When I realised I have depression

Much of my work as a clinical psychologist has focused on treating individuals with depression, so I’ve learned a lot about what it looks like. And yet when I gradually slipped into my own state of depression some years ago, I didn’t recognise it.

Over time I had developed the telltale symptoms, including a pervasively negative view of myself as a ‘loser.’ In hindsight it was so obvious that I was thinking like a depressed person, but at the time I believed the self-loathing thoughts. Finally I recognised that they were being driven by my mood.

My experience could be chalked up to “another psychologist without self-awareness,” and yet I don’t believe that tells the full story. Many people I’ve treated have described a similar blindness to their own depression, until it became unmistakable.

Even the people we’re closest to might not realise we’re depressed, especially if we’re going at “soldiering on.” They may sense we’re not at our best, but might attribute it to other factors.

Given the greater public awareness of depression — and professional experience in my case — how is it possible to not know when it’s present? There are several factors that can play a role: > Can look really different from person to person. Two people who are both depressed might have zero symptoms in common. Robin, for example, might feel really low, have terrible insomnia, be unable to eat more than a few bites at each meal, struggle with concentration, and be so miserable she’s considering ending her own life. Terry, on the other hand, doesn’t feel noticeably down but has no interest in anything, even activities he used to enjoy. He’s sleeping 12 hours a day but is still terribly fatigued and physically slowed, and feels completely worthless. As different as these two examples are, they both are consistent with major depressive disorder. > Depression tends to have develop gradually. The development of each symptom of depression can be like hair growing, with no noticeable change day to day or even week to week. Since we’re never not with ourselves, we may not have a good sense of small changes over time as our mood, energy, and view of ourselves dip.

Several “talk therapies” have strong research evidence for alleviating depression. For example, a few weeks of cognitive behavioural therapy generally has a big effect on depression

> In a related way, the various symptoms often develop at different times. Depression often has an insidious onset — we develop a symptom here, a symptom there. We might not have as much energy as before, and a few weeks later we notice we’re often crankier than usual. We might not suspect that both experiences are connected to the same condition. > There may be no obvious “reason” to be depressed. On the other hand, our moods can tank without any cause that we can identify. It could be that we have a genetic predisposition to depression, or we’re sensitive to seasonal shifts. There could also be identifiable changes in our lives that could account for our low mood, but we don’t make the connection. For example, we may have gotten a better job, which we expect would improve our mood; however, we also left behind a solid group of friends at our old job, and now have a stressful commute in the car whereas before we could take the train. Without an obvious trigger for our depression, we’re less likely to see it when it comes. > Some symptoms might not seem like depression.

So, how does recognising depression help? First, depression can affect all areas of our life, making us feel like everything is falling apart: We’re not sleeping well, we’re irritable, our motivation is gone, nothing is fun anymore, and so forth. By putting these many struggles under a single umbrella, they become much more manageable. Rather than having 15 problems, we have one, and obviously it’s easier to tackle a single problem than 15.

Second, once we’ve named it we know how to treat it. Several “talk therapies” have strong research evidence for alleviating depression. For example, a few weeks of cognitive behavioural therapy (CBT) generally has a big effect on depression symptoms.

There are also medications that are used to treat depression, some of which can even be as effective as the best psychotherapies.

For many people, depression can be managed without professional assistance, especially if the depression falls in the mild to moderate range, and if there’s a low risk for self-harm. I was able to manage my own depression through a combination of self-help, strong support from the people closest to me, and getting involved in triathlon. — Psychology Today Seth J Gillihan is a clinical assistant professor of psychology in the Psychiatry Department at the

University of Pennsylvania.