Distinguishing Between Normal Sadness and Clinical Depression

Unable to distinguish between depressive mood or disorder?

I have been experiencing a depressive episode for quite some time.
I used to be a positive and happy person, but recently I have been feeling increasingly down.
I am wondering if this is just a normal depressive mood.
Life feels very unmanageable lately; I am constantly in a state of depression (sometimes without any reason) or feeling numb.
Everything seems to go wrong, and my mood just won't improve.
I find school very uninteresting and exhausting, my classmates are boring, and I don't want to socialize.
Attending classes feels tiring, which is not how I used to feel.
At home, I feel a lot of pressure and want to escape; I don't want to be there at all.
My parents are always arguing and constantly scolding me, nitpicking over trivial matters that can lead to a long lecture lasting the entire night.
Recently, when I get scolded, I have many extreme thoughts and have started to act out more aggressively.
For example, one moment I might be calmly talking, and the next moment I am kicking the door and yelling, or I might be quietly listening to a lecture and then suddenly scream and run out of the house.
However, I feel that this is just my emotions reaching a breaking point that I can no longer tolerate.
After being scolded, I sometimes feel like I don't want to live in this world anymore, wanting to disappear, or I might see a knife and have thoughts of wanting to draw or look at it, but I have not acted on those thoughts.
Normally, I have a big appetite, but recently I sometimes feel no hunger and have a decreased appetite.
My mood towards my boyfriend, friends, and family has also become more irritable.
In summary, I feel that everything in this world is frustrating, and nothing is going smoothly.
I feel annoyed and uncertain about the future, thinking that I am useless.
I have started to develop an avoidance mentality; I don't even want to go to school tomorrow and want to skip classes all day.
Yet, I still have the rational awareness that this behavior is not good for me, but sometimes I suddenly feel motivated to study and become very happy, as if the world has brightened (even more than when I was in a normal emotional state).
I feel motivated and hopeful about life, planning to study for three hours each day, but usually, shortly after, I revert back to the negative emotions I mentioned earlier.
I am unsure if this is simply a depressive mood or a so-called low period, or if there is a real problem.
I would also like to ask the doctor how to get out of this negative emotional state.
Thank you.

Niming, 10~19 year old female. Ask Date: 2023/02/20

Dr. Li Guanying reply Psychiatry

From your letter, it is evident that you are experiencing discomfort and distress due to both depressive symptoms and interpersonal pressures.

1.
Facing an uncertain future, psychosomatic disorders are common in modern individuals.
This is a chronic condition that requires long-term treatment for recovery.

2.
Psychosomatic disorders are chronic illnesses characterized by episodes of exacerbation, remission, recovery, and relapse.
More than half of patients may experience a recurrence of symptoms even after they have subsided.
Due to individual differences in constitution, your friend's situation requires medical attention, and the appropriate medication will take time to determine.

3.
Regarding pharmacological treatment, each primary medication requires 4 to 6 weeks to assess its efficacy.
It is advisable to record the duration and frequency of any persistent symptoms you may experience.

4.
In addition to medication and psychotherapy, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive treatment that does not require anesthesia, has a high safety profile, and does not necessitate hospitalization.
It can help improve anxiety and depressive symptoms.
Please encourage your friend to discuss their psychosomatic issues thoroughly with their physician during follow-up visits.
Our clinic is open for consultations from Monday to Friday, both in the morning and afternoon.
We recommend considering a visit to allow the physician to personally evaluate your symptoms and collaboratively discuss the best course of action for you.

Wishing you mental and physical well-being.

Reply Date: 2023/02/20

More Info

Distinguishing between normal sadness and clinical depression can be a complex task, especially when emotions fluctuate and life circumstances become overwhelming. Based on your description, it seems you are experiencing a range of symptoms that could indicate more than just typical sadness. Here’s a breakdown of how to differentiate between the two and some suggestions on how to manage your feelings.

Understanding Normal Sadness vs. Clinical Depression
Normal Sadness:
- Typically arises in response to specific events or situations, such as loss, disappointment, or stress.

- It usually lasts for a shorter duration and tends to improve as circumstances change or as time passes.

- Individuals experiencing normal sadness can still find moments of joy or interest in activities they usually enjoy.

- There is generally no significant impairment in daily functioning, meaning you can still go to school, maintain relationships, and perform daily tasks.

Clinical Depression (Major Depressive Disorder):
- Symptoms persist for at least two weeks and can last for months or even years if untreated.

- It involves a pervasive low mood that is not necessarily tied to specific events and can occur even when things are going well.

- Common symptoms include:
- Persistent feelings of sadness, hopelessness, or worthlessness.

- Loss of interest or pleasure in activities once enjoyed (anhedonia).

- Changes in appetite or weight (e.g., significant weight loss or gain).

- Sleep disturbances (insomnia or hypersomnia).

- Fatigue or loss of energy.

- Difficulty concentrating or making decisions.

- Thoughts of death or suicide, or self-harming behaviors.

- Increased irritability or agitation.

Given your description of feeling persistently low, experiencing significant changes in appetite, and having thoughts of wanting to escape or even self-harm, it is crucial to take these feelings seriously. The emotional volatility you mentioned—where you feel extreme highs followed by deep lows—can also be indicative of mood disorders, including depression or even bipolar disorder.

Recommendations for Managing Your Feelings
1. Seek Professional Help: The most important step is to consult with a mental health professional. They can provide a proper diagnosis and recommend treatment options, which may include therapy, medication, or a combination of both.

2. Therapy: Cognitive Behavioral Therapy (CBT) is particularly effective for depression. It helps you identify negative thought patterns and develop coping strategies. Additionally, talking therapies can provide a safe space to express your feelings and work through your emotions.

3. Medication: If diagnosed with clinical depression, medication such as antidepressants may be prescribed. These can help regulate mood and alleviate symptoms. It’s essential to discuss any concerns about medication with your doctor.

4. Lifestyle Changes: Incorporating regular physical activity, a balanced diet, and sufficient sleep can significantly impact your mood. Exercise, in particular, releases endorphins, which can help improve your overall sense of well-being.

5. Build a Support Network: Reach out to trusted friends or family members. Sharing your feelings can alleviate some of the burdens and help you feel less isolated. Support groups can also be beneficial.

6. Mindfulness and Relaxation Techniques: Practices such as meditation, yoga, or deep-breathing exercises can help reduce stress and improve emotional regulation.

7. Journaling: Writing down your thoughts and feelings can provide clarity and help you process your emotions. It can also serve as a tool to track your mood over time.

8. Limit Stressors: If certain situations or people contribute to your stress, try to set boundaries or limit your exposure to them. This can help create a more manageable environment.

Conclusion
It’s crucial to acknowledge your feelings and understand that seeking help is a sign of strength, not weakness. The symptoms you described warrant professional evaluation and support. Remember, you are not alone in this, and there are effective treatments available that can help you regain a sense of balance and joy in your life.

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