Recognizing Depression

Depression is an illness that afflicts tens of millions of Americans and hundreds of millions of people all over the World. It can sometimes be hard to describe to those who are not depressed, but it is important to understand that depression is a medical condition that often requires medical treatment. Some of us may experience the "blues" at times or experience sadness from a tragedy but these reactions will pass with time; clinical depression is more long-lasting and more severe.

The symptoms of depression vary from individual to individual, although there are some commonalities. Perhaps the best way to learn about depression is from the words of those who are depressed. There are several well-known Internet celebrities who have written about their depression. Here I excerpt some passages from the blog posts of Noah Smith, Allie Brosh, and Wil Wheaton starting with descriptions of their depression.

Noah:

Depression is not sadness. During the most intense part of a major-depressive episode, what I've felt is nothing at all like sadness. Mostly, it's a kind of numbness, and utter lack of desire and will. Underneath that numbness, there's the sense that something awful is happening - there's a very small voice screaming in the back of your mind, but you hear it only faintly. There's an uncomfortable wrongness to everything, like the world is twisted and broken in some terrible but unidentifiable way. You feel numb, but it's an incredibly bad sort of numbness. This is accompanied by a strange lack of volition - if a genie popped out and offered me three wishes at the depth of my depression, my first wish would be for him to go away and not bother me about the other two. Looking back on this experience, I've conjectured that part of depression might be like some kind of mental "fire sprinkler system" - the brain just floods the building completely to keep it from burning down.

Depressed people often remark that it's impossible to remember what depression is like after it's over, and impossible to imagine feeling any other way when you're in the middle of it. Therefore, most of what I'm saying here comes from things I wrote when I was in the middle of major depressive episodes. I think my most colorful description was that depression was like "being staked out in the middle of a burning desert with a spear through your chest pinning you to the ground, with your eyelids cut off, staring up at the burning sun...forever."

Allie:

I remember being endlessly entertained by the adventures of my toys. Some days they died repeated, violent deaths, other days they traveled to space or discussed my swim lessons and how I absolutely should be allowed in the deep end of the pool, especially since I was such a talented doggy-paddler.

I didn't understand why it was fun for me, it just was.

But as I grew older, it became harder and harder to access that expansive imaginary space that made my toys fun. I remember looking at them and feeling sort of frustrated and confused that things weren't the same.

I played out all the same story lines that had been fun before, but the meaning had disappeared. Horse's Big Space Adventure transformed into holding a plastic horse in the air, hoping it would somehow be enjoyable for me. Prehistoric Crazy-Bus Death Ride was just smashing a toy bus full of dinosaurs into the wall while feeling sort of bored and unfulfilled. I could no longer connect to my toys in a way that allowed me to participate in the experience.

Depression feels almost exactly like that, except about everything.

Wil:

I went to my doctor yesterday, and told him how crummy I’ve been feeling. We talked about a lot of different things, and ultimately decided that it was probably a good idea to change up my brain pills. This morning, I started something new, and I really feel a lot better. I honestly don’t care if it’s a placebo effect at this point, but the end result is the same: I don’t feel despondent, depressed, and shitty about myself. 

“You are very hard on yourself,” he told me yesterday. “I know,” I said, “I just have really high expectations that I want to meet, and with all these incredibly successful friends …” I trailed off because I felt like I was starting to feel sorry for myself. 

“Being judgmental about what you make or don’t make doesn’t help you at all,” he said, “you have to do your best every day, even if your best isn’t what you want it to be.” I knew he was right, and I knew that it was my depression getting in between me knowing that was right, and accepting that it was right. 

That’s one of the incredibly frustrating things about depression: I can know that the way I feel is just my brain chemicals being messed up, but whether I accept it or not, the end result is the same: I feel awful. It’s a little unfair that it doesn’t work in both directions, but after living with it for my whole life, I can tell you that depression doesn’t care about being fair; it’s really a dick that way.

The National Institute of Mental Health (NIMH) has extensive information on depression including a section on signs and symptoms of depression which I reproduce here for completeness:

• Persistent sad, anxious, or "empty" feelings 
• Feelings of hopelessness or pessimism 
• Feelings of guilt, worthlessness, or helplessness 
• Irritability, restlessness 
• Loss of interest in activities or hobbies once pleasurable, including sex 
• Fatigue and decreased energy 
• Difficulty concentrating, remembering details, and making decisions 
• Insomnia, early-morning wakefulness, or excessive sleeping 
• Overeating, or appetite loss 
• Thoughts of suicide, suicide attempts 
• Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

I will end this post with some wise words from Wil Wheaton:

"So, please, if you or someone you know suffer from Depression — with or without thoughts of suicide — please talk to someone, and get help from a doctor."

Figure 1. Don't suffer in silence if you are depressed, please seek out medical attention (graphic by Allie Brosh).