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Beyond Blue: Examining the Line Between Sad and Depressed

Updated: May 24, 2020

Have you felt a prolonged feeling of sadness – one that is persistent and filled with a loss of interest in things you previously enjoyed? It is normal to have feelings of sadness. Most people go through periods of feeling sad, especially after experiencing loss or during and after a stressful period. Clinical depression, however, is more constant –the sad or empty feeling does not go away after a couple of weeks, and everyday activities that were a routine become a struggle to accomplish; everyday routines like eating, sleeping, working and socializing are impacted.

Depression has traditionally been viewed as an issue faced by women, however depression is a health issue faced by both genders, and men may showcase symptoms like anger and irritability. Per recent estimates by the World Health Organization, 264 million people are affected by depression globally. Per National Institute of Mental Health, depression is one of the most common mental disorder in the US. Depression can affect children, adolescents, and adults.

People who experience depression describe it as an agonizing pain that cannot be shaken. They often verbalize feeling trapped, reporting feeling numb, empty and hopeless. Some depressed people may suffer to an extent where they may contemplate suicide. Almost all people suffering from depression express decrease of pleasurable activities, a reduction of energy, feeling disconnected socially, having trouble with sleep (sleeping too much or too little), and an overall persistent feeling of sadness. Sufferers of depression experience either an increase or a decrease in their appetite, which is sometimes accompanied by weight fluctuation. A large portion of people suffering from depression report that their symptoms are exacerbated in the morning.

Below are some symptoms of major depression (from National Institute of Mental Health). It is not necessary for a person suffering from depression to experience all the symptoms noted below; some may experience a few, while others may experience several. For a depression diagnosis, a low persistent low mood is accompanied by some persistent symptoms noted below:

· Persistent sad, anxious, or “empty” mood

· Feelings of hopelessness, or pessimism

· Irritability

· Feelings of guilt, worthlessness, or helplessness

· Loss of interest or pleasure in hobbies and activities

· Decreased energy or fatigue

· Moving or talking more slowly

· Feeling restless or having trouble sitting still

· Difficulty concentrating, remembering, or making decisions

· Difficulty sleeping, early-morning awakening, or oversleeping

· Appetite and/or weight changes

· Thoughts of death or suicide, or suicide attempts

· Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Many people often ask what causes depression. Although there isn’t a conclusive understanding of the causes of depression, there are several risk factors, including genetic features such as history of depression in the family, changes in the brain’s neurotransmitter levels, severe trauma/stress, major life changes, physical illnesses, as well as psychological and social factors. Although depression can occur at any age, it’s onset of symptoms are most often seen beginning during adulthood.

Despite seeming like an unchanging constant sorrow, even the most severe cases of depression can be treated. Depression is treatable and managing symptoms, depending on the severity can fall into two categories: psychotherapy and drug treatment.

Psychotherapy also known as mental health/talk therapy for depression includes Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT). Both have an excellent success rate with helping people manage depressive symptoms. For some forms of depression, psychotherapy is usually the first line of treatment, while some people respond better to a combination of psychotherapy and medications. A good relationship with the mental health therapist can improve outcomes.

Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT) are the two main types of psychotherapy for depression. Cognitive behavioral therapy has been shown to help significantly with managing depressive symptoms. CBT helps evaluate and change negative thinking patterns associated with depression. CBT is a structured, time limited therapy treatment that aides with building coping tools for symptom management.

Interpersonal therapy (IPT) is another therapy that is successful with depressive symptoms; it focuses on improving problems in personal relationships and other changes in life that may be contributing factors of the symptoms. IPT, like CBT, is often time limited.

Psychoeducation is also useful and involves teaching the person about depression, how to identify symptoms, manage them, and recognize signs of relapse. Family psychoeducation can be helpful for family members who want to understand what their loved one is experiencing.

If you or someone you know needs help with depression or relationship stressors, reach out – both are treatable. Managing depressive symptoms can have a profound impact on health, individual and family quality of life. Email:


“Depression.” World Health Organization, World Health Organization,

“Depression.” National Institute of Mental Health, U.S. Department of Health and Human Services, 28 Feb. 2018,

©2020 by Irem Choksy, LMFT

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