What is depression?
Depression aka. Major Depressive Disorder (MDD) is one of the most widespread psychological disorders, often referred to as the “common cold” in mental health. The prevalence has become increasingly alarming– even the World Health Organization (WHO) predicts that depression will be the second most disabling disease following heart disease by year 2020, affecting people aged 50 and above especially.
The Health Ministry also reported that up to 10% of Malaysian would be affected by mental illness by 2020. Depression (locally or worldwide) will soon be the number one threat of psychological well-being and the leading cause of disability in 21st century. In addition, untreated depression is also the first cause of suicide. Hence, this is a pressing issue as we are living through a worldwide epidemic of depression.
How is depression different from sadness?
The core emotion for depression is sadness. Everyone experiences sadness, as it is a universal emotion and an integral part of life. We all feel sad when we lost a job or a loved one but we are not labeled as depressed just because we are grieving a loved one. Despite the fact that everyone feels sad at times, not everyone became depressed in the face of life’s adversities.
So what distinguish depression from sadness? According to the latest edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-V), depression is characterized by a prolonged period of low mood, marked loss of pleasure, significant change of appetite or sleep, loss of energy, sense of hopelessness, suicidal thoughts and etc. Symptoms should last more than two weeks for a clinical diagnosis of depression. Depression is different from the usual mood fluctuation in response to challenges in life. It is a long-lasting kind of sadness ranging from moderate to severe intensity, affecting individual daily functioning and causing impairment in various aspects of their life. It would negatively affect how you feel, the way you think and how you act. This prolonged sadness then becomes a serious mental health condition, affecting more women than men in general.
How does depression look like?
Depression is not always obvious–not everyone with depression has a tag on their forehead stating that they have depression. Many people live with depression showing only subtle symptoms or none and suffer silently their whole life. It might surprise you that people around you who seem to live a happy life might suffer depression behind closed door due to social stigma. Even many celebrities who live seemingly glamorous life suffer from depression.
For instance, although Robin William (an Oscar-winning actor & comedian) has brought enormous happiness and laughter to the world, he suffered (ironically) from depression and took his life at the age of 63. Therefore, depression is not just about having a miserable life and being sad about it. Many depressed people do not appear sad but simply do not see the meaning in life anymore. “The opposite of depression is not happiness, but vitality. —Andrew Soloman” To put yourself in their shoes, you may visit the journey shared by those battling with depression (DE Project) to get a flavour of how is it like to live with depression.
Is Depression a disease?
Calling depression a ‘disease’ is implying that the symptoms of depression are a manifestation of pathological physiological processes (disease), which can be diagnosed and treated using a medical model. It sounds so simplistic as if you can give someone a checklist and say “oh yes, you have fulfill the symptoms of depression and here is your pill” but it is far more complex in reality. Although there are some evidence of biological, genetic or neurological predisposition to depression, none of which have been unequivocally proven to be the cause of depression.
Even though the symptoms of depression can be mitigated by medication, the underlying root of depressive evidently remains; rendering even medicated patients vulnerable to relapse. It is found that more than half of those with depression are likely to develop another episode in the future. Thus, depression is not fundamentally a medical condition but a biopsychosocial disorder requires far more than pharmacological intervention.
Nonetheless, medical assessment should not be completely ruled out from this equation because depression can be presented with medical conditions as well. Many patients with chronic illness, such as Alzheimer’s disease or terminal cancer could develop depression. It is also undeniable that people who suffer from very severe depression manifest physiological symptoms, such as nausea, vomiting, insomnia etc., which might lead to the classic debate of chicken and egg. Therefore, it is important to note that depression could be the primary problem or secondary to any medical conditions.
Essentially, it is always good to bear in mind that depression can easily co-occur with other medical/mental health illnesses or go undiagnosed by other allied health professionals who do not have a psychology background. However, the good news is that depression is treatable! For milder depression, it can be treated with psychological treatment, such as Cognitive Behavioral Therapy (CBT)/ Interpersonal Therapy (IPT), whereas more severe depression can be treated using both psychological and pharmacological treatments, such as antidepressant drugs (e.g. SSRIs). Despite its drawbacks and side effects, drugs provide a relatively rapid relief to the suffering which can be otherwise life-threatening.
In a nutshell, depression is not equivalent to sadness but a normal human experience on a more extreme end of the emotion ‘spectrum’ of sadness. It is not a ‘disease’ but a psychological disorder, which is affecting our mental health. It is important that we see those who are affected in a non-judgmental way because underneath their illness, there is usually a story untold. In addition, depression is not the counterpart of weakness. If you think that it is okay to see a doctor when you have a flu or feeling ill, it should be completely fine for you to seek professional help when you are feeling mentally unwell. It is simply idiosyncratic if you care so much about your physical health but not your mental health as if your body and mind are two separate entities.
People who care about their health and well-being should be perceived as responsible and strong individual. The social stigma and shaming about mental illness need to stop. Instead, we need more acceptance and love in this society. We should applaud their courage in fighting mental illness and the perseverance for self-improvement. Often time, the difference between life and death is just someone who genuinely cares. Perhaps before more people start to talk about it to professionals, we should talk about it more as a topic itself. Some people who recovered from depression actually shared that their journey helps them to find and cling to joy, to experience positive emotions more intensely, and that is a highly privileged rapture. Given that depression is so common, it could probably be the least stigmatized among all the psychological disorders. Maybe after all… depression is not so difficult to talk about.