Many people say that when they are in the grip of depression they feel like they are in a thick black fog or that there is a constant 'quiet terror' that hangs over them.
Many depressed people will lose interest in their lives, surroundings, loved ones and selves. They will talk of feeling bleak and tired of having a lack of desire for anything in life and they often view the future with despair. Severely depressed persons will lose interest in everything and often neglect personal hygiene and retreat into a world of darkness. Thats is the most severe form of depression from the outside looking in.
Lets have a look at some symptoms and signs of depression that you may not be aware of in the illness of depression:
Guilt/shame - sometimes to extreme proportions
Disinterest in food
Eating without thinking - bingeing
Sleep disturbances - extreme insomnia particularly waking around 3am
Difficulty falling asleep - associated with milder cases
Mood Variations - starting well in the morning and deteriorating by the end of the day.
Slowing down of thinking, foggy thoughts and behaviours
Severe speech problems - sometimes the person stops talking
Restlessness that leads to agitation
Hallucinations - usually auditory
Sexual promiscuity - mostly in adolescents
Truancy - mostly adolescents
Poor academic performance - adolescence
Recurrent thoughts of death and suicide
As you can see depression has a very wide range of signs and symptoms. As health professionals we say to look for a marked change in behaviour, referring to the above, over a two week period, particularly if its sudden and completely out of character.
A major depressive episode can begin gradually and last over a few weeks. Some people will recover completely from one episode of depression and will never have another attack again. Some people will have several attacks of depression but be symptom free in between. Others will have more extreme episodes that last for a few days but occur every few weeks - these people are the most likely to commit suicide. And some people have depression seasonally which we now know of as Seasonal Affective Disorder (SAD).
Untreated major depression lasts between 6-12 months and untreated mania (associated with depression) can last around 3 months. This mania can be particularly deceptive as most people do not associate mania with depression.
Typically the recurrence of episodic depression decreases with age.
Minor Depression has in the past been referred to as reactive depression so when something happens in that individuals life and it sparks an episode of depression. Milder types of depression are also associated with anxiety. So if you have anxiety you are more likely to flick into depression if something triggers you but you have that predisposition to depression in the first place.
Then there is Dysthymic Disorder, also known as low grade depression, it is a constant low mood and presents more in women than men. It is often signalled by a marked pessimistic nature, lack of enthusiasm, indecisiveness, low energy and low self esteem. This usually begins in late adolescence. Within this type of depression there may be bouts of severe depression and this is when the person may seek help for their overall malaise.
Lastly there is "lowered mood" this is when a situation happens to trigger a low mood so it can also be called circumstantial depression, ie marital breakup, job loss, physical illness. Medical terminology refers to it as adjustment disorder (take the disorder word lightly) with depressed mood. As the situation gets better so does the mood of the person.
So you see there are SO many factors and variations of depression. And not all of them are clear cut. Depression can also be Co-Morbid meaning it occurs in the presence of other illnesses. People with chronic physical illness can present with depression, alcoholics can also have depression, Post Traumatic Stress Disorder can also present with depression, complex post traumatic stress disorder can present with depression. At times it is hard for the person and people around the depressed person to decipher which comes first the chicken or the egg? This is where therapy and at times medication can be extremely useful. Many therapists (particularly Psychotherapists) will work with the root cause and address that in co-morbid cases of depression.
So what to do? If you suspect someone is suffering with depression or you yourself are the best option is to see your regular doctor, if you know them well. They will hopefully see a marked change in your behaviour. They will often refer you either to a psychotherapist or a psychologist if it is a minor depressive episode or if there is a suspected specific trigger to the depression. If however it is very severe you might be referred to a psychiatrist who will do a very thorough evaluation with the risk of suicide being at the forefront of their evaluation. And often a period of medication may be prescribed to enable the individual to come back to a place of stability in order to do the work with a psychotherapist or a psychologist.
Depression is a very gripping illness and one that consumes the individual. It can tear families, relationships and lives apart. And it takes a huge amount of empathy and understanding that at times can be exhausting for all concerned.
There is a lot of help available nowadays for depression, the stigma around depression is lessening and with more information available to the public hopefully over time it will be seen for what it is, an illness. I personally deeply admire people who have overcome depression. It is often a very slow recovery but it can be done with the right guidance and care in place. And it may take time to find the right therapist and doctor to worth it but keep looking and keep asking the questions this is your life and you do not have to live stumbling day by day. There are options out there.