When traumatic events happen in our lives, it’s often difficult to understand the difference between the emotions caused by these events: are they symptoms of depression or are they simply sadness?
Traumatic events may lead to intense feelings of both. They may make us angry, or they may make us fearful. It all depends on who we are. Different people react to the same event or events in different ways.
For instance, we can say with certainty that the first two years of the COVID-19 pandemic were traumatic for millions of people across the country – but everyone reacted to those two years in their own way. Some of us feared getting sick and feared for the health and wellbeing of friends and family. Others did not fear the illness at all. For them, the public health safety measures enacted across large portions of the country – e.g. social distancing, facial coverings, virtual work and school – led to major disruption in their typical daily life, and were a major source of stress and inconvenience.
The combination of these two things – the pandemic itself and the consequences of our response – also led to a significant increase in levels of anxiety and depression around the country.
In this article, we’ll focus on depression: what it is, what the primary symptoms are, what the risk factors are, and how to tell the difference between depression and sadness. We’ll also offer insight on traditional and new approaches to depression treatment.
First, though, let’s take a look at the information we have on the topic we raise above: an increase in rates of mental health symptoms and mental health disorders as result of the COVID-19 pandemic.
Depression: Study Identifies Increased Prevalence After COVID-19
In the paper “Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic” researchers from Boston University examined the impact of the pandemic on rates of depressive symptoms among adults in the U.S. They examined the health records of close to 1,500 hundred patients from two national surveys on depression.
Let’s take a look at what they found:
- Before COVID:
- 8.5% of patients reported symptoms of depression
- Women: 10.1%
- Men: 6.6%
- 8.5% of patients reported symptoms of depression
- After COVID:
- 7.8% of patients reported symptoms of depression
- Women: 3%
- Men: 9%
- 7.8% of patients reported symptoms of depression
The research team also identified increases in symptom severity before and after the onset of the public health crisis. Here’s what they observed:
- 52% increase in mild depressive symptoms
- 160% increase in moderate depressive symptoms
- 276% increase in moderately severe depressive symptoms
- 628% increase in severe depressive symptoms
What we find most informative in this data is that the researchers observed the largest increases in people with the most severe symptoms. We interpret that as meaning that COVID-19 had the most significant impact on the people with the most disruptive symptoms of depression.
That brings us to the topic at hand: the difference between depression and sadness. To understand the difference, we need to understand and define both sadness and depression, and offer a list of the symptoms of clinical depression, since sadness itself is not a clinical diagnosis.
Let’s start by defining sadness.
What is Sadness?
The American Psychological Association (APA) offers this definition of sadness:
“Sadness is an emotional state of unhappiness, ranging in intensity from mild to extreme and usually aroused by the loss of something that is highly valued (e.g., by the rupture of a relationship). Persistent sadness is one of the two defining symptoms of a major depressive episode, the other being anhedonia.”
That aligns with what we all understand already: sadness is a temporary state of low mood, dissatisfaction, or despair. It’s no fun at all, but it passes. It’s important to understand that feeling sad is a healthy response to disappointing or stressful circumstances and situations. Sadness may come and go. Specific events may trigger a sad memory, but – as we mention – sadness typically passes in a day or two.
In most cases, sadness doesn’t lead to extreme changes in behavior. Sadness may temporarily affect interest or impair some aspects of daily life, but the disruption or impairment doesn’t persist. Experiencing sadness during or after a crisis or disturbing event is part of the human experience: it’s a totally healthy, positive reaction. When people are sad – even when they’re very sad – they can typically find relief from talking things out with a trusted friend or family member, crying, venting, or finding a way to release their emotion through a hobby, such as playing music or working out.
Those common fixes for sadness don’t work for depression, because depression is more serious than the type of sadness most of us understand and know how to manage.
What is Depression?
The Diagnostic and Statistical Manual of Mental Disorders Volume 5 (DSM-5-TR) offers this definition of clinical depression, known as major depressive disorder (MDD):
“Major depressive disorder is a mood disorder characterized by is an overwhelming feeling of sadness, isolation, and despair. To meet the criteria for clinical depression, an individual must experience five or more depressive symptoms for two weeks or longer at a time, and report at least one symptom related to low mood and one symptom related to loss of interest/loss of pleasure in daily activities.”
One part of this definition that differentiates depression from sadness is the duration: in combination with other symptoms, a low or sad mood that lasts for two weeks or more may indicate the presence of clinical depression. That’s in contrast to the type of low mood that appears for a day or two and then passes, or recurring low mood that appears and fades quickly.
In addition, it’s important to understand the difference between grief and depression. Grief involves sadness – and may last for a significant period of time – but certain characteristics of grief differentiate it from sadness. First, grief often involves painful feelings that come in waves, rather than persist at a consistent level. Second, grief typically doesn’t involve decreased self-esteem, while depression does, as we’ll show below. Third, a person in grief over the loss of a loved one may express the desire to be with their loved one, but this is not suicidal ideation. In most cases, grief does not involve the desire to end one’s own life, whereas a person with clinical depression may engage in suicidal ideation.
Depression is a multifaceted mental health condition, and understanding the causes can be just as complex as the symptoms themselves. It’s common for depression to appear after a significant trauma or event, but there are a variety of reasons a person may develop depression. Factors that increase the likelihood of developing depression are called risk factors. We’ll discuss those in a moment.
First, we’ll share the symptoms of depression.
The Symptoms of Depression: More Severe and Persistent Than Sadness
The National Institute of Mental Health (NIMH) identifies the following symptoms of depression:
- Persistent sadness/low mood
- Crying ever day or almost every day
- Persistent feelings of pessimism
- Persistent feelings of hopelessness
- Uncharacteristic anger/ hostility/ irritability
- Constant feelings of guilt/ worthlessness/helplessness
- Declining or total loss of interest in favorite activities
- Withdrawing from friends, family, and peers
- Problems communication with friends, family, and peers
- Persistent fatigue/low energy/boredom
- Uncharacteristic restlessness/agitation
- Problems with concentration, memory, and decision-making
- Changes in sleep patterns: inability to sleep, or sleeping too much
- Changes in eating patterns: sudden loss or gain of weight
- Phantom maladies: stomach aches, headaches, or physical pain/discomfort that have no clear cause and don’t respond to typical remedies
- Suicidal ideation: thinking about, talking about, or attempting suicide*
*If you or someone you love is considering suicide, please call The National Suicide & Crisis Lifeline: dial 988 or use The Lifeline Chat for immediate help 24/7/365.
If you or someone you love is having a medical emergency right now, call 911 or go to a hospital emergency room.
Before we move on, we want to emphasize that last bullet point and remind people that help is a phone call away: evidence from the National Suicide Crisis line shows that talking to someone on a crisis line can de-escalate suicidal thoughts and behavior, and help people find the support they need.
With that said, let’s consider the symptoms above in light of the topic of this article: the difference between sadness and depression. Mental health professionals and the available evidence tell us that the symptom of sadness in depression differ from non-depressive sadness in both severity and longevity. Symptoms must last at least two weeks and represent a change in level of practical daily function for a diagnosis of major depressive disorder.
Next, we’ll share the common risk factors for depression.
Depression: Risk Factors
The National Institute of Mental Health (NIMH) identifies the following factors that can increase the likelihood an individual will develop a depressive disorder. Risk factors for depression include:
- Family history of depression
- Depression in the family is associated with childhood onset of depression and early-adult/adolescent onset of depression
- Mental health history:
- Previous diagnosis of mental health disorder increases depression risk
- Previous diagnosis of alcohol or substance use disorder increases depression risk
- Significant life changes, trauma, and stress:
- Job loss, divorce, and a death in the family all meet criteria for significant stress or trauma that can increase depression risk
- Living through a natural disaster increases depression risk
- A public health emergency such as the COVID-19 pandemic increases depression risk
- Significant illness or injury:
- Diagnosis of a major illness can increase depression risk
- A serious injury or accident can increase depression risk
Those are the risk factors for depression. And yes – the stress caused by COVID-19 – or the stress associated with things associated with COVID-19, such as isolation, job loss, and/or income insecurity and major life disruption can also increase risk of developing a depressive disorder.
Therefore, if you experience the symptoms of depression we list above, they exceed the threshold for typical sadness, and the risk factors for depression apply to you and your life, then we encourage you to seek a comprehensive evaluation for depression administered by a mental health professional. If you receive a diagnosis of depression, it’s critical to know one thing: treatment for depression can work, and it’s available at high quality treatment centers around the country.
Lets’ take a look at the current options available for depression treatment. We’ll start with traditional approaches, then discuss the latest developments in treatment for depression.
Treatment for Depression: Therapy and Medication
The most common approach to treating depressive disorders is a combination of psychotherapy – a.k.a. talk therapy – and medication.
The most common types of talk therapy that therapists use to treat sadness and other symptoms of depression include, but are not limited to:
- Cognitive behavioral therapy (CBT)
- Dialectical behavior therapy (DBT)
- Mindfulness based cognitive behavioral therapy (MBCBT)
- Motivational interviewing (MI)
Talk therapy helps people with depression develop healthy and productive coping mechanisms, use problem-solving skills, and learn to recognize and process patterns of thought and behavior associated with depression. The goal of talk therapy is learning to manage the symptoms of depression with total independence, and return to full participation in daily activities as soon as possible.
Alongside talk therapy, treatment professionals may prescribe antidepressant medications to reduce the chemical imbalances and functional errors in the brain associated with depression. Common antidepressants include, but are not limited to:
Selective serotonin reuptake inhibitors (SSRIs).
This is the most prescribed type of antidepressant, and has the fewest side effects
Serotonin and norepinephrine reuptake inhibitors (SNRIs).
These medications are similar to SSRIs, but also act on the norepinephrine system in the brain. Some patients experience more symptom relief with SNRIs than with SSRIs, but one is not always more effective than the other.
Tricyclic antidepressants (TCAs).
These medications may be prescribed when SSRIs or SNRIs do not relieve the symptoms of depression. They’re older medications with more severe side effect, but may work when SSRIs and SNRIs do not.
Antidepressants are prescribed by a doctor and can be used as a short or long-term solution for depression.
Treatment for Depression: Transcranial Magnetic Stimulation (TMS) and Psychedelics
For patients who’ve tried antidepressants without success, new, evidence-based treatments are available. One safe and effective treatment is transcranial magnetic stimulation (TMS).
What is Transcranial Magnetic Stimulation (TMS)?
Transcranial magnetic stimulation (TMS) is designed to treat depression, OCD, and other common disorders safely and effectively. TMS works by emitting gentle magnetic pulses to the area of the brain that regulates mood. These pulses activate specific areas of the brain and decrease symptoms of depression.
TMS does not require anesthesia or hospitalization and has no systemic side effects. Treatment sessions last about 20-minutes. Patients are awake, receive treatment in a comfortable chair in an outpatient office setting, and can drive home after treatment. TMS is approved by the Food and Drug Administration (FDA) and is covered by most insurance.
TMS has a high success rate for patients with treatment-resistant depression and/or obsessive-compulsive disorder. Even in cases where medications are not effective, TMS can help patients overcome symptoms and live a full and productive life.
Another innovative approach to treating depression is psychedelic therapy, which we’ll discuss now.
What is Psychedelic Therapy?
Psychedelic therapy is the use of specific chemical compounds known as psychedelics to relieve the symptoms of depression. Two types of psychedelic therapy are FDA-approved: treatment with ketamine and treatment with SPRAVATO®. These medications are important for three reasons:
- Evidence shows that both ketamine and SPRAVATO® offer quick relief from the symptoms of depression, whereas typical antidepressants can take weeks to relieve symptoms.
- The effects of ketamine and SPRAVATO® can last for weeks or months after one treatment, while the effect of traditional antidepressants does not persist when a patient stops taking the medication.
- Evidence shows ketamine and SPRAVATO® can relieve symptoms for treatment-resistant depression (TRD), which is defined as depression that does not improve after at least two attempts at treatment with traditional antidepressants.
Now let’s take a look at how clinicians administer these two treatments.
- Trained clinicians administer ketamine through an intravenous (IV) infusion
- Patients sit in comfortable chair to receive infusion
- Infusion last about 45 minutes
- Medical staff monitors patients for 30 minutes after infusion
- Most courses of treatment with IV ketamine involve 6 infusions over 2-3 weeks
- Treatment most often occurs in an outpatient office setting
- Patients self-administer SPRAVATO® via a nasal spray under the supervision of medical staff
- Clinicians observe patients for a minimum of two hours after treatment
- The treatment schedule for SPRAVATO® varies, but most patients start with two sessions a week for a month, transition to one session a week for an additional month, and then attend sessions every other week.
Those are the important basic facts about these two cutting-edge treatments for depression. The primary takeaway is that TMS and psychedelic therapy are fast-acting, safe, effective, and can offer symptom relief when other treatment approaches do not.
Depression and Sadness After COVID-19
We began this article by discussing the impact of the COVID-19 pandemic on mental health. We focused on the increase in depression and depressive symptoms reported by adults in 2020 and 2021. Now, two years later, many people still feel the emotional effects of those two years. If you experience the symptoms of depression, we encourage you to seek support as soon as possible. We suggest a full evaluation with a mental health professional. If you receive a diagnosis of major depressive disorder, you can seek traditional treatment. Or you can consider innovative new therapies like TMS or psychedelics.
Finding Help for Depression
At Relief Mental Health, we’re proud to offer SPRAVATO® (esketamine), IV ketamine infusions, and treatment with TMS. Ketamine and SPRAVATO® can be used in conjunction with TMS treatment, antidepressants, and psychotherapy. Most patients engage in more than one form of treatment while to achieve optimal health.
If you have a depressive disorder, please understand these two things:
- You’re not alone
- Treatment works
With the right treatment plan, you can learn to manage the symptoms of depression. You can get your life back. You can be happy again – and Relief Mental Health can help.
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