Clinical Depression: Signs and Symptoms

We all have our moods.  There are times when we are particularly sad or irritated, and there are also occasions when we are quite cheerful.  No one is exempted from these ups and downs.  And yet, there are also periods, sometimes even more prolonged than usual, when we feel listless and sad.  We then refer to these times as occasions when we are “depressed.” 

Although we use this word in everyday conversation, we psychologists (and other mental health professionals) have an understanding of what it means when a person is diagnosed to be clinically depressed.  Although the presentation of each individual may be quite unique, some of the more common telltale signs are as follows: 

• Persistent sad, anxious or "empty" feelings
• Feelings of hopelessness and/or pessimism
• Feelings of guilt, worthlessness and/or helplessness
• Crying spells
• Irritability and restlessness
• Difficulty focusing on everyday tasks and concentrating
• Loss of interest and enthusiasm in activities or hobbies once pleasurable
• Physical lethargy and fatigue
• Physical aches or pains (e.g., headaches, sore muscles, cramps or digestive problems) that continue despite treatment
• Having disturbed sleep, inability to sleep, or sleeping too much
• Overeating or appetite loss, resulting in significant weight gain or weight loss
• Thoughts of suicide, or even suicide attempts

People who are clinically depressed will display at least five of these signs over a period of at least two weeks. 

Since we Filipinos are generally sociable and fun-loving, we tend to ignore these signs both in ourselves and others.  We can simply brush our feelings aside when we are in the company of others.  We genuinely enjoy the brief, passing laughter with friends, and quickly return to our usual routines.  For those of us who tend to cope in this manner, perhaps the above signs become more pronounced when we are alone.   

Clinical depression is rather common.  No wonder, it has been touted as the “common cold” of mental illnesses.  No one is exempted from it, as it can occur among children, adolescents and adults of both genders across socio-economic levels. 

There is, however, an apparent difference in the way men and women tend to display signs of clinical depression.  In a culture where men are not allowed to show much emotion, with the exception maybe of anger, there is very little room for men to admit to feeling depressed.  And so, men can tend to hide these feelings, sometimes not even able to admit it to themselves.  And so, men will tend to report more fatigue, irritability, and loss of interest.  As for women, feelings of sadness, worthlessness and guilt might be more common.  Also, biological factors, including hormonal cycles (including menstrual cycles and post-partum conditions), may be one factor that influences women’s moods. 

Clinical depression can happen in children as well.  Younger children tend to display depression in a slightly different way.  Some of the signs are as follows:

• Refusal to go to school
• Sudden dip in school performance and/or trouble in school
• Clinging behavior towards parents and other caregivers
• Persistent worrying that a parent or caregiver might leave or die
• Sulking and crying spells
• Recurrent sad themes in stories and drawings
• Defiant and irritable behaviors

Again, these signs often do not occur in isolation, but form a context of sadness, hopelessness, and a lack of energy. 

In severe cases, this condition can also be life threatening, as suicide is a major risk for people who are severely and chronically depressed.  Generally, there are more men who die of suicide than women.  Data from the World Health Organization (2004, from http://www.who.int/mental_health/media/en/345.pdf) show that most reported suicides in the Philippines (1993 data) are in the age range of 15-34 years. 

In many cases, suicide can be prevented.  As suicide is often linked to feelings of hopelessness, clinical depression plays a key role in this phenomenon.  If properly diagnosed and treated, a person’s life does not have to end in suicide, especially given the fact that depression is a very treatable illness.        

So, what can you do if you suspect that you or someone you care about might be depressed?  Seek the consult of a professional; that would be either a psychiatrist or a clinical psychologist, or both.  As this condition is understood to have multiple causes and effects, crossing over biological, psychological (includes both cognitive and emotional aspects), and social aspects, treatment also needs to cover all these areas.  As such, a combination of counseling/psychotherapy and medical interventions is most effective.