitive behavioural therapy looks at specific types of thought patterns that lead to abnormal behaviours and beliefs, which may seem true but in reality are distortions of truth.

Counselling can also be of enormous benefit in adapting to losses which are over-whelming and cannot be dealt with on your own. In Clinical Depression, people frequently lack the tools to make changes, or to stick with a plan of recovery. Having a key person who offers supportive counselling can make progress possible.
Other therapies like hypnosis, exercise programs, and music therapy all work harmoniously together to produce a life changing effect.

Recovery requires a collective approach.
Together with the right anti-depressants and complimentary therapy, it is possible to overcome Clinical Depression to the point of being able to live a normal life. Happiness is again possible, and even normal sadness and melancholy can occur without it being a crippling event.

In Depression Part 2 which is coming up, I will look at that which is born of sadness, but is not mental illness. A more investigative look which will make it easier to define the differences.

If you are concerned that you have Clinical Depression, write your list and make an appointment with your Doctor. No-one has to live like this when there is so much that can be done to turn it all around.