Depression is a serious condition that significantly decreases one’s quality of life, sometimes leading to suicide. Depression is also a major risk factor for developing a substance use disorder. One study found that people with depression had a 16.5 percent chance of developing an alcohol use disorder and an 18 percent chance of developing a drug use disorder. That’s compared to about an eight to 10 percent chance of developing a substance use disorder among the general public. Although it has gotten more attention in recent years, many misconceptions about depression persist. These may prevent people from recognizing their own depression symptoms or make them reluctant to seek help. The following are some common misconceptions about depression.
Sadness is often a symptom of depression, but depression is much more than sadness. First, the difference between sadness and depression is a bit like the difference between weather and climate. Sadness comes and goes, but depression is a long-lasting condition. Even when you are frequently sad about something — say the death of a loved one — sadness doesn’t typically persist without relief for weeks on end; you’re sad when thinking about the loss, but otherwise, you feel relatively normal and occasionally happy. Depression, on the other hand, typically affects you constantly for a long period. You have to experience symptoms most of the time for at least two weeks for a clinical diagnosis.
A diagnosis of depression also requires symptoms other than sadness. The necessary symptoms include a depressed mood or loss of interest in things you usually enjoy. In addition, you must experience at least four other symptoms during the same two-week period. These symptoms might include weight changes, slow thoughts or movements, fatigue, feelings of worthlessness, inability to concentrate, or thoughts of suicide or death.
It’s true that women tend to experience major depression more often than men, but the gap appears to be narrowing to some extent. According to the National Institute of Mental Health, 8.7 percent of women experienced a depressive episode in 2017 compared to 5.3 percent of men. The difference may actually be smaller since men are typically less likely to recognize the symptoms of depression or seek professional help. There are also some risk factors that make women more vulnerable to depression. These include hormonal changes that affect mood and a greater likelihood of being victims of abuse or assault. However, millions of men suffer an episode of depression every year and the consequences range from unhealthy substance use to suicide. Men are almost four times as likely to die by suicide and some of that difference is attributable to undiagnosed or untreated depression.
Men also may experience depression differently. As noted above, many people assume depression is primarily sadness. However, in men, depression often presents as irritability, anger, or aggression. Men are also more likely to have physical aches, and depression is often only diagnosed after men seek help for physical symptoms such as headaches or chest pain.
Well-meaning friends and family often try to cheer up someone with depression — but, as noted above, depression is not sadness. When you’re depressed, you not only feel awful; you also can’t imagine not feeling awful. When you’re merely sad, you can cheer up by thinking about something you enjoy or something you’re looking forward to. However, when you’re depressed, you no longer enjoy anything. Something much deeper than your present attitude is to blame and attempts to cheer you up only make things worse.
Exactly what’s going on is a matter of ongoing research. For decades, the chemical imbalance hypothesis has predominated. Now, depression is increasingly thought of as having multiple pathways. For example, recent research has found that inflammation may play a significant role in some forms of depression but not everyone with major depression has inflammatory markers. Other approaches have focused on social connection, feelings of self-efficacy, or structural differences in the brain. Regardless of which of these hypotheses turn out to be most accurate, it’s pretty clear you can’t just snap out of depression.
People often believe that if you’re depressed, you must be depressed about something. Sometimes this is true. For example, some people fall into a depressive episode after the death of a loved one or after losing a job. However, that’s typically a minority. One study found that about 19 percent of people who were unemployed for a year became depressed, compared to about seven percent of people in the general population. That suggests long-term unemployment can increase your risk of depression significantly, but on the other hand, 81 percent of the long-term unemployed don’t develop depression.
Conversely, many people develop depression without any specific cause. This is especially true of people with recurrent depression. In recurrent depression, the first episode may have been caused by something specific, but then symptoms can return every year or 18 months without any clear cause. Depression is sometimes caused by seasonal changes, too: a condition called a seasonal affective disorder or SAD.
As noted above, the chemical imbalance hypothesis of depression has predominated in recent decades, and many antidepressant medications are thought to work by increasing the available serotonin in the brain. Medication can be helpful for many people experiencing depression, but it doesn’t always work and it isn’t always necessary. Cognitive behavioral therapy, or CBT, is currently the most popular form of psychotherapy. There’s a lot of research showing its effectiveness and it can help relieve depression symptoms in a matter of weeks. Sometimes CBT is combined with medication and sometimes it isn’t. Healthy lifestyle changes such as a healthy diet, regular exercise, adequate sleep, and maintaining supportive relationships have also been found to help people recover from depression and avoid future episodes.
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