Hi, I'm Dr. Tracey Marks, a psychiatrist,
and I make mental health education videos.
Today, I'm talking about how to tell the difference
between feeling depressed
and having major depression as an illness.
This is a very relevant topic in this current time,
as we deal with this pandemic
and all of the negativities that come with it.
I don't think we've begun to see the mental impact
that this is gonna have on us long term.
Drug manufacturers are having a hard time
keeping up with the demand for antidepressants
because more people are being prescribed antidepressants
to help with the situation.
And that makes sense, look what we've got,
longterm isolation and disconnectedness,
loss of life, economic ruin.
Any of these things occurring by themselves
can set you back emotionally,
but all of them simultaneously can fill you with apathy,
making you not wanna go on.
Does this mean you have depression?
Not necessarily.
Depression is an emotional state.
Major depressive disorder is an illness.
As humans, we're reactive.
but not every negative reaction is an illness.
There's another mental disorder
called adjustment reaction with depressed mood.
Some people call it situational depression.
It's a milder form of the depressive illness
that's triggered by a trauma or a stressor.
This disorder is defined as having marked distress
that's out of proportion
to the severity or intensity of the stressor,
and significant impairment in social, occupational,
or other important areas of functioning.
Notice in the first part of the description,
it says out of proportion
to the severity and intensity of the stressor.
There's some subjectivity here
to determine what's out of proportion.
We are expected to have reactions to things,
but what would be an expected reaction
to receiving daily news of deaths,
job loss, illness, protests,
and being unable to connect with the people
that you like and love?
Under these circumstances,
what would proportional distress even look like?
I think the answer to that
is in the second part of this criteria
for an adjustment disorder,
which is that you have distressing emotions
that cause certain behaviors that lead to impairment.
Degree of impairment is generally
how we determine the severity of an illness
and what kind of treatment you should pursue, if any.
So, what do we mean by impairment?
With impairment, we look at the degree of problems
that it's causing in your day-to-day life
in three main realms,
social, occupational, and personal functioning.
Social functioning would include how you relate to people
with your communication and your connectedness.
Occupational functioning
includes your school ability as well,
and your ability to maintain a job, to support yourself,
and get along with people in your work setting.
And then, your personal functioning
would be how well you're taking care of yourself.
So, here's how you can think
about how seriously your emotions are affecting you
based on your level of functioning in these areas.
And I'm grouping these into superior functioning,
mild impairment, moderate to serious impairment,
and profound impairment.
This is based on the Global Assessment of Functioning Scale
that we used to use as part of the diagnostic process.
We still think of it in these terms,
but we don't use the scale anymore,
and I'll have a link to the scale in the description.
Superior functioning would be that life's problems
never seem to get out of hand for you.
And you're even sought out by others
because of your many positive qualities.
Mild dysfunction would be things like having mild anxiety
related to a stressor, like an exam,
or worrying about finances after losing your job.
Or you could have symptoms
that are expected reactions to a stressor,
like being unable to concentrate
after you've had an argument with someone.
Moderate dysfunction would be having some trouble sleeping
or trouble meeting your personal,
work or school responsibilities
because of thinking problems or having poor motivation.
You may have occasional panic attacks
or have some conflicts with coworkers
or relationship problems.
Some examples of serious dysfunction
would be feeling suicidal,
being unable to keep a job at all,
having no meaningful relationships,
having severe obsessional rituals.
Profound dysfunction affects the way you think,
like being delusional, neglecting personal hygiene,
being frequently violent,
being unable to work because you can't get out of bed,
or you're making a suicide attempt.
So, those are just some examples,
but for a bird's eye view of this,
if you're struggling mentally,
ask yourself, are you meeting your daily milestones?
Are you maintaining a job and relationships?
Are you keeping up with other responsibilities,
like paying bills and taking care of people,
or things that depend on you?
With major depression,
you have more than a sad or irritable mood.
Depression affects your energy level, your sleep,
your appetite, your motivation, and your outlook on life.
And these arise independent of life stressors.
That said, you can get to the point
where you feel so low for so long
that you start to deteriorate in other aspects of your life.
It becomes more than feeling in a funk
and negatively impacts your overall functioning.
Everyone has a different threshold
for what they can tolerate,
but it's generally the moderate to severe dysfunction
that makes people seek professional help.
Medications can be very helpful for depression,
but they may not work as well for mild symptoms.
That is, you may not see as much of an improvement
for symptoms that only cause mild impairment.
And medications come with side effects,
like weight gain, agitation and nausea,
just to name a few things.
So, you may want to address mild symptoms
with other interventions, like exercise,
building in pleasurable distractions,
and increasing your self-care or self-soothing activities.
Then, save medication for persistence symptoms
that you can't pull yourself out of,
or that are causing too many problems for you.
For more on depression,
watch this video on what depression looks like.
See you next time.