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The Big Picture of Depression Symptoms

John Folk-Williams has lived with major depressive disorder since boyhood and finally achieved full recovery just a few years ago. As a survivor of ...Read More

Depression can be a powerhouse of misery that leaves you feeling helpless, but it’s not one massive force, whatever it may feel like.

Depression is a combination of several conditions, and there are effective ways to deal with each one. It takes a lot of trial and error to find the best treatments, but I have found it helpful to use a mapping method to get started:

1. Get the big picture of depression symptoms and the dimensions of life they distort.
2. Track the symptoms that most disrupt your life and the specific impacts they have.
3. Choose the treatments and lifestyle changes that focus on those problems.

Once you have this map in mind, the challenge then is working with it every day, despite setbacks. None of this is easy, or follows a simple logic, but it helps to have a guiding idea of what to do. You may well lose sight of the overall picture during the worst episodes, but it’s something to come back to when you’re out of those depths.

Getting Beyond Helplessness

What does your depression feel like? Most people I know answer this by trying to find words to capture the overwhelming nature of the illness. You’re under a cloud or a huge weight or drowning or flattened or feeling dead or living in a fog. You use some powerful image to get across the totality of the experience.

You can’t do anything, don’t want to see anyone, and barely manage to drag yourself through the workday. Depression is a vast force you feel powerless to change. It seems hopeless, you feel helpless, you don’t know what to do.

During my worst episodes, I felt exactly like that and for years couldn’t imagine anything else. That began to change, however, as I learned more about the full scope of the illness. There were not only a lot of symptoms that I had never linked to depression. There were also ways to group them so that I could see how they reinforced each other.

This was no intellectual exercise. I had lived with the disappointment of ineffective treatment for a long time and knew I had to do more on my own. As I learned more, depression felt less like an overwhelming force and more like a complicated problem I could do something about.

Learning the Full Scope of Depression Symptoms

There are a lot of explanations and paradigms of depression symptoms, but most group them as disrupting the healthy processes of your body, thinking, feeling, behavior and relationships. A grouping of this type helps you form of picture of what your depression is like, but you can’t stop there. You also need to know how the symptoms interact, reinforce each other and sustain the illness over time. That’s the dynamic process of depression.

To start with the lists, the best known one covers the nine criteria for identifying an episode of major depression. These symptoms are based on clinical practice as the most reliable ones for differentiating depression from other conditions. They’re not the only ones, but they comprise the crucial indicators that moves you toward a formal diagnosis.

I won’t go into the details of diagnosing different types of depression – that would take several posts. As far as grouping symptoms is concerned, they’re broken out into two lists. The first group includes the two defining characteristics of depression. A diagnosis requires that you have one or the other.

1. depressed mood much of the time or
2. lack of interest, enjoyment or feeling for anything

There are seven more, and the screening requires that you have at least five of them:

1. significant changes in weight or appetite
2. sleep disturbance nearly every day
3. physical agitation or slowing
4. fatigue or loss of energy
5. feelings of worthlessness or excessive or inappropriate guilt
6. diminished ability to think, concentrate or make decisions
7. recurring thoughts of death and suicide or plans or attempts to commit suicide

This is the list you’re most likely to have encountered. You find it in every book about depression and on every mental health information website, along with screening tests that use these criteria. But the list is too short to capture the full scope of the illness. There are many more symptoms you might experience that are shared by countless others.

Getting the Big Picture

I’ve put together a more extensive list here, though you may find it still doesn’t capture everything you’re living with. I realize many of these symptoms don’t define depression exclusively since they could also indicate a different condition. However, all of them can and often do accompany depression.

You may find it as helpful as I did to be able to link all these to the illness. It can be reassuring to know that a problem you thought was part of who you were turns out to be a treatable symptom. But there is a downside to long lists of symptoms.

If you only count them up one by one, you might become more convinced than ever that depression is too overwhelming to deal with. That’s why it’s important to go beyond a bare list. Many symptoms are closely related and act together to intensify their impact. So it helps to group them, and many experts do that according to their effects on the basic dimensions of your life that I’ve mentioned: what they do to your body, thinking, feeling, behavior and relationships.

That’s the way I’ve organized them here.

Body:

  • sleep disturbance
  • significant weight loss or gain
  • fatigue or loss of energy
  • physical agitation or slowing down of movement and speech
  • unexplained pain

Thinking:

  • diminished ability to think, concentrate or make decisions
  • ruminating, obsessive thinking
  • recurrent thoughts or death or suicide
  • impaired memory
  • negative thinking

Mood and Feelings:

  • depressed mood
  • lack of interest or enjoyment in anything
  • hopelessness
  • irritability and anger
  • feeling helpless
  • anxiety
  • feeling worthless or guilty

Behavior:

  • self-defeating behavior
  • inactivity
  • lack of motivation
  • crying for no apparent reason
  • blaming and angry outbursts
  • attempts at suicide
  • substance abuse

Relationships:

  • social isolation
  • loss of empathy
  • unwillingness to communicate
  • emotional withdrawal
  • social anxiety

You may divide up the symptoms differently, but breaking them out like this can give you a starting point for making choices about treatment. Before you can get to treatment, however, you need to profile your own depression in as much detail as possible. Making a list of all the symptoms you experience shows you how pervasive the illness is, but you probably don’t experience all the symptoms at the same time or always with the same intensity.

It’s important to track them over time while looking also at what else is going on in your life. This is one way to get a sense of the overall patterns that sustain depression. Have you put together the big picture of your illness? Is that a helpful approach, or does something else work better? Has learning more about depression in this way helped you take a more active role in your treatment?

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