Does Depression Equal Sadness? — Part I

Photo by Liquid (Artiste) Arya

A theme that comes up frequently when I facilitate any family meetings is about support — how to ask for support; how to offer support. Most people think it should be pretty straightforward to do either, but often it is not. Time and again, patients share anecdotes of how their loved ones bungled such attempts. Here is one example:

You feel depressed. You try different ways to get yourself out of the funk but nothing works. Finally, you seek professional help and get diagnosed with clinical depression. You then open up to your loved ones about your struggle, and their response is, “Oh I know depression!” They proceed to tell you how they overcame it quickly after a setback and suggest that you do the same.

If you feel demoralized by such a reaction, it is probably because you know clinical depression is not just feeling sad. Clinical depression can affect one’s cognition, affect range, psychomotor presentation, interest, and motivation. In fact, if left untreated, clinical depression can limit one’s ability to tap into a wide range of emotional experiences. If you observe people suffering from chronic depression, you will notice that many of them do not report deep sadness or anguish; instead, they convey apathy, aloofness, and even a sense of detachment. It is not that they no longer feel; it is that their range of emotion has narrowed. Not a lot of highs; not a lot of lows. It has more or less flatlined.

As depression improves, the range widens once again. This is when people start to notice that they can tap into positive emotions spontaneously — feel hopeful; laugh at jokes; engage in friendly banter; make funny comments; flirt. At the same time, however, they may find themselves grappling with negative emotions more than ever. Feelings of grief, loss, sadness, fear, anxiety, and anger can resurge, and an avalanche of emotion may follow. When this happens, some may feel rattled as they interpret it as a sign of worsening depression. But the reality is, being able to access a wide range of emotions is critical to a sense of well-being. It is, in fact, what we hope to achieve through treatment.

So, no, depression does not equal sadness, just as the absence of sadness does not equal health.