Health & Wellness

Am I just sad — or truly depressed?

Nineteen million American adults suffer from clinical depression. As staggering as that figure is, everyone is sad sometime in their life. So how do you tell the difference between clinical depression and just feeling sad?

Some of us worry that feelings of sadness or anxiety mean that something is wrong with them and they need to go on medication. While others who may be clinically depressed feel that they should just ride it out, and let things get resolved in time, and not seek professional help.

Eighty percent of people who screened positively for depression were not in treatment at that time, and 60 percent never had been in treatment. This has a lot to do with the myth that if you were strong enough you could just fight off depression by your own sheer will. In fact, 54 percent of people believe that depression is a personal weakness. This is absolutely not correct.

Depression is caused by a combination of biological, psychological and social factors. It is also highly treatable which makes it especially distressing that many people never seek treatment.

So what is depression?

What depression is not is grief. Feeling very upset and in mourning after a loss is completely appropriate and even important in processing the loss. Feeling sadness after divorce, losing someone close to you, losing a job or having to move is very normal and does not require treatment. It is wise to talk to others and find support systems so that the sadness does not evolve into depression.

However, if those feelings seem to happen a lot, and sadness or fear take over, they can impair your ability to function and to enjoy your life. This is what a true depression can do. If you are motivated to understand why and how to manage them better, then I highly recommend psychotherapy where you will learn the tools to better cope with the day-to-day struggles of life.

How do you know if you are truly depressed?

If you have half or more of the following symptoms for more than two weeks, or if any symptoms are impairing your ability to function, then you may have a clinical depression:

1. Persistently sad, anxious or empty mood.

2. Sleeping too little (awakening in the early morning and unable to go back to sleep) or sleeping too much.

3. Lost appetite or increased appetite.

4. Not able to enjoy any activities, lack of interest in doing anything.

5. Feeling restless or irritable.

6. Difficulty concentrating or being decisive.

7. Feeling exhausted

8. Feeling hopeless, helpless and worthless.

9. Physical problems that have no medical cause like headaches or stomach aches.

10. Thoughts of death or suicide.

Depression may look different in different people. One may be slow, exhausted, feel numb and utterly hopeless while another may appear anxious and irritable.

These are both signs of depression but different kinds and a professional will need to determine which it is in order to recommend the proper treatment.

Most research shows that some combination of medication and psychotherapy is best for a moderate to severe depression. For a milder depression psychotherapy alone may be sufficient and there are several “naturally occurring compounds” such as SAM-e and St. John’s Wart that may be effective. However, all things taken by mouth can and do have side effects and you should consult with your doctor before taking anything.

What is most important is to be aware of the signs and symptoms of depression, get a proper evaluation and know that treatment does work. A National Mental Health Association Survey found that 41 percent of women cited embarrassment or shame as a barrier to getting treatment. This is tragic. Depression is an illness that is not your fault and can be treated well. Without treatment it can be deadly. Fifteen percent of those suffering from depression will commit suicide. If you are unsure whether you or a loved one are feeling the kind of sadness and anxiety that is a part of the human condition or a clinical depression then get an evaluation. You can also get more information by visiting the National Mental Health Association Web site at: or calling 1-800-520-6373 to find the center closest to you.

Dr. Gail Saltz is a psychiatrist with New York Presbyterian Hospital and a regular contributor to “Today.” For more information, you can visit her Web site, Her new book, “Becoming Real: Overcoming the Stories We Tell Ourselves That Hold Us Back,” is to be published in May 2004.

PLEASE NOTE: The information in this column should not be construed as providing specific medical or psychological advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician, psychiatrist or psychotherapist.