Depression – it’s a word used by many on a daily basis to express sadness and discontent with a situation.
However depression is not just ‘feeling sad’. Although there are specific criteria used to diagnose depression, it is experienced differently by different people; it disrupts diverse areas of one’s world and our response to the disruption will be as unique as we are.
Depression is a disorder of mood. For those of us who experience depression mildly, we may not feel ‘bad’ all day, but rather have a dismal outlook on life and feel a sense of gloom.
Those experiencing depression will generally have a negative view of themselves, their environment (the world around them), and of their future (Otto, 2013).
Symptoms of Depression
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 gives us the following indication that we may be struggling with depression.
Five or more of the following symptoms present during the same two-week period, representing a change from previous functioning. At least one of the symptoms is either depressed mood or loss of interest or pleasure. The symptoms are:
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (eg the person feels sad or empty) or observation made by others (eg appears tearful); in children and adolescents this can be irritable mood.
- Markedly diminished interest of pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others).
- Significant weight loss when not dieting or weight gain (eg a change of more than five percent of body weight in a month), or decrease or increase in appetite nearly every day (in children, this may manifest as failure to make expected weight gains).
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013)
With five of the above list being the requirement for a diagnosis of depression – the answer is yes, you could have depression without feeling sad, particularly if you are a child or adolescent.
What causes Depression?
Genetic factors: Depression often runs in families, meaning that we may inherit genes making us more vulnerable to developing depression. Although keep in mind that we can be the only one in our family experiencing depression, or the only one not experiencing depression.
Hormones: There can be some hormonal changes that occur in depression. Our brains goes through some changes before and during a depressive episode and there are certain parts of the brain affected. This may result in an over or under production of some hormones, which may be responsible for some of the depressive symptoms.
Medication can be an option for managing this.
Brain chemicals: Nerve cells in the brain communicate to each other by specific chemical substances called neurotransmitters. It is believed that during depression, we have a decrease in activity of one or more of these neurotransmitter systems. This breakdown in communication between the neurotransmitters can result in a disruption of the areas of the brain responsible for regulating your sleep, appetite, mood and more.
Medications such as antidepressants are commonly used to assist the neurotransmitters to increase their communication. (Otto, 2013).
Thinking: Many thinking styles are associated with depression. Some of these can include:
- Overstressing the negative;
- Taking responsibility for only ‘bad’ events and overlooking the good ones;
- Inflexible standards about how one should behave;
- Thinking that you know what others are thinking, and that they are thinking badly of you.
There are many ‘unhelpful’ thinking styles that we use at times (or regularly) which contribute to how we think about a situation (or ourselves in that situation). This in turn affects how we feel and therefore how we behaves. When we experience depression, generally we see ourselves in a negative way, our self esteem and self confidence are low, we ruminate on how badly we feel, see the world as an awful place and that ‘everything’ is hopeless (O’Kelly, 2010).
Physical: There are physical aspects that change when we are experiencing depression. We may notice a difference in sleep patterns (difficulty falling asleep, waking through the night, sleeping more than usual). Regular sleep is important for our physical and mental health as the body rests, rejuvenates and processes the day (Chow, 2020).
We may notice that we have no interest in eating anything, that eating is too much effort or that our appetite increases and we eat more than we usually would, resulting in weight loss or gain.
We may notice that our levels of energy decrease, resulting in low motivation to complete everyday activities and we stop engaging in activities that we previously enjoyed.
Interacting with other people: When we experience depression, we may also notice that we are dissatisfied or unhappy with some of our personal relationships with family, friends or partner.
We can feel anxious or shy in a group or with people unknown to us, we may feel isolated or lonely, and have an unwillingness to reach out to others (due to how we see ourselves, the situation, mental health stigma, too much effort etc.).
Situational: Sometimes we can experience depression in relation to a life situation or event such as a separation, loss of job, friendship breakdown, relationship breakdown, death of a loved one, bereavement etc.
Before we get too depressed over depression, there is some good news which you can read in my next article, “Breaking the Depression Cycle“.
Author: Aleah Haffenden, B Soc Wk, Grad Cert Suicide Prevention, AMHSW.
Aleah Haffenden is an Accredited Mental Health Social Worker, working primarily with young people (aged 15 and up). She takes a client-focused approach, using a mix of Cognitive Behaviour Therapy (CBT) and Acceptance and Commitment Therapy (ACT), tailored to their specific needs.
To make an appointment with Aleah Haffenden, try Online Booking. Alternatively, you can call Vision Psychology Wishart on (07) 3088 5422 or M1 Psychology Loganholme on (07) 3067 9129.
- Beck, A., Rush, A.J., Shaw, B.J., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press. ISBN (cloth): 0-89862-0007; ISBN (paperback): 0-89862-919-5.
- Beck, A.T. & Weishaar, M.E. (1995). Cognitive Therapy. In Current Psychotherapies, 5th Ed., Corsini, & Wedding, Eds. Itasca, Illinois: F.E. Peacock Publishers, Inc.
- Chow, C. M. (2020). Sleep and Wellbeing, Now and in the Future.
- Johnson, Sharon L. (1997). Therapist’s guide to clinical intervention : the 1-2-3’s of treatment planning. San Diego :Academic Press,
- O’Kelly, M. (2010). CBT in ACTION: A Practitioner’s Toolkit. CBT Australia.
- Otto, M.W. (2013). Cognitive Behavioral treatment of major depression. Boston University: Center for Anxiety and Related Disorders, NIMH Excellence in Training Award (MH25 RH08478). Retrieved on 17 September, 2014, from: CBT-for-Depression_Slide-set-for-Teaching.pdf
- Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM?5: Classification and criteria changes. World psychiatry, 12(2), 92-98.
- Schmied, V. & Tully, L. (2009). Effective strategies and interventions for adolescents in a child protection context: Literature review. Ashfield, NSW: Centre for Parenting & Research, NSW Department of Community Services. Retrieved on 24 June, 2014, from: www.community.nsw.gov.au