The difference between sadness and depression

As a therapist, the most common problem I encounter among clients is depression. In fact, depression has been called “the common cold of psychiatry.” Most of us are going to struggle with it at some point in our lives. For some people, depression arises as a result of events in our life situation, such as the end of a significant relationship. This kind of depression might last a while, and then gradually lift, even if we don’t seek treatment. However, for many people, depression can be a chronic condition, lasting months or years at a time, without ever seeming to completely go away. This type of depression has the potential to drain us of joy, energy, and motivation.

The good news is that depression is a very successfully treatable condition, if the person suffering with it gets help. That help might come in the form of medication, therapy, or both. (As a therapist, I’m a bit biased toward therapy, but I am in no way anti-medication.) There are many types of therapy, such as cognitive-behavioral, psychodynamic, gestalt, etc., which might cause one to wonder which is the best. The truth is, they all work, and none of them work perfectly. I tend to believe that the type of therapy used, as well as the initials after the therapist’s name, are not as important as the quality of the relationship between the therapist and the client.

So what is depression? People often use the terms “sad” and “depressed” to mean the same thing, but the two terms are not exactly synonymous. A psychiatrist I used to work with made an offhand comment one day to the effect that “sadness is just plain old sadness, and depression is sadness plus self-blame.” After giving that statement some thought, I decided that, while it is a bit over-simplistic, there is some truth in it, which I’ll get to in a moment. But first, let’s look a little more closely at what causes depression, and how to treat it.

Depression has been described as a bio-psycho-social condition, which doesn’t mean anything to most people until you break it down. “Bio” refers to our biology – in particular, the chemistry of our brain and central nervous system. Low levels of certain compounds like serotonin and dopamine have been associated with depression, and anti-depressant medications attempt to correct for this. When they work, people feel better, but there are no “magic pills.” I’m always amused at the TV commercials for some of these meds, like the one featuring the sad, pill-shaped guy with the rain cloud over him, who then takes a wonderful anti-depressant, and then the sun comes out. If only it were that easy.

But I digress. “Social” refers to our social environment – what’s going on in our life situation. Depression is often caused in part by significant stressors, such as problems with finances, health, the legal system, housing, job, relationships, etc. These things can get us down, particularly when we feel like our power to fix the problems is limited, or nonexistent.

Finally, there is the “Psycho” in bio-psycho-social, which refers to what’s going on in our minds. Mostly what we’re talking about here are thoughts and beliefs. Some beliefs are helpful, while others hold us back and cause problems. Here are a few examples of beliefs that contribute heavily to depression: “I’m stupid.” “I’m not good enough.” “I’m ugly.” “I’m weird.” “If people knew the real me, they’d run away.” “I’m defective.” What do all of these beliefs have in common? They are all some variation on the belief, “There is something fundamentally wrong with me,” and that belief, in my opinion, is the cause of more depression than anything else, period.

So. Let’s look again at the equation, “depression equals sadness plus self-blame.” Here’s an example: If I break up with my partner, I’m probably going to feel sad, unless it was a truly lousy relationship that I couldn’t wait to get away from, and even then, I might still feel sad. I might say to myself, “Well, I thought this relationship was going to last forever, but it didn’t work out that way, and now we have gone our separate ways.” Naturally, I feel sad, but not necessarily depressed. However, what if I make the above statement, but add to it statements like, “Of course it didn’t work out, because who would want to be with me? There’s always someone better who is going to come along. I might as well get used to being alone, because no one in their right mind would want to spend their life with a defect like me.” Pow! Now I’ve got all the ingredients for depression, because I’m sad, and I’m beating myself up and putting myself down on top of it.

If any readers are thinking, “That’s me, all right,” then again, there is good news. You don’t have to live the rest of your life under the rainy cloud of depression. One of the most significant steps in finding reasonable happiness is to challenge such self-defeating ways of thinking, and learning to believe that who you are is okay, even if you’ve got more than your fair share of baggage and hang-ups. I’m not saying it’s easy – I’m saying it’s doable. It is the job of the therapist to help.

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