“Am I sad or depressed?” is a conversation I have with my psychiatrist on a regular basis. He’ll ask me how I’m doing and I tell him that I’m not sure. This week is easy. With Robin Williams’ death, I am sad, but it’s not always that easy to tell the difference. I guess it’s a good problem to have because it means I’m balanced more than I use to be. I still get manic and I still get depressed, but most of the time I’m in the middle.
About once a week I have a day that sucks. The door stays locked, the blinds stay closed, no shower, no shaving and I eat a lot. My daily trip to Starbucks across the street doesn’t happen because I can’t even drag my ass out to the mailbox.
When I tell my pdoc that I’m having a hard time determining whether I’m sad or depressed, he drives me crazy with his typical response, “That’s always the big question isn’t it?” That’s the only response I get. WTF??? Not very helpful. We then go on to something else and end our short discussion with my prescriptions being handed to me. I’ve accepted that if I want the answers it was up to me to figure it out.
The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-V), published by the American Psychiatric Association is a tool doctors use to assist them in making a diagnosis. If you are suffering from insomnia, I highly recommend it. It’s more effective than Ambien. Using the DSM-V for my quest to help determine whether I’m sad or depressed I learned there’s not much difference. What makes them different is simply a matter of degree.
If you’re sad or have the blues, you may experience some of the following feelings:
◦ depressed mood, nearly every day during most of the day.
◦ Marked diminished interest or pleasure in almost all activities.
◦ Significant weight loss (when not dieting), weight gain, or a change in appetite.
◦ Insomnia or hypersomnia (excess sleep).
◦ Psychomotor agitation or psychomotor retardation. psychomotor is related to movement or muscle activity associated with mental processes (ex. Rapidly bouncing leg up and down – twitch)
◦ Fatigue or loss of energy.
◦ Feelings of worthlessness or inappropriate guilt.
◦ Impaired ability to concentrate or indecisiveness
◦ Recurrent thoughts of death, recurrent suicidal
Any of this sound familiar? Sure, we all face some of these, or even most of these at some time in our life. So how do you know if you are sad or depressed? A diagnosis of a major depression would be:
1. At least 5 of the items listed.
2. These symptoms must be present during the same 2 week period.
3. These symptoms must represent a change from a previous level of functioning
I guess what I experience each week would be described as sadness – at least that’s what it is when I go by the book. But, since I’m heavily medicated, is it sadness or is it a little of that good ‘ol depression popping in for a day? It’s hard for me to classify these weekly episodes as sadness because they are so heavy and difficult to get through. They last a shorter piece of time, but, they feel exactly like the deep, dark depressive hole I use to live with nearly every day. Am I sad or depressed? Now I’m even more confused and am not sure. I’ve just decided to call it whatever the hell I want to, which is….oh hell, I don’t know.
This is a good question. I more often have to ask myself, am I really happy about how life is going, or am I getting manic? I don’t know which question is tougher, but I find myself asking the other question, too. As well as the — “is this a symptom or an emotional reaction?” Sure would be nice if the pdocs of the world would give us some answers, huh? 🙂
Yes. My pdoc just hasn’t learned that I expect him to have all the answers. If only there was a kind of thermometer thing that you stick in your mouth and it reads out what is your current status. Oh, if only…
I relate to this, Bradley. I’ve found that I am over sensitive to sadness. I know it’s a normal emotion that is perfectly okay to feel. But when you experience clinical depression, and things are okay, if a touch of sadness pops up, I begin to panic. Is it depression? Is it coming? I wonder if the worry brings on my depression? With Robin’s death, I’ve felt horribly sad. I think recognizing that something very sad has happened is a good start.
I wonder the same thing, Mandy. Does concern about depression become a self fulfilling prophecy ?
I had (have) the same thing w/anxiety. I’m starting to think there might be something to the “Believe (think ) it and you will see it” …
I think sometimes we have to put flashing lights around a message for our psychiatiists. Skip asking and say something like: “I’m having recurrent bouts of moderate to severe depression that lasts 24 hours. This typically happens once a week/twice a month/whatever. It is having a negative impact on my school, my relationships snd my life in general. I don’t want to leave this appointment without a plan for reducing these.” Seriously, sometimes you have to talk to them like they are little kids. And I know this sounds terrible, but don’t be afraid to embellish with a symptom or two. I learned that when going to the doctor with pneumonia. You have to say at home your fever was 101 and “yes of corse I’m caughing up stuff that looks….yadda yadda.”. Same thing before i had my knee surgery. I learned i HAD to say the pain was a ten for them to treat me appropriately. So maybe you add some suicidal ideations to your rotten 24 hours. “At risk for harming self” makes it real to the doc. Fine, if that’s what it takes for him to actually hear you.
I think the DSM definition is for making the initial diagnosis of bipolar. Every depressive or manic episode you have after that does’t need to be held up against that yardstick. If it’s your version of depression/mania then that’s what it is.
Curious what others think about this.
Great post, Lora. And, you’re right about the DSM being about the initial diagnosis, I was being a little dramatic, but it is hard to tell sometimes if I am getting depression coming back or just sad about something.
As far as playing it up to get the help needed – that’s a tool I had to use just to get into the county clinic I currently go to, but it still wasn’t easy.
I would say if it keeps you from living an aspect of your life then it is depression of some degree – mild, moderate or severe. But mild depression is pernicious and saps life of what it is meant to be. My definition of “sad” is that I feel it, but at the same time I still feel like I’m me. I can still think and problem solve. I can still remember good things. It feels proportional to what ever triggered it. (it doesn’t feel like a family member just died.) There is a clear reason for it. And normal sadness isn’t bleak.
Great description of sad. My belief is those days I can barely get out of bed are days that I usually am depressed, They do sap my will to do anything. I try to keep up with the usual blogs I follow, but I can barely read a sentence, so a blog post of 300 words or more are out of a question. They’re damn frustrating and I hope they don’t hamper study time since I’m going back to school in September
Hi Bradley,
This is a good topic to inquire about….I’ve thought a lot about the difference between sad and depressed.
What Lori wrote is close to what I believe.
I distinguish between sad and depressed. Sad is a feeling about something. Depressed is a big mix of things, that can include emotions, but also be a damper on feeling emotions.
For me, when I’m sad, it’s a feeling that I can express or talk about the source of, or let myself mourn or grieve over. I think that sadness and grieving are natural and that grieving is the process of healing sadnesses.
Depression is complex and includes negative thinking and obsessive thinking and anxiety and unhappiness and physical depletion and chronic aches and loss of a sense of direction or purpose and shame and pessimism and a down mood and a sense of being stuck and hopelessness…..and probably more. At different times just a few of things may predominate.
The thing that is helping me most with depression is to gently focus on individual aspects and address them individually when possible. Here’s one example: When I notice that exhaustion is a part of my depression mode, then I let go of expecting myself to be productive for the present. This releases shame and self criticism. Both of which will make me spiral even lower into to depression.
But I don’t stop there. I ask myself to rest or to adjust my expectations of what I can accomplish while feeling extra tired. It seems empowering to DO something about depression, even while I am accepting it. I don’t like the term ‘depression’ because it seems like a dead end and I feel like a powerless victem. But when I ask myself what exactly am I experiencing when I’m depressed, taking it apart, then I seem to be able to address the parts little by little.
Thank you for this topic. I always appreciate how pro-active you are and how you write about things that help others.
xxoo
Very insightful, Gel. I like your explanation of allowing yourself to feel depression, acknowledge it and give yourself permission to adjust your expectations. Looking back, I think that is what I do, but not necessarily on a conscious level. I’m going to work to be more conscious because I believe that is a healthier route to take.
Thank you for the o9mpliments. It’s good to have you back.
Great post and the comments are so helpful!
Some Psychiatrists can irritate the life out of us! I tend to be expressive, like Lora suggests, but then I get paranoid they probably think I’m being a drama queen!!
Jee…. now I’m also confused. I think of this subject a lot in terms of why some people get over their depression/sadness without meds, while others, like me, need them just to raise their head off the pillow. I suppose, some days we might feel sad and on others, crippled with depression. My Mother suffers bad depression, but always manages a face for her churchy-friends. It’s something I’ve never been able to understand or achieve.
I tend not to fight the depression/sad days. Struggling against it can often carry guilt and frustration. I can usually judge mood by whether or not I need to take to bed for an afternoon nap. Whenever the mood dips, I usually take it as a sign for some down-time. Shutting myself away and indulging is my way of coping. I’m not saying that it’s necessarily the “right way”, but it works for me!