Way back when I was young (that IS way back!) I never heard any reference to depression. I now know that expressions like ‘Not very well’, ‘She has some troubles’, etc. may well have referred to someone who looked perfectly alright, happy even. It turned out that depression is cunning, baffling and powerful — and very sneaky. According to several scientific reports on it, there is a wide range of depressions, from the mild, temporary kind to the clinically depressed. The Mayo Clinic defines depression as “a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depression, major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems.”
As another website puts it: “Sadness or downswings in mood are normal reactions to life’s struggles, setbacks, and disappointments. Many people use the word “depression” to explain these kinds of feelings, but depression is much more than just sadness.
“Some people describe depression as ‘living in a black hole’ or having a feeling of impending doom. However, some depressed people don’t feel sad at all—they may feel lifeless, empty, and apathetic, or men in particular may even feel angry, aggressive, and restless.”
The symptoms, like the disorder itself, are often difficult to spot. Depression is different in each case, though there are common traits.
Given that there are different types and different stages of the disorder, when is it important enough to seek help? And it is important to seek help: the later stages of depression can lead to devastating illness and even death.
The real answer to the question above is: When you are overwhelmed by it. This applies to both women and men, although men manifest depression differently (More about depression in men below.)
Fine, so how do you, or your friends and relations, know where you and they are with depression? Here are some symptoms and warning signs, gleaned from various studies.
Helplessness and hopelessness. Frequent references to those feelings, to a bleak outlook: “What’s the point?” “Nothing I do is right!” etc.
Little interest in their surroundings or their daily activities. They’d rather just sit around instead of taking an active part in their usual pastimes, hobbies, group activities. Even loss of interest in sex.
No evidence of joy or pleasure. For instance if he or she used to visibly, evidently enjoy strawberries and cream and all of a sudden comes out with, “No, thanks, I don’t feel like it.”
Loss of appetite and significant weight changes (often disguised as, say, “See? That’s what I always wanted”, which could also point to another manifestation of depression and addiction: eating disorders). According to HelpGuide.org, a gain or loss of 5% in body weight in a month, is worth looking into.
Changes in sleep patterns. Waking up much earlier than usual, not being able to get to sleep at night (insomnia), or sleeping in later (hypersomnia).
Sudden mood changes. A short temper, anger, irritability and even a ‘need’ for violence, are signs of the depression becoming more ‘aggressive’ in its process.
Loss of energy. Constant fatigue, tiredness, physically drained; small tasks seem enormous, overwhelming, not even worth starting as they’ll take so long to complete.
“I hate myself” is a classic unsolicited remark from someone in depression. “Why did I do that?” is another. These, and other such remarks, point to a large degree of self-hate and/or guilt.
“I want to be alone,” Greta Garbo’s famous phrase, is a sign of isolation. As the depression gets worse, which it doesn’t always, the need for isolation becomes acute. Sometimes, they will not want to have anything to do with the outside world; they’d rather stay in bed with their face against a wall.
Escape into reckless behaviour. The usual escape routes are substance abuse (drugs and alcohol mainly), compulsive gambling, dangerous driving or high-risk sports. Alcohol and certain drugs feed the depression. Alcohol is a depressant in any case, so the matter only gets worse. The come-down from some drugs can lead directly to a deep depression. Some studies suggest that bi-polar disease is related to substance abuse, manifesting as depression followed by a manic phase, followed by more depression, and so on and on.
Concentration and memory problems. It is hard to concentrate for any length of time. Short-term memory loss is worse than usual (we all forget where we left the keys, after all). Decision-making is a burden and sometimes unendurable, so important decisions are ‘put aside’.
Physical pain and changes. Unexplained headaches, back-aches, stomach-aches or aching muscles can be symptoms of depression, particularly in someone who is not known for such complaints. The stomach is often a good indicator inasmuch as either diarrhea or its opposite, constipation, sometimes manifests in depressed people.
The above symptoms rarely come at the same time, but a combination of two or three of them is definitely a warning sign, indicating action may have to be taken. The sooner the better.
The risk of suicide is certainly one result. “The deep despair and hopelessness that goes along with depression can make suicide feel like the only way to escape the pain. If you have a loved one with depression, take any suicidal talk or behavior seriously and learn to recognize the warning signs,” according to HelpGuide.org.
If someone you care about is suicidal, ask for help immediately.
In the US, Call 911 or
In the UK
Samaritans UK & ROI
Contact by: Face to Face – Phone – Letter: – E-mail:
Hotline: +44 (0) 8457 90 90 90 (UK – local rate)
Hotline: +44 (0) 8457 90 91 92 (UK minicom)
Hotline: 1850 60 90 90 (ROI – local rate)
Hotline: 1850 60 90 91 (ROI minicom)
Depression can present differently in men and women, in teenagers and older adults, though the symptoms can often be similar. To know the difference means that you can ensure that the disorder is recognised and treated immediately. As with most illnesses and disorders, the sooner the better.
Depression in men
Men and women are different (now there’s a novelty!), even in depression and its manifestations. In our culture, it is all too frequently considered a weakness, of being over-emotional. And so it is especially with men.
Our society is still hungover with the ‘a-man-doesn’t-cry syndrome’. Therefore men are taught from the very beginning that they can’t show emotion, can’t ‘be in touch’ with their feelings. So they’re not, for the most part.
As a result, depression in men shows up as irritability, angry reaction to trivial situations, fatigue, aggressiveness, sleep pattern changes, loss of interest in work or hobbies. Other symptoms as described above may also present. Very rarely will you hear a man complain of self-loathing or hopelessness. “Pull your socks up!” is still a prevalent reaction to any signs of depression.
Again according to HelpGuide.org, “Even though depression rates for women are twice as high as those in men, men are a higher suicide risk, especially older men.”
Depression in women
Depression is often seen as a ‘woman’s disease’, a miopic view probably exacerbated partly by hormonal factors such as premenstrual tension (PMT), post-partum depression (and the recently-‘discovered’ pre-partum depression) or perimenopausal deppression. It is also true that women tend to suffer more from seasonal affective disorder (SAD) than men.
In other words, women appear to be depressed a lot more than men.
The signs and symptoms in women tend to be strong feelings of guilt, too much sleep, over- or under-eating, sudden and evident weight gain or loss.
Depression in teens
It is a truism that teenagers are ‘mostly’ sad and depressed, angry or aggressive. To some extent this is normal adolescence, when body changes are combined with hormonal changes and the biological need to find their way to adulthood (‘separation disorder’ according to some psychologists).
Indeed, a depressed teenager can be hostile, highly irritable and complain of aches and pains. These and others, such as manifestations of self-loathing (often expressed as “I look ugly”) will be very difficult to differentiate from ‘normal’ teen behaviour.
However, if left untreated, depression in adolescents can quickly and easily lead to unforeseen problems at home and with studies, school, drug and alcohol abuse — in turn these can become worse, to the point of homicidal violence or suicide.
Parents, do not despair, teenage depression is treatable.
Depression in the elderly
A number of factors are associated with depression in the older adult, among which are bereavement, loss of independence and health problems. Without a strong support system in place (a rare thing today) these and other factors can lead to depression. However, depression is NOT a normal part of ageing.
Older adults tend to complain about physical problems rather than emotional ones, which means the disorder can, and frequently does, not get proper recognition or treatment. The disorder is often associated with poor health and a recognition of mortality, among other things, and there is therefore a higher risk of suicide. Diagnosis and treatment are extremely important.
(In Part 2 we will look at other manifestations of depression.)
(Alberto Bullrich is not a psychiatrist or psychologist. This article is the result of personal experience and thorough investigation on the subject, as well as consultation with experts.)
(C) Copyright 2015 Alberto Bullrich