A Bad Mood Or Depression? Destigmatizing Mental Illness

Fast But Lost
Fast But Lost: Overcoming Depression in City Life by Dr Pallavi Joshi  focusses on depression in urban India, it addresses special challenges like maintaining a work–life balance, dissatisfactory relationships, poor lifestyle and disillusionment. This book also addresses the myths and facts about depression and its treatment.

We all feel sad and low when something bad or unwanted happens to us, but are we all depressed? Certainly not! Below are some of the key differences between sadness and depression.

Duration of low mood

Sadness: In sadness, the low mood lasts for a pretty short duration, and is usually not associated with other features of depression like changes in sleep and appetite, low energy levels, and major changes in thinking patterns like feelings of hopelessness, helplessness and worthlessness. Depression: In depression, low mood needs to be present for at least two weeks and is accompanied by other criteria for
the same.

Normal reaction versus abnormal state of the mind

Sadness: Sadness is marked by a normal reaction and a normal emotion to disappointing, unpleasant events that all of us experience from time to time and will keep on experiencing.

Depression: In depression, it’s just not an abnormal emotion of low or negative mood; it’s an abnormal mental state which influences all other areas of functioning like feeling, thinking, behaving, judgement, decision-making, etc.

Reasons for feeling low

Sadness: We know the specific reasons behind our sadness, e.g. a failed relationship or poor performance in exams.

Depression: Reasons behind the depression may not be clear; it may happen without any external stressor. A triggering or stressful event may or may not be present in depression. In endogenous depression, there are no external stressors; meaning, in this kind of depression, we are unable to find any external cause for it. This is the case with almost 25 per cent of the total cases of depression.

I remember the example of the famous Bollywood actress Deepika Padukone, who is now an advocate for depression awareness. In an interview, she stated,

…I had won all my awards and you know all the appreciation for 2013, everything had happened and it was a great time and obviously at once one gonna think like why is she depressed, she has everything going for her. But, I woke up one morning just feeling empty you know like this pittish feeling in my stomach that I was telling them that I get this pittish feeling in my stomach. I woke up like feeling directionless, I didn’t know where to go, I didn’t know what to do and I had these bouts of feeling so low that I would just start crying at the drop of a hat.

In endogenous depression, one may have intrinsic hormonal disturbances such as disturbances of the thyroid. In exogenous depression, yes, external stressors are present, but o$en these are just a starting event and the illness persists even when the stressor is gone. Even simple, routine activities become stressful with time in such cases.

Interest in the activities which you like to do

Sadness: In sadness, interest in pleasurable activities remains intact, such as shopping, watching movies or hanging out with friends.

Depression: Depression is marked by a loss of interest in all previously enjoyable activities. I remember the example given by a patient who got cured of depression. He told me, ‘Doctor, going to office on Monday was always a pain and I never considered my reduced interest in day-to-day activities and lower focus at work as a sign of depression. I thought I was fine, but sometime later, when a plan for a trip to Goa did not excite me, I knew something was seriously wrong with me and I came to you for evaluation.’

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Changes in sleep and appetite

Sadness: The low mood doesn’t affect activities like sleeping or eating routines. In fact, sadness or stress may lead a person to overeat or indulge in eating more sweets and chocolates, as stress increases the craving for something sweet and chocolates have stress-busting neurotransmitters such as anandamide and tryptophan.

Depression: Generally, a depressed person will have a disturbed sleep. There can be difficulty in falling asleep or maintaining sleep, and they may not feel fresh after waking up in the morning.

There is less interest in eating too. If the depression advances, the patient may eat very little and experience profound disinterest in eating. In some cases, the patient may tend to sleep a lot and eat large amounts of food. This may happen in a variant of depression called ‘atypical depression’.

Socio-occupational deterioration

Sadness: This is a very important criterion. We may have thoughts like: ‘Oh, I don’t feel happy nowadays’, ‘Life is pretty stressed’ or ‘Of late, people find me boring’. But as long as we are able to function well in our social and occupational circle, that is, are able to work properly and maintain our relationships well, it does not indicate a serious issue.

Depression: There is deterioration in work performance. Social and family relations too may suffer.

Thoughts of guilt and regret

Sadness: There is an appropriate sense of guilt or regret owing to a mistake, but it is limited to that event only.

Depression: There is an overall feeling of failure, multiple regrets and inappropriate guilt about things the patient is not even
actually responsible for.

 Depressogenic thinking

Sadness: In sadness, there are no thoughts like hopelessness about the future, helplessness about the situation and worthlessness
about overall life. There is clarity of thought.

Depression: All patients have at least one of the three important depressogenic thoughts mentioned above and, in addition, have other distorted thoughts like overgeneralization, which means feeling that if one bad situation happens once, it will happen again and again; maximization, where external problems are glorified and minimization, i.e. the feeling that your strengths are minimal and your achievements are insignificant.

 Associated features of anxiety

Sadness: #ere will be no symptoms of anxiety, like a constant feeling of restlessness or the fear that something bad is going
to happen.

Depression: It invariably comes with anxiety until it reaches a terminal state, where there is no anxiety. The majority of patients report restlessness, fears of known or unknown things and the sense that something bad is going to happen. There may be free-floating anxiety which the patient feels throughout the day or on-and-off episodic anxiety issues, which are associated with rapid heartbeat, cold and sweaty hands and feet, and dryness of the mouth.

Suicidal thoughts, suicide attempts, self-harm

Sadness: There are no extreme thoughts like self-harm or suicidal ideas, as sadness is a normal emotion and doesn’t involve serious disturbance with thoughts and doesn’t reach the extreme of any emotion including sadness.

Depression: In depression, depending on the severity, the patient may have desires to harm themselves, express suicidal ideas or there may be attempts to harm or kill themselves.

Multiple undiagnosed body pains

Sadness: Sadness is not associated with body pains or other complaints related to the body.

Depression: There could be multiple body pains, for which the cause may not be known/detected through blood or imaging tests. Yet, they will persist and are very much real. They can be addressed as well, but only if we address depression first. Why do they happen in depression? When we are happy, we still have minor pains or discomforts in the body, but we don’t normally pay attention to them or recognize them. When suffering from depression, the pain, which may be a three on a scale of 10, becomes a 10/10. Stress increases the pain perception as well. Also, the mechanism called nociception becomes active when we are depressed. This is when the pathway in the body which conveys unpleasant sensations becomes hyperactive, so that more and more unpleasant sensations are conveyed. Some antidepressants have an excellent action on pain pathways and uplift the mood as well. So they can be used to treat this condition.

Excerpted with permission from Fast But Lost: Overcoming Depression in City Life by Dr Pallavi Joshi published by Rupa.

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