“I speak of a clinical depression that is the background of your entire life, a background of anguish and anxiety, a sense that nothing goes well, that pleasure is unavailable and all your strategies collapse”. -Leonard Cohen
Just a warning here folks, this is a blunt account of mental disorders and depression. Though I do think this is an important topic to address and while I’ve done my best to keep it light where possible, this post may trigger ‘at risk’ individuals so, please, if you think exposure to a necropsy of depression may trigger you, please skip this one or have a friend/loved one (who appreciates your condition) read it first and offer you some bullet points. -Thank you
Most people just go through their lives treating depression like the toupee wearing friend-of-the-family at gatherings who pulls quarters out of people’s ears.
We do our best to make sure it doesn’t happen to our kids and if we’re unlucky enough to be confronted with it ourselves, we try ignore it and hope it goes away quickly.
But, while this strategy works for most folks, the fact is that tens of millions of people globally, are currently dealing with the terrible effects of depression. Not only is this a dreadful burden for them but the families and loved ones of these people are also affected.
It is my hope that this post unveils a few misconceptions about depression and encourages more empathy and support for those struggling with the disease.
For more information and a broader look at some other conditions please feel free to click on Mental Conditions We Should All Know.
Talking About Depression
Ironically, although depression itself is pervasive, the word “depression” seems taboo in almost all circles except those where the people using the word have little or no idea about what depression really is.
While in a Starbucks in the US recently I overheard a group of 20-something girls chatting.
One of the young ladies, named Janet, offered her account of that weekend’s activities:
“Ermahgerd, like on Sunday, we went to the beach and like, as we got there, we were like oh yeaaah we’re here!, but the sun was like, oh no I’m gone, and we were like W.T.F. sun, not cool, why does this always happen to us, and I was like SOO depressed, I can’t even tell you, like hashtag eyeroll, hashtag fed-up, sad-face emoji..”
As upsetting and traumatic as I can only imagine this was for Janet, I’m pretty sure she has about as much insight into depression as she does the English vernacular (which is great news for her).
Of course, broaching the subject of depression is difficult, for everyone. But it’s most difficult for the person suffering from the disorder, so, no matter how uncomfortable it is to broach the subject, do it anyway.
Sometimes just talking to someone helps, and if it doesn’t, get them to see a professional, but don’t avoid it.
If you bring up the subject to someone you feel may be suffering in silence, what’s the worst that can happen? You can’t make them depressed again, it’s like chickenpox, they won’t catch it twice.
And for those who are depressed themselves, talk to someone, and keep talking to people until someone listens, you may think it’ll make you feel worse, but it won’t.
Remember, if you are a person who suffers with depression, is not a weakness. Some of the greatest minds have suffered from it too. From Albert Einstein to Charles Darwin, Vincent Van Gogh and Ludwig Von Beethoven to Harrison Ford, great minds and lovely people are often also the darkest, so you’re in very good company.
Also, don’t forget that, people who suffer from depression are likely to be intelligent which means you can think your way out of it with the right help.
Everyone Feels Lost Occasionally
Birds know exactly what to do don’t they? They eat worms, fly around, build nests, mate, lay eggs, feed their young and repeat. They are always confidently and swiftly flying around, going about their business. When did you last see a bird alone, just slowly kicking stones along the sidewalk looking sad or lost?
Never, and it’s like this with most animals in the wild.
I grew up in South Africa where I was fortunate to see many animals in the wild, bright eyed and bushy tailed with a spring in their step.
It wasn’t until later in life when I visited a zoo for the 1st time that I saw suffering in the face of animals. The glazed, confused and defeated look a wild animal in captivity has, is something I found difficult to witness.
Most of the animals have a far-off stare that you have to work very hard to ignore. Imagine what it must be like to be a lion born in captivity. Their huge bodies built to roam the vast open savannahs of Africa with instincts burning deep inside them.
Instead however, they are kept in a zoo enclosure or tiny circus cage and made to do tricks and activities they were never born to do, for all of their days.
Sometimes the things that seem so glaringly obvious to us in other creatures are difficult to see in ourselves.
About 100,000 years ago our human ancestors lived in tiny groups on the open Savannah’s of Africa. They, much like the other wild animals, roamed free and there was never any doubt as to how to live their lives.
Life was hard but simple, an existence different to their own would have been inconceivable to them. They were busy, they all had specific tasks and if they were lucky, about a third of them would live past the age of 2 and die at the ripe old age of 19 or 20 from something like an infected cut, broken leg or impacted wisdom teeth.
Their brains had evolved to perform 3 main functions: Eat, have sex and try not to die.
Since then our brains have evolved very little. In fact, just 1,000 years ago we weren’t living much more comfortably than we did 50,000 years ago.
If you went back in time 50,000 years, 20,000 years or 3,000 years, there would be almost no difference to the way people lived in each of these eras, but if I just brought my great great grandfather back, the world would be unrecognisable to him.
We are now exposed to more faces and expressions in a week then we would have been in an entire lifetime just a short while ago. We have more news and information thrust at us in a single day than we would have consumed in 10 lifetimes just a few generations ago.
We are forced to make thousands of difficult decisions a day, the outcomes of which sometimes have far reaching consequences.
We have to suppress almost all the basic instincts that made us successful as a species. We can’t show anger, fight, eat whenever we’re hungry, flee when we’re scared, cry when we’re sad or be promiscuous when we’re feeling horny.
And if we happen to slip up on any of the above during a moment of weakness, we have 1 of about half a dozen made up religions to ensure we feel guilty about it.
The pace of change, pressure to conform and need to make a living are immense, it’s little wonder then that we sometimes feel like something is wrong and wonder what is really going on.
The only things we are ever quite sure about is that we get hungry, horny and we don’t want to die.
We are now the animals in the zoo, taken from the Savannas and cast into this crazy prison for 80 years of confusion and hard labor, expected to perform tasks we were never designed to do.
The sadness of the zoo has fallen on society. We are all just winging it in this senseless menagerie that we think is our lives. So, let’s allow for the possibility that some of us just aren’t emotionally or mentally equipped for the world in which we have been dropped into and that we need to find Ways to Cope With Stress.
Most people who suffer from depression do so sporadically, and the changes in their behaviour stand out which makes it easier to identify that something is wrong.
How they interact with others and their eating habits are 2 such indicators. Also, their depression can often be linked to an event or loss of a loved one.
Some major depressive disorders however, take place over very long periods and can be almost undetectable to friends and family. What compounds the problem is the stigma attached to this type of condition.
Even if the disorder is revealed to family and friends, it is seldom (if ever) spoken about in any depth for fear of embarrassing themselves or the person afflicted.
Also, it’s difficult for an innately cheerful person to empathise with someone suffering from depression. And who could blame them? From the perspective of the cheerful person, there is nothing obviously wrong with the depressed person.
They have a job, they’re not broke, they’re not dying of cancer so, how bad can things be? “Why can’t they just snap out of it..” I’ve heard people say. “Life is hard for everyone, just put on your big boy pants and deal with it..”
But, as any neuroscientist will tell you, there is no shared reality to snap into or out of, there’s no actual reality at all, everything is subjective. Our minds form our own realities from external stimuli and internal processes.
External stimuli are subjective and exposed to preconceived notions about oneself and the world. In addition to this, some people’s internal processes are perched precariously on mental scaffolding, ill-equipped to deal with the weight of their perceived reality.
We don’t see the world as it is, we see the world as we are, because there is no “world as it is”, only the reality we create for ourselves.
The Dangerous Mask
So, what about people who joke around and laugh a lot? Surely they’re not depressed? We know that “poets need the pain as the deserts need the rain” (at least according to Jon Bonjovi).
And we all appreciate the stunning works of some very famous artists who were mentally ill. But is it possible for those who appear to be outwardly happy, to secretly be suffering?
If you think about it, the reason comedians are so extraordinarily funny is because they reveal truths we all recognise but that we somehow have never thought very deeply about.
These people also cause us to laugh by saying things that are unusual or unexpected. Their brains seem to be wired in a different way and they are able to see deeper into the human condition, beneath life’s reflective veneer that blinds all but the gifted.
In an alarming number of the cases, that “gift” is a terrible depression. A constant companion that casts darkness on all the is light and light on all that is dark.
I’m certainly not claiming that all amusing people are depressed, but depression can often be hidden in plain sight and recognising it isn’t always as simple as it seems.
To illustrate my point, I have placed below a list of some of my favourite comedians of all time.
All of these people battled different types of depression their entire lives. All of them have seriously considered suicide and a full third of them have actually attempted it.
10 Most Common Types of Depression
- I have intentionally not listed them in order of severity.
- The below is only to be considered as guidelines/indicators to the different types of depression.
- The below list is not exhaustive.
- Please consult a professional before embarking on a recovery strategy.
- If you suspect you have any of the below, please seek professional/medical help immediately.
- When I speak of “professionals” who you should consult, I personally do not regard psychologists among this group. In my personal opinion, someone with severe depression should be seem by a psychiatrist after being referred by a competent General Practitioner or Medical Doctor.
- It is a good idea (for everyone) to look into meditation as a means to manage stress and anxiety. Meditation is not a cure for clinical depression but it can be a great supplement to a medical intervention.
General Anxiety Disorder (GAD)
It’s important to remember that the word “general” is used here to describe the scope of the disorder and not the level of severity. This condition is typically a lifelong illness that can come with other pathologies or disorders stapled to it.
It is a state of almost constant fear of things that the person is experiencing or might experience. GAD often comes coupled with a Panic Disorder* which, if left unchecked can restrict a person’s entire world.
The sympathetic nervous system (where panic attacks arise) originates in the spinal cord and it triggers the panic response when there is no actual danger, though it feels very real for the person suffering the attack.
From the outside the person may just appear afraid and out of breath (though some people do collapse and think they are dying of a heart attack), but, for the person suffering the attack, they can experience a similar level of emotional horror as someone being attacked by a great white shark.
Though the bouts can be treated with medication and therapy, it is important to understand that these attacks (and fear of having these attacks), though completely harmless physically, are exceedingly real and utterly terrifying for the victim.
Highly educated and rational people have been known to leap from speeding cars or try to open aeroplane doors in attempts to flee the attack even though they will almost certainly die trying.
A beautiful 19-year-old Cambridge University student recently suffered a panic attack on board a small aeroplane and leapt to her death, fighting off the other 2 passengers as they tried to cling to her legs.
*a panic disorder may accompany many different types of depression or it may happen in isolation. They can range from a single attack to frequent attacks for decades if left untreated. Both panic attacks and a panic disorder can be managed or completely cured with the correct therapy and medication
You may also hear your doctor call this “major depressive disorder”. If a person feels depressed most of the time for most days of the week, then they are potentially battling “Major Depression”.
Some noticeable symptoms which can occur are:
- Loss of interest or pleasure in activities
- Weight loss or gain
- Trouble getting to sleep or feeling sleepy during the day
- Feeling restless and agitated, or else very sluggish and slowed down physically or mentally
- Being tired and without energy
- Feeling worthless or guilty
- Trouble concentrating or making decisions
- Thoughts of suicide
A doctor might diagnose folks with Major Depression Disorder if they have five or more of these symptoms, on most days, for 2 weeks or longer. At least one of the symptoms must be a depressed mood or loss of interest in activities.
Persistent Depressive Disorder
If you have depression that lasts for 2 years or longer, it’s called persistent depressive disorder. This term is used to describe two conditions previously known as dysthymia (low-grade persistent depression) and chronic major depression.
The person may experience symptoms such as:
- Change in appetite (not eating enough or overeating)
- Sleep too much or too little
- Lack of energy, or fatigue
- Low self-esteem
- Trouble concentrating or making decisions
- Feel hopeless
Treatment may include psychotherapy, medication, or a combination of the two.
A person suffering with bipolar disorder, which is also sometimes called “manic depression“, experiences significant mood incidents that vary between extreme high energy (or up mood) to crushing lows (depressive mood).
It’s important to note here that the person experiencing these mood changes actually believes that each phase of the mood is their actual reality and will be their reality permanently. The disorder prevents the sufferer from being able to appreciate that their reality will change.
People in a manic or up phase can be energetic, charming and funny and can convince all those around them (including themselves) that they no longer require treatment or medication
They might say things like, “I’m fine, it’s over now” or, “I’m really over it, a switch has gone off and I no longer need my medication, I’ll be fine”.
This is of course not the case and the manic phase is followed by a devastating fall into what is described as “a bottomless pit of despair” which the sufferer feels is and will be their reality forever.
This is the most dangerous phase, for obvious reasons and the person/patient or their loved ones should seek medical advice for the best course of action.
Although there is no cure for this illness, medical intervention can definitely help control and level out the mood changes so that the person can lead a more normal life.
The medications vary from country to country and each person responds differently to type and dose. The most popular mood stabiliser for this condition has historically been lithium.
In the United States, 3 medicines have been approved by the FDA to treat the depressed phase:
Doctors do occasionally prescribe other drugs “off label” for bipolar depression, such as the anticonvulsant lamotrigine or the atypical antipsychotic Vraylar.
Traditional antidepressants are not always recommended as first-line treatments for bipolar depression because there’s no proof from studies that these drugs are more helpful than a placebo (a sugar pill) in treating depression in people with bipolar disorder.
Also, for a small percentage of people with bipolar disorder, some traditional antidepressants may increase the risk of causing a “high” phase (manic phase) of illness, or speeding up the frequency of having more episodes over time.
Psychotherapy can also help support you and your family.
Seasonal Affected Disorder (SAD)
SAD (Seasonal affective disorder) is a period of major depression that tends to happen in people who live in countries which have long periods of cloudy winter months. The lack of sunlight and consequently Vitamin D, seems the likely cause if not aggravator of this disorder.
It typically goes away in the spring and summer. Which is good news for anyone experiencing SAD but it does make these people more anxious as autumn arrives.
If you have SAD, antidepressants can help. So can light therapy. You’ll need to sit in front of a special bright light box for about 15-30 minutes each day.
Psychotic Depression (Psychosis)
People with psychotic depression tend to have symptoms of chronic major depression along with “psychotic” symptoms, such as:
- Hallucinations (seeing or hearing things that aren’t there)
- Delusions (false beliefs)
- Paranoia (wrongly believing that others are trying to harm you)
I think it’s worth highlighting the difference between Psychotic Depression and Paranoid Schizophrenia. Psychotic Depression is a temporary hiatus from reality which reveals itself in previously normal (or “normalish”) individuals with little to no history of the disorder. Sometimes the afflicted may experience a build-up of sorts which eventually leads to the separation of reality from experience in a fairly significant way.
Paranoid Schizophrenia, by contrast, is a lifelong condition that typically emerges in adolescence (though sometimes later) and for which there is no cure.
Both can be treated with a combination of antidepressant and antipsychotic drugs or Electro Convulsive Therapy (ECT).
Postpartum Depression (Baby Blues)
Women who suffer from Major Depression in the weeks or months after childbirth may have peripartum depression. This condition is more serious than the term Baby Blues may indicate.
Most new parents will have to cope with the lack of sleep and gravity of the new situation, so some adjustments are normal. But when those adjustments trail on for weeks or months, it’s time to seek professional help.
The same antidepressant drugs that are offered to people with Major Depressive disorder can also be helpful to mothers who tend to have a bumpy ride.
Premenstrual Dysphoric Disorder (PMDD)
Women with PMDD suffer from depression and other symptoms at the beginning of their periods.
Besides feeling depressed, the woman may also have:
- Mood swings
- Trouble concentrating
- Change in appetite or sleep habits
- Feelings of being overwhelmed
- Screaming and shouting at poor unsuspecting partner (I couldn’t resist..)
Antidepressant medication, or sometimes oral contraceptives, can treat PMDD
This isn’t a recognised term in psychiatry but, a “normal” person can experience very dark and difficult periods during challenging and painful times of their lives.
When one is going through a divorce, has lost one’s job or dealing with the loss of a loved one, the resulting pain and anguish can cause severe depression that doctors call “stress response syndrome”.
Again, the term “stress Response Syndrome” belies the terrible weight that life’s challenges can place on anyone of us at any time.
To those of us who has suffered a great loss, we understand the anguish that is associated with it, agonizing sometimes even unto death. The Japanese call it “Takotsubo” – a grieving surge of abnormal electrical waves, that causes the heart to deflate and contort, until it resembles a crushed fishing pot. A cold and empty vessel at the bottom of a fathomless sea.
Scientifically, “Takotsubo cardiomyopathy” (or broken heart syndrome) is now recognised as a medical condition which mimics “acute coronary syndrome” and is accompanied by reversible transient left ventricular apical ballooning in the absence of angiographically significant coronary artery stenosis.
Psychotherapy can often help you get through a period of depression that’s related to the time of pain. Medication is typically discouraged as it lengthens the time one needs to grieve and potentially recover from such an event.
This type of depression diverges from the persistent sadness of typical depression in that the person may experience a positive event which can temporarily improve their mood allowing them some respite before sinking into sadness again.
This type of depression is usually the one where the sufferer’s closest friends and family members are unaware of the condition because they witness some moments of levity and assume the patient is of sound mind.
Other symptoms of atypical depression include:
- Increased appetite
- Sleeping more than usual
- Feeling of heaviness in one’s arms and legs
- Oversensitive to criticism
Antidepressants can offer some resistance to the lows of this condition. Your doctor may suggest a type called an SSRI (selective serotonin reuptake inhibitor) as the first-line treatment.
Doctors may also consider placing the inflicted on an older type of antidepressant called MAOI (monoamine oxidase inhibitor) which is a class of antidepressants that has been well-studied in treating atypical depression.
Below is a beautiful account of one man’s struggle with depression and how he became an expert on the subject. His insights in this short video really struck home with me and offered me some great value. Even if you have never suffered with depression, this video offers you some insights into what myself and other sufferers have to contend with. I’m sure you will enjoy it as much as I did..
13.7 billion years ago, time itself began and the great mystery of it all was set in motion. For billions of years, life wasn’t possible.
But stars exploded everywhere in champagne supernovas, like gigantic cosmic fireworks which caused the tiny particles and building blocks that would one day make up all of us.
Then, the gravity of a small, unremarkable star gathered up some stardust to form a fiery rock which would eventually cool and spark life.
That life changed and evolved to form plants and animals that went about their business without ever even wondering where they had come from or where they were going.
Humans eventually evolved, and with them came consciousness.
Finally, there was a creature that was “awake” in the magnificence of it all. A creature able to appreciate the beauty of the world and wonder about the stars.
But as a hundred billion humans lived and died over tens of thousands of years, there were never any answers to any of their questions.
Only you and I (and those alive today) are fortunate enough to be living at the exact time in the ‘history of everything’ to have the answers to the mysteries of our origins.
Against unfathomable odds, we have been given the briefest flash of life, and with it the gift of consciousness, to experience colour and light, love and loss, thunderstorms and snowflakes.
We are all survivors of immeasurable events, flung upon some reach of land, small wet miracles without instructions, only the ability to experience the wonderment of it all and to help each other.
Life is too short to be unhappy. We should all either be receiving help or giving it to others and living the happiest lives we can. We owe it to the universe for giving us this fleeting but precious gift of life.
Thanks for reading..
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