What is Clinical Depression, exactly?

TW: depression, depression symptoms, brief mention of suicide

The term “depression” can be used in multiple ways. Like it says in Merriam-Webster’s definition for depression, it could be referring to a mood state, as indicated by feelings of sadness, despair, and discouragement. We’ve all felt depressed before; think of the last time you were sad or frustrated.

But then there’s Major Depressive Disorder (MDD), which is a whole different beast. When clinicians refer to depression, they’re usually referring to MDD. Nobody really knows how one develops MDD, exactly. But as more and more scientific research comes out, indicators point to genetics more than anything else. While many things cause depression, in a simple model, as an individual grows or experiences life events, genetic dispositions eventually lead to an imbalance in brain chemical levels (particularly serotonin, norepinephrine and dopamine). This imbalance may not only manifest itself as MDD, but also other chronic mental disorders such as Bipolar Disorder, Dysthymia, Seasonal Affective Disorder, or Borderline Personality Disorder.

So what exactly are individuals suffering from clinical depression going through?

People suffering with MDD are still perfectly normal human beings, like you and I. They can still experience joy, laughter, have moments of good momentum, and accomplish things. But frequently, they also feel worthless, have a diminished ability to manage their life, have to fight to get out of bed, have no interest in almost anything, and sometimes, can be suicidal. For some people, these episodes can last days on end, while for others, they only last hours.

Depression isn’t all mental – it takes a physical toll on the body as well. To be diagnosed for clinical depression, a person must be evaluated by a PHQ-9 or DSM 5 Depression Questionnaire. According to these screenings, common symptoms include: “Insomnia or hypersomnia nearly every day,” “Psychomotor agitation or retardation nearly every day,” and “Fatigue or loss of energy nearly every day.” 

To an apathetic observer,  individuals suffering from depression can come off as lazy, selfish, and irresponsible. But would you blame somebody for their own autoimmune disorder? If somebody suffered from high blood pressure, would you blame that individual, who had no control over his condition and was simply unlucky, for his high blood pressure? I hope not, and in the same way, people suffering from mental disorders have absolutely no control over their illness. Nobody chooses depression.  It’s simply an illness that affects an individual, and the symptoms manifest themselves in a way that makes it hard for people to manage their life and do simple, everyday things that we find easy, like brushing their teeth or eating a meal. It’s important to remember that the individual suffering has absolutely no control over his/her brain structure and genetics.

Furthermore, depression is a complex illness. According to UptoDate, remission only occurs in 34% of patients after their initial treatment, so more often than not, the illness takes multiple efforts to treat, and the process can be a frustrating nightmare. Even after 4 separate treatment steps, remission is only 50%. That means half of those suffering from depression will have to fight it chronically, with no recourse in sight, over the course of years. And of course, it’s crushing and discouraging to try treatment after treatment with no avail, which only makes the problem worse.

So what do we do if someone you know has MDD? It’s important to remember that everybody can recover from depression, so you shouldn’t give up hope. Instead, you should try your best to patiently encourage and support them as they find ways to cope and continue with life. The coping strategies they come up with might fail; this can be frustrating, but it’s important to remind them that it’s okay, and all of it is a learning process to find a way to live with MDD that does work.

~ Anonymous ’23

Further Reading

Coping strategies:

• https://sunrisertc.com/distress-tolerance-skills/
• https://www.therapistaid.com/therapy-worksheets/cbt/none

Finding Support:

• https://nami.org/Support-Education/Support-Groups/NAMI-Connection
• https://healthunlocked.com/anxiety-depression-support
• https://www.inspire.com/groups/mental-health-america/topic/depression/
• https://healthunlocked.com/anxiety-depression-support
• https://www.dbsalliance.org/
• https://www.psychologytoday.com/us
• https://www.smartrecovery.org/
• Dartmouth Resources
  • Mental Health Union Peer Support
  • Counseling Center
  • Student Wellness Center
  • Full list here

For more information on the science of depression:

• The Course of Depression https://www.uptodate.com/contents/unipolar-depression-in-adults-course-of-illness?search=depression&source=search_result&selectedTitle=8~150&usage_type=default&display_rank=8
• Depression: Neurobiology https://www.uptodate.com/contents/unipolar-depression-neurobiology?search=depression&source=search_result&selectedTitle=16~150&usage_type=default&display_rank=16