Depression Isn't 'Just' Feeling Sad

Feeling down and being ill with clinical depression are worlds apart.

Unfortunately, many people don't know the difference, so they use the "J word" when trying to help a friend who's clinically depressed, according to Jon G. Allen, Ph.D., a Houston psychologist and author of Coping with Depression: From Catch-22 to Hope.

"The word is 'just,'" Dr. Allen says. "They say things like 'Just enjoy yourself'; 'Just quit moping'; 'Just snap out of it.'"

It would be nice if it were that easy. If you were "just" feeling down for a spell, that would be one thing. But when you are severely depressed, all the things you must do to recover are made more difficult because of your symptoms. You get caught in a catch-22.

"Realizing the challenges you face, and the many reasons for hope, are the first steps toward regaining real, lasting enjoyment in life," Dr. Allen says.

Understanding the causes

You can inherit a predisposition for depression—meaning if a close relative has been clinically depressed, you have an increased chance of becoming depressed yourself.

Depression also can be triggered by an intensely stressful event. Researchers have even found evidence that it's linked to biochemical changes in the brain, as well as changes in brain activity.

"Although predisposition plays a role, with enough stress almost anyone is liable to get depressed," Dr. Allen says.

Death of a loved one, loss of a job, illness, alcohol or drug abuse, giving birth, even certain medications can bring on depression.

Most experts have come to see depression not as a one-time, short-term event, but as a long-term vulnerability to illness that can recur throughout life, seldom goes away rapidly by itself, and can require ongoing treatment.

Reason for hope

Even though depression can be dark indeed, there is a dawn. Depression tends to respond well to two primary modes of treatment: antidepressant medications, which can help restore healthy brain chemistry and improve mood, sleep, appetite, and other symptoms; and psychotherapy, which helps identify triggers of depression and can change negative thought and behavior patterns.

Both talk therapy and ongoing medication can reduce your chance of falling back into depression the next time you face a stressful event.

"Especially if you have severe depression, it's best if you can do both," Dr. Allen says. "Medication may be necessary for a person to move forward in psychotherapy. But if you aren't doing something to change the situation that's causing the stress, such as conflict in close relationships, medication may have only limited effects."

Most important, get ongoing support and advice from your health care provider, therapist, counselor, or other health professional. A psychiatrist has the best medical training to prescribe effective medications.

"He or she also can help identify when depression isn't caused by stress, but by some other existing medical condition or by drugs prescribed for that condition," Dr. Allen says.

Breaking the cycle

These self-care steps also can help relieve depression's hold:

• Connect with family and friends. This can be a major challenge because depression tends to make you want to isolate yourself, climb into bed, and pull the covers over your head. "It's hard to make conversation because you may feel your depression is contagious, that you'll be a burden to other people," Dr. Allen says. "But it can be a great mood elevator to be connected with someone who's not in that condition and can help you see past that state."

• Get physically active. You may believe you lack the energy for exercise, but activity itself can energize you, and some studies have found exercise can even be an effective antidepressant.

• Stay away from alcohol and illegal drugs. These can numb the emotional pain in the short term, but used over time they actually tend to worsen depression.

• Stay on your medications. It's common for people to start feeling better after they start taking antidepressants, then stop taking them—and lapse right back into the cycle of suffering. Some people find it takes several weeks for these medications to take full effect.

Recovery is likely to take time; however, the vast majority of people recover from episodes of depression.

"Don't give up," Dr. Allen says. "Get the treatment you need."