Depressed, Or Just Feeling Blue?

All of us have days when we feel depressed. Over the span of a lifetime, one out of six people will suffer from major depression. But how can we know if what we’re feeling is real depression or just a case of “the blahs”?

“The first characteristic of real depression is that it doesn’t go away quickly,” says John Preston, PsyD, professor of psychology at Alliant International University’s Sacramento, CA, campus, and author of 14 books, including You Can Beat Depression. “By definition, depression has to last continuously for at least two weeks, but for most people, it lasts for months. Depression tends to be engulfing and, despite people’s best efforts to shake out of it, they really can’t.

“Second, depression interferes with functioning and begins to take a toll on people in especially two areas: interpersonal relationships and at work or school,” says Preston. “And third is the presence of severe symptoms like thinking about killing yourself. There are also physical symptoms that are red flags for what is called clinical depression, including severe sleep disturbance, loss of sex drive and/or changes in appetite. Those are things that suggest this is probably not just the normal ‘blues’ or having a bad day.”

The good news, says Preston, is that there are alternatives to pharmaceuticals for treating depression.

“One thing, which could be a challenge for EMS personnel who do shift work, is to try to normalize sleep patterns,” he says. “With depression, sleep can become very disturbed, and the loss of good sleep makes the depression worse. There are three things in particular that people should do to avoid having sleep disturbance: avoid caffeine, or use it minimally during the day; avoid using drugs like alcohol and tranquilizers to help you fall asleep; and exercise. Studies show that regular exercise can be as effective as antidepressant medications if done the right way.

“Alcohol use and abuse is one of the single most important factors that cause depression,” Preston adds. “When people are feeling stressed and in despair, if they have a couple of drinks, the immediate effect oftentimes turns the volume down on some of the emotional suffering. But it’s been well-documented that even moderate alcohol use during depression tends to make it a lot worse.”

The last nonchemical treatment method, says Preston, is psychotherapy or counseling.

“I believe that for severe depression there is a role for antidepressant medication treatment,” he adds, “but long before you think about taking medications, it’s best to make sure you sleep, exercise and avoid drugs that make depression worse.”

There are overt symptoms that family members or coworkers should be alert to, says Preston, such as withdrawal, irritability and impaired ability to work. Preston suggests the following approach to dealing with a depressed employee or family member.

“I would say, ‘I can’t in good conscience not say anything about something I’m noticing.’ Then, in a nonjudgmental way, mention specific things: ‘You seem like you’re tired all the time,’ ‘You’re very withdrawn,’ or ‘I notice you’ve been making more mistakes lately.’ Tell them you understand that depression is high in the general population and encourage them to meet with an employee assistance counselor or primary care doctor. The problem is that most people don’t know what to say, or they’re afraid if they say something, the other person will be offended.”

Depression shouldn’t be taken lightly, says Preston, adding that it ruins careers and marriages, leads to health problems, and sometimes leads to suicide.

“In the grand scheme of things, it’s much better to have a person get irritated with me if I bring it up than if I say nothing,” says Preston. “A lot of these people feel so isolated and shut down, and nobody says anything because they don’t want to hurt their feelings. And yet, this person’s life is falling apart.”

Aside from outside influences, there is a definite genetic link to depression, says Preston. If one parent has a history of severe depression or bipolar illness, the odds are about 20% that a child will develop the disorder. For that reason, Preston adds, adults who experience depression should be alert to signs of depression in their children.

Every human being who lives a long life will run into grief and disappointment somewhere along the way, says Preston, but there’s help available when they do.

“Yet, two-thirds of people who are depressed never get treatment,” he says, “and it’s one of the most treatable of all emotional problems. I would stress that depression is very common: It happens to people who are bright and competent and mature. It’s a human condition for which there is treatment that works for most people. There’s no shame in being human.”