Depression
According to the DSM-5, “Depression is classified as a mood disorder and is diagnosed as major depressive disorder (MDD) when an individual experiences a specific set of symptoms (at least 5) over a defined period (more than 2 weeks)…”
Depression or Sadness?
Sadness is an emotion. It is powerful, but temporary. Sadness is a normal response to situations that are upsetting, painful, or disappointing. The intensity of sadness can bring us to our knees, even holding our lives captive. Thankfully, the feelings of sadness are temporary and do fade with time. We can usually still function when we are sad. Sadness comes and goes.
Depression is a persistent feeling of sadness, worthlessness, and the lack of desire to do the things we use to like. Depression lasts longer. It sticks-around and can be debilitating. Depression can interfere with our ability to focus, emotionally balance and manage our everyday world. Some say it feels like a heavy, wet blanket, making everything difficult, even getting out of bed.
Symptoms of Depression
Remember: at least 5 symptoms, for more than 2 weeks.
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Depressed feelings can mean a lot of things:
Sadness, loneliness, hopelessness, worthless and regret, loss and grieving, sorrow, pain, distress and despair.
The duration and impact of our suffering can help us to know when sadness might become depression.
In diagnosing Major Depressive Disorder, the focus is on “how long your symptoms have been an issue” and “does it affect most of the day, every day?”
Symptoms that last more than 2 week may be serious. Reach out and schedule your appointment today.
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Clinically speaking, this is “highly diminished interest or pleasure in all, or almost all, activities most of the day.” What can that look like? Isolating, withdrawing, not going out to normally fun experiences. Avoiding people, sometimes even friends and family. There may be a lack of motivation to seek happiness or an actual avoidance towards pleasure.
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With so many of us on diet plans or following diet trends, changes in weight can be hard to spot. Some of us eat when we are sad, some of us refuse to eat when we are upset. What we are looking for is significant weight loss when we are not dieting or weight gain, or a decrease or increase in appetite, nearly every day.
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Depression is often associated with an increased need to rest or sleep. It’s not just more than usual, it’s a lot. “Low energy” is the key term. A depressed person may sleep or lounge most of the day and still feel tired. The reason is complex, but there are 2 main issue: 1) managing feelings of sadness, loneliness, hopelessness, hour-after-hour, day-after-day. We wear-down and our resistance to everyday distress lowers. We feel drained, thin-skinned and flat;. 2) there are many biochemical changes that occur during depression. These changes can severely limit the physical amount of energy available to us.
Interestingly, some depressed people report insomnia or being unable to sleep, despite feeling exhausted. They still have LOW ENERGY.
Combination approaches, using medicines and psychotherapy, are usually more effective than using one or the other because they treat both of these areas.
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Worthlessness can be a very complex spiral of emotions. We may harbor intensely negative beliefs about ourselves, viewing our abilities, accomplishments, and contributions as insignificant or pointless. We may engage in harsh self-criticism, focusing only on our perceived failures and shortcomings. Constant critical self-evaluation and judgement may lead to a very distorted and excessively negative view of ourselves. We can lose sight of who we really are.
Spiraling further, worthlessness can lead to a powerful sense of hopelessness, where we may believe our situation is impossible to improve, that somehow we are destined for continued failure and disappointment. Interrupting spiral-thinking, intrusive thoughts and feelings is usually a part of therapy.
Worthlessness may effect many areas of a person's life, including work performance, marriage, relationships and friendships. It can impact our daily activities and our sleep. This is another example of how depression can be truly debilitating.
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Depression may include feelings of restlessness, feeling on-edge or anxiousness. This can make it difficult to focus and stay on track. Some feel unable to sit still, fidgeting and constantly shifting their positions. Often, there are sharp increases in irritability, combined with lowered tolerance towards general-distress. This can lead to impulsive reactions and less-thought-out behaviors.
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Self-harm has many forms: cutting, picking, scratching, even banging our heads and hair-pulling are very common forms. But, there’s also burning, hitting ourselves or objects we know will hurt, like a wall. These are deliberate and intentional acts, but are usually not suicidal behaviors. They inflict physical harm on our own body. Some express that it relieves emotional distress. Others suggest it’s more about “just feeling something”.
In every case, it is harmful.
Self-harm may have a complex effect in that the pain experienced sets off an endorphin rush, perhaps providing relief from deep distress.
It is very important to recognize self-harm as different from suicidal thought, plans or actions. Self-harm does not involve a conscious intent to commit suicide. For that reason, it is referred to as “Non-Suicidal Self Injury (NSSI).
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Reoccurring thoughts about death or suicide, without a plan.
Any past suicidal attempt
A specific plan for committing suicide.
Most suicides are linked to some form of psychiatric illness, particularly depression, and the more severe the depression, the greater the risk.
If you or someone you know is having suicidal thoughts, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or your local crisis line.
Risk Factors of Depression:
Substance use (including cannabis and alcohol)
A history of any other mental health conditions
Insufficient social support system
Experiencing Trauma / Childhood trauma
Chronic health conditions
Poor self-esteem
Stressful life events
Brain chemistry (we’ll examine this in a moment!)
Symptoms of Depression in Children
Depression in children can look very different from depression in adults. It can be much more challenging to recognize due to developmental differences in how kids express themselves.
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Children with depression may frequently appear sad, tearful, or irritable. They may express feelings of hopelessness or worthlessness, but these emotions can also manifest as irritability or mood swings.
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Children with depression may lose interest in activities they once enjoyed. They may withdraw from friends, family, and social interactions, preferring to spend time alone rather than engaging in social or recreational activities.
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Depressed children may experience changes in appetite, leading to noticeable changes in weight. They may either overeat or have a decreased appetite, which can result in weight gain or loss.
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Depression can affect a child's sleep patterns, leading to difficulties falling asleep, staying asleep, or excessive sleeping (hypersomnia). Some children may also experience nightmares or sleep disturbances related to anxiety.
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Children with depression may complain of feeling tired or having low energy, even after adequate rest. They may appear lethargic and have difficulty completing daily tasks or participating in school activities.
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Depression can impair cognitive functioning in children, making it challenging for them to concentrate, focus, or make decisions. This can negatively impact academic performance and social interactions.
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Depression can impact a child's academic performance and behavior at school. They may have difficulty concentrating in class, completing homework assignments, or following rules. They may also exhibit disruptive or defiant behavior.
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Depressed children may express feelings of guilt, self-blame, or worthlessness, often related to perceived failures or shortcomings. They may exhibit low self-esteem and have a negative self-image.
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In severe cases of childhood depression, children may express thoughts of death or suicide. They may talk about wanting to die or engage in self-harming behaviors. Any mention of suicide or self-harm should be taken seriously and addressed immediately by a mental health professional.
If you or someone you know is in crisis, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or your local crisis line.
Physical Illness in Adult Depression
While Depressive Disorders are considered a mental health issue, it can also manifest with physical symptoms that may not be immediately recognized as being linked to depression. Physical symptoms can vary widely and may present alongside or separate from depression symptoms.
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Depression is often experienced with a constant feelings of tiredness or “lethargy”, decreased physical energy with deflated enthusiasm. Even after getting adequate rest, individuals may still feel drained and lacking in energy.
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Chronic pain, including headaches, muscle aches, and joint pain, can be physical manifestations of depression. These symptoms may not respond well to conventional treatments and may persist despite medical interventions.
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Digestive issues such as stomachaches, bloating, nausea, and changes in bowel habits (constipation or diarrhea) are common physical symptoms of depression. These symptoms can contribute to discomfort and further exacerbate feelings of distress.
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Depression can lead to feelings of weakness, heaviness, or physical slowing. It can affect reaction time and extend how long it takes you to coordinate and settle. We may actually move and speak more slowly, and may have difficulty completing tasks previously not an issue.
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Depression can affect sexual desire and function, leading to decreased desire, erectile dysfunction (in males), and difficulties reaching orgasm in both men and women. These issues can strain intimate relationships and contribute to feelings of inadequacy.
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Individuals with depression may have heightened sensitivity to physical pain, leading to increased discomfort and decreased pain tolerance. It can feel like everything is sharp or as if we have very thin, frail skin.
Types of Depression
Depressive disorders come in different forms, like any other illness, such as heart problems. Let’s take a look at the three basic forms of depression.
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Depressive disorders come in different forms. By definition, symptoms last more than 2 weeks. Depression is not a sign of personal weakness and to be clear, it cannot be willed away. It also tends to be episodic, meaning it comes back around, sometimes lasting weeks or months.
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Major depressive disorder manifests as a persistently sad mood accompanied by a number of other symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. A disabling episode of depression may occur only once but more commonly occurs several times in a lifetime. Depression effects the entire body.
Researchers have established, for example, that immune function is often compromised in depressive states, and impaired immune function may in part underlie the link of depression to such other disorders as heart disease. -
Dysthymic disorder, or persistent depressive disorder, also called dysthymia, involves symptoms of sad or down mood most days for most of the day over a long term (two years or longer) but the depressed mood is not disabling, although it impairs functioning to some degree. Many people with dysthymia also experience major depressive episodes at some time in their lives.
Specific Depressive Disorders
Some forms of Major Depressive Disorder (MDD) have additional features, like psychotic episodes. Other forms only occur during specific times, like Seasonal Depression.
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Premenstrual dysphoric disorder (PMDD) occurs in the days leading up to menstruation, improves shortly after menstruation begins, and typically resolves within a week after menstruation. Around 3 to 8 percent of reproductive-aged women meet the strict criteria for PMDD, as stated by the National Institutes of Health.
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Major depression with psychotic features, or psychotic depression, occurs when a severe depressive illness is accompanied by delusions and hallucinations. The psychotic features may be mood-congruent with the depression—that is, consistent with the depressive themes of personal inadequacy, guilt, hopelessness, or death. Or, the delusions and hallucinations may be mood-incongruent, not involving such depressive themes.
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Major depression with postpartum onset, or postpartum depression, is diagnosed if a woman develops a major depressive episode during pregnancy or within four weeks after delivery. It is estimated that 3 to 6 percent of women experience postpartum depression.
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Major depression with seasonal patterns, or seasonal affective disorder (SAD), is characterized by the onset of a depressive illness during particular times of the year. Typically, the depression develops during the winter months, when there is limited natural sunlight, and completely remits in the spring and summer months. In a minority of cases of major depression with seasonal patterns, the depression occurs during the summer months. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not respond to light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.
Psychology & Depression
The psychological basis of depression involves cognitive, emotional, and behavioral factors that contribute to the onset, continuance, and triggering of depressive feelings. While depression has biological and genetic components, psychological factors play a crucial role in its development.
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Negative cognitive biases - People with depression tend to focus on the negative. They often pay more attention to bad things, see neutral situations as bad, and predict that things will turn out badly.
Cognitive distortions - These are ways of thinking in depression where people see things in a negative and unrealistic light. Examples include thinking in extremes, making broad assumptions, and taking things too personally.
Rumination - Rumination is a type of thinking problem where a person gets stuck on negative thoughts. It feels like being stuck in a record groove. These thoughts keep coming back, making it hard to focus on anything else. It causes a lot of stress and can make daily life difficult. People with rumination often feel down on themselves and have trouble letting go of these thoughts. It can affect their work, relationships, and how they feel physically.
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Emotion regulation difficulties - People with depression often struggle to control their feelings well. They might be more sensitive to bad emotions and find it hard to handle them in a healthy way.
Low self-esteem - Depressed individuals tend to have low self-esteem and negative self-appraisals. They may perceive themselves as unworthy, incompetent, or unlovable, which can exacerbate feelings of sadness and hopelessness.
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Social withdrawal - Depression can make people want to be alone because they feel too tired or unmotivated to socialize. Being alone like this can make them feel even more lonely and sad.
Activity avoidance - Depressed individuals may avoid activities they once found enjoyable or meaningful due to a lack of interest or pleasure (anhedonia). This avoidance can perpetuate feelings of emptiness and contribute to a downward spiral of depression.
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The idea of learned helplessness says that when people feel like they can't control the problems in their lives, they may become depressed. This feeling often comes from facing lots of failures or tough situations they can't change, making them feel hopeless and stuck.
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Conflicts, losses, or strained relationships with family members, friends, or romantic partners can contribute to the development or exacerbation of depression.
Origins of Depression
Where does depression come from? Why do I get depressed?
Depressive disorders are complex conditions that involve a combination of genetic, bio-chemical, and psychological factors. Let’s take a closer look at what Science and research suggests contribute to depression.
Brain Chemistry & Depression
Biochemical processes in the brain play a crucial role in regulating mood and emotions. Neurotransmitters such as serotonin, dopamine, and nor-epinephrine are key chemical messengers involved in mood regulation.
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Serotonin is a neurotransmitter involved in regulating mood, sleep, appetite, and other physiological functions. Low levels of serotonin have been associated with depression.
Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressant.
Schedule your initial appointment and start your path to healing!
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Dopamine is another neurotransmitter that plays a role in mood regulation, motivation, pleasure, and reward. Dysregulation of dopamine signaling has been linked to depression, particularly in cases of anhedonia (the inability to experience pleasure).
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Norepinephrine is involved in the body's stress response and plays a role in mood regulation. Abnormal levels of norepinephrine have been observed in individuals with depression. Some antidepressant medications, such as tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors (SNRIs), target norepinephrine levels to alleviate depressive symptoms.
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Cortisol is a hormone released in response to stress. Prolonged exposure to high levels of cortisol, as seen in chronic stress, can disrupt neurotransmitter systems and contribute to the development of depression.
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BDNF is a protein that supports the survival and growth of neurons. Reduced levels of BDNF have been observed in individuals with depression. BDNF is thought to play a role in the neuroplasticity changes associated with depression and antidepressant treatment.
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There is growing evidence suggesting a link between inflammation and depression. Increased levels of inflammatory markers, such as cytokines, have been observed in individuals with depression. Chronic inflammation may disrupt neurotransmitter function and contribute to the development of depressive symptoms.
Genetics in Depression
The genetic basis of depression is multifaceted and involves the interplay of multiple genes, each contributing a small portion to an individual's susceptibility to the disorder. While specific genes associated with depression have been identified, the genetic architecture of depression is complex, and no single gene is solely responsible for its development.
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Research consistently demonstrates that depression is influenced by genetics, meaning that inherited factors play a role in an individual's likelihood of experiencing the disorder. Studies suggest that approximately 30% to 40% of the risk for depression can be attributed to genetic factors, highlighting their substantial contribution to differences in depression susceptibility among people.
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Various genes linked to neurotransmitter signaling, stress management, and brain adaptability have been identified as potential contributors to depression. For instance, genes related to serotonin, dopamine, and nor-epinephrine pathways have received significant attention due to their involvement in depression.
Depression is viewed as a condition influenced by multiple genes, known as a “polygenic disorder”. This means that many genes collectively impact its development, with each gene having a modest effect. Genome-wide association studies (GWAS) have revealed numerous genetic variations associated with depression. However, each variation usually contributes only a small portion to the overall risk of developing the disorder.
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Among the genes extensively researched concerning depression, the serotonin transporter gene (SLC6A4) stands out. A specific variation in its promoter region, termed the serotonin transporter-linked polymorphic region (5-HTTLPR), has been linked to depression risk.
The shorter version of this variation has been associated with heightened susceptibility to depression, especially when experiencing stress.
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A person's genetic tendency toward depression can combine with environmental factors like stress, trauma, and early-life experiences to raise the likelihood of developing depression. These interactions between genes and the environment are believed to heavily influence how depression begins and progresses.
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Epigenetic alterations, such as DNA “methylation” and “histone acetylation”, can influence gene activity without of changing the DNA sequence.
Changes in genes involved in stress and mood regulation have been associated with depression through epigenetic modifications.
This is one way environmental factors directly impact gene behavior, potentially contributing to depressive disorder and mood instability.
Florida Resources For Depression
Systems Family Therapy: Systems Family Therapy provides on-line mental health services to Florida residents. We bring higher-level care to patients seeking individual, marriage or couples counseling. We also specialize in managing Depression and Mood Disorders, Borderline Personality Disorder, Trauma/PTSD and Bipolar disorder. We offer after-hours appointments, short and long-term care, and we accept insurance. Make your appointment online, now!
Florida Behavioral Health Association: This organization offers a directory of mental health providers, including therapists and counselors, across Florida. They can help individuals find mental health services tailored to their needs. Website: floridabha.org
Florida Department of Children and Families (DCF): The DCF offers mental health services and support programs for individuals struggling with depression. They provide information on accessing mental health treatment and support services. Website: myflfamilies.com/service-programs/mental-health
Florida Suicide Prevention Coalition: This organization provides resources and support for individuals struggling with suicidal thoughts or depression. They offer crisis intervention services, support groups, and educational resources to help individuals cope with depression. Website: floridasuicideprevention.org
Florida Association for Community Mental Health (FACMH): FACMH represents community-based mental health agencies in Florida, offering a range of mental health services, including counseling, therapy, and support groups for individuals with depression. Website: facmh.org
National Alliance on Mental Illness (NAMI) Florida: NAMI Florida offers support groups, educational programs, and advocacy efforts for individuals and families affected by mental illness, including depression. They provide resources for finding local support groups and accessing mental health services. Website: namiflorida.org
211 Helpline: Individuals can dial 211 or visit the website to access information and referral services for a variety of social services, including mental health resources. The helpline can connect individuals with local resources for depression treatment and support. Website: 211.org/services/mental-health
National Institute of Mental Health (NIMH): NIMH offers comprehensive information on depression and mood disorders, including symptoms, treatment options, and research updates. Their website provides resources for individuals seeking help for themselves or loved ones. Website: nimh.nih.gov
Depression and Bipolar Support Alliance (DBSA): DBSA provides online resources, support groups, and educational materials for individuals living with depression and bipolar disorder. Their website offers information on managing symptoms, finding treatment, and connecting with others for support. Website: dbsalliance.org
Anxiety and Depression Association of America (ADAA): ADAA offers information and resources on depression, anxiety, and related disorders. Their website features articles, webinars, and self-help tools to assist individuals in managing their mental health. Website: adaa.org
Psych Central: Psych Central is an online mental health resource that provides articles, quizzes, and self-help tools for depression and mood disorders. They offer information on symptoms, treatment options, and coping strategies for individuals struggling with depression. Website: psychcentral.com/depression.
Depression can significantly impact our thoughts, emotions, behaviors, and overall well-being. It can interfere with our ability to focus, feel emotionally balanced and manage our everyday world.
Despite feelings of hopelessness and worthlessness, Depression is a treatable. Book an appointment with today to see how we can help.