The Many Hues of the Blues

By Dr. Omer Liran | Published March 2^nd, 2010, 12:17 AM

  “I’m depressed” - a  contemporary cliché, if there ever was one.

The circumstances that inspire the use of this expression span the gamut from those that are universally acknowledged as painful and traumatizing, to those that are disappointing in a far less grave manner – such as discovering that the coffee shop around the corner has run out of your favorite hazelnut lattes. I use that example only half in jest  - Although most of us are aware that we sometimes use the word “depressed” in an exaggerated way to emphasize our frustration, the difference between sadness and depression is one that can be subtle and difficult to identify in an individual instance.

Contemporary psychiatry recognizes many variations on the theme of unpleasant feelings. To begin with, unpleasant feelings and sadness are perfectly normal constituents of the bittersweet experience of being human. Sadness or feeling low is a normal response to trying or unpleasant circumstances. It is not always clear when the boundary between sadness and depression has been crossed, but depression is understood to have a life of its own, and to have a certain intractable quality to it. You may be sad as a reaction to a problem, but depression is when the sadness itself becomes a problem.

To be diagnosed as having an episode of major depression, you have to have experienced low mood or the inability to experience pleasure for at least two weeks, in addition to experiencing several other symptoms, such as disturbances in sleep, feeling tired, losing or gaining weight without intending to do so, experiencing a loss of motivation, having a poor appetite, being unable to concentrate, feeling worthless, feeling slowed down or restless, having recurrent thoughts of death and dying, or having thoughts of wanting to hurt yourself. If any of these thoughts or experiences sounds familiar, or if you feel as though your mood is getting in the way of being the person you always knew yourself to be or enjoying what you enjoyed before, it is imperative to seek help from a mental health professional.
I cannot assert strongly enough how important it is to seek help immediately if you having any thoughts of wanting to hurt yourself. Managing an acute crisis by seeking professional help has enabled many people to enter a different phase in which they can, in retrospect, appreciate the beauty and preciousness of being alive and be grateful for the help they sought – or, in some cases – the help that was thrust upon them.

If you are indeed depressed in the clinical sense of the term, a combination of antidepressant medication and therapy to address your problems is the standard of clinical care to help you tide over the crisis, keeping in mind that most antidepressants take three or more weeks to act.

When you are feeling sad or depressed, you may not meet the diagnostic criteria for a depressive episode, but may be experiencing what is known as dysthymia - an uncomfortable sense of lingering sadness, defined by the standard psychiatric diagnostic manual as lasting for two years or more.

As the first in a series of articles examining and reflecting on mood and disorders afflicting the same, I believed it would be appropriate to commence the series with a glimpse of what I believe to be one of the most significant transitions of all in the grand scheme of human sadness: when sadness outgrows its own definition, and becomes depression.