Depression #2 - What does it feel like to be depressed? How do I know if I am?

In this, the second of our blog posts by Dr Stephanie Hughes on depression, we discuss the thoughts and feeling of those who suffer from depression, and how a doctor will go about diagnosing the illness. We also give some quotes at the end, from genuine sufferers of the illness, which you may find distressing, but which we feel are important to publish, to raise awareness of this much misunderstood and underestimated condition. 


What is Depression? How will I Know if I am Depressed?
The main symptoms of depression include, unsurprisingly, low mood, sadness, tearfulness, and an inability to enjoy life – depressed patients may feel as though the slightest little thing can send them spiralling into a deep sense of hopelessness and despair. A depressed patient may also describe irritability or a tendency to “fly off the handle”. A degree of low self-esteem and guilt is also very common.

Apart from these mood symptoms, people may also suffer from other problems associated with their depression – for example, they may describe an inability to concentrate or retain information; they may find that they are disinterested in things that used to bring them happiness (including sex – reduced libido is an extremely common symptom of depression), that they have very low energy levels, that they have sleep problems (patients often describe waking up very early in the morning, but might also find they cannot sleep at all, or sleep far too much), that they lose interest in food and lose weight (or, sometimes, find themselves eating far too much and gaining weight). Other symptoms might include being restless and agitated, or alternatively being very “slowed down” (this is called “psychomotor retardation”). As mentioned above, people with depression can also complain of aches and pains with no obvious physical cause, as well as other physical symptoms. Rarely, depressed patients may experience strange sensations, such as hallucinations, or have bizarre thoughts and beliefs which don’t make sense to other people. Depressed people often don’t take care of themselves as well as they should, and other people might notice that their appearance or hygiene is not as it used to be.

How will a doctor assess whether I am depressed?
Doctors tend to use their clinical skill to diagnose depression on the basis of the symptoms their patients describe to them, as well as their observations of the patient’s behaviour and thought patterns. To help classify the severity of depression, doctors may use the PHQ-9 tool – this is a questionnaire with 9 main questions, against which patients score the frequency of their symptoms. Depending on the severity and duration of symptoms, and of course taking into account the patient’s wishes, the doctor can begin to formulate the most appropriate management plan – which may or may not include medication and/or psychological therapies. It is key to this initial assessment that the doctor knows about not only the duration and severity of each symptom, but also the degree to which the symptoms are affecting the patient’s life. Doctors should be alert to the possibility of depression, even if you don’t mention it yourself, if you have certain risk factors, such as a history of depression, or a long-standing, life-limitinghealth condition.

These screening questions will sound something like this: “During the last month, have you often been bothered by feeling down, depressed or hopeless? During the last month, have you often been bothered by having little interest or pleasure in doing things?”. Answering a “yes” to either question will prompt the doctor to ask more about symptoms of depression.

Here are some genuine quotes from sufferers of depression, which will give you a further idea of how it feels to be genuinely depressed.

“Mysteriously and in ways that are totally remote from natural experience, the grey drizzle of horror induced by depression takes on the quality of physical pain.”

 “Depression is not only an experience in the mind; it is also an affliction of the body.  There is a lack of energy, a painful heaviness; sadness and a grief that permeate to our marrow.”

 “That’s the thing about depression: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end.”

Depression and suicide
It’s always a distressing thing to talk about, but doctors must and will always ask patients with depression about whether they have ever thought about suicide. About 5,000 people in the UK commit suicide every year – that’s one every two hours – with at least ten times as many suicide attempts annually. Suicide is incredibly distressing for families and communities, and one can only imagine the horror of feeling such despair that ending one’s own life becomes a real prospect. Many depressed people describe a desire to “leave it all behind” or say that they wish they could “run away and not come back”, but they are expressing a wish for life to be different, not over altogether. True suicidal intent is rare, but it is part of a doctor’s job to seek it out, so depressed patients shouldn’t be at all surprised or offended to be asked quite directly if they have ever thought about killing or harming themselves.

This was the second of our series of 4 blog posts on depression. In the next posts we will be discussing what can trigger depression, including discussions of Seasonal Affective Disorder (SAD), Post Natal Depression (PND) and the impact of social media. We also explore what happens at a chemical and physical level in the brain to explain the condition. In our final post we will discuss the various treatment options available, to reassure those sufferers that there is a lot that can be done to help them on the road to recovery. Please consider liking and sharing with those you care about. Thank you.