Diagnosis: Depression
Depression is a condition in which a person feels a prolonged sense deep sadness, right?
Actually, no, not necessarily.
When I was being discharged from the hospital, the nurse told me that major depressive disorder was probably included in my diagnosis for insurance purposes, so that they would approve me staying in the hospital and keep paying for it. I left the hospital thinking that the staff on the psych floor were totally badass and amazing people for seeing a need and understanding that insurance companies sometimes don’t know what the hell they’re doing.
Then I went to IOP (intensive outpatient program). One of the things I really enjoyed about IOP was that they didn’t just teach us how to make ourselves feel better. They taught us everything about the conditions we were dealing with. Everything from how a condition is diagnosed, how substance abuse is most often a form of self-medication, what is happening in the body when you have a panic attack, what different kinds of medicines did for your brain, and, of course, coping strategies to deal with the symptoms of our conditions.
One day at IOP a social worker came in and started writing the symptoms of depression, according to the DSM-5 on the white board. They included:
Experiencing a depressed mood (the persistent and deep feeling of sadness that everyone talks about).
Diminished interest in or taking no pleasure in most or all activities, also known as anhedonia.
Significant changes in weight and appetite, either an increase or decrease counts as significant change.
A slowing down of thought and reduction of physical movement, observable by others.
Fatigue or loss of energy.
Feelings of worthlessness or excessive or inappropriate guilt.
Diminished ability to think or concentrate, or increased indecisiveness.
Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, a suicide attempt, or having a specific plan for completing suicide.
In order to be diagnosed with depression, one must exhibit at least five of the above symptoms for most of the day nearly every day for a two-week period. At least one of those five must be one of the first two bolded symptoms: depressed mood or anhedonia - but you do NOT have to have both. And thus we have reached a big misunderstanding about depression: you don’t actually have to experience a depressed mood to be diagnosed with depression.
As I sat in the IOP class taking notes on the symptoms of depression, I slowly realized that, when at the height of my anxiety, I was in fact also depressed. While I did not experience a depressed mood, I did experience anhedonia.
(Sidebar: doesn’t anhedonia sound like the name of a wealthy Victorian child? “Oh Anhedonia, do fetch the smelling salts, I feel I could faint!” Just saying.)
Anyway, when I am really anxious and stop being able to function, I take no pleasure in anything. I have no interest in any activity. I have anhedonia in those moments. I also stop eating, I have no energy, feel completely worthless, and cannot focus or concentrate on anything. If you’re counting along, you’ll notice that adds up to five total symptoms which means…TA DA! I have in fact had depression.
For me depression is a side effect of my anxiety disorder. In order for me to experience the depression symptoms I have to be deep in an anxiety wormhole from hell, which has thankfully only happened a few times in my life (knock on wood). When I get my anxiety under control, the depression symptoms start to ebb as well. In this way I am very lucky.
Depression is a common and very serious mood disorder. It has significant impact on an individual’s ability to function socially, professionally, and even privately. On our daily checklist for IOP that we had to complete for check in, one of the questions we had to answer was whether or not we brushed our teeth. It may sound bizarre to a functional person, but when you are suffering with depression it is really fucking hard to brush your teeth! Brushing your hair, changing your clothes, taking a shower; basic hygiene is really difficult. For me sometimes it was because brushing my teeth or standing in the shower was too much free time for my brain - I would start worrying and then spiral out, so those moments were best avoided. At other times I just couldn’t motivate myself to get up; I simply didn’t have the energy. So I just didn’t do it, any of it.
So, while the staff on the psych floor were and are total badasses, they weren’t lying to the insurance company to keep me in the hospital. I did have depression when I was admitted.
I told you all of that so that I could tell you this: depression is a serious condition and, as demonstrated above, can be sneaky. I didn’t know I had it until a social worked spelled it out for me and I recognized myself in the symptoms list. You don’t have to be constantly sad, nor do you have to be having suicidal thoughts to have depression, a very common misconception.
The point being: if you see those symptoms in yourself or in someone you know, please talk to someone. Seek help. Even if it doesn’t feel like a big deal in the moment, it is very serious. Mental health conditions can turn on a dime, and all of a sudden something that was manageable becomes an immediate crisis. Don’t waste time. You deserve to feel better and the best way to get there is to find professional help.
And I cannot wrap up Mental Health Awareness Month without reminding everyone of one of the most important numbers you can know: 988, the national suicide and mental health crisis hotline. Note that this service is not solely for suicide prevention, but also for crisis emergencies. Learn it, share it, use it if you need it. Everyone deserves care and help and it is out there!
