Recognising depression: more than just a low mood

As a psychiatrist I am often asked: 'Am I depressed, or just down for a while?' It is an important question, because the answer determines whether you have to sit something out or rather seek help. In more than fifteen years I have learned that a depression is much more than sadness, and that it often shows itself differently than people expect. In this article I help you recognise the difference, in yourself or in someone you love.

Low mood is not yet depression

Let us start with reassurance: feeling down is part of life. A setback, a loss, a grey period, it does not have to be a depression straight away. Sadness comes in waves, has bright spots and usually ebbs away by itself once circumstances change.

A depression is of a different order. It colours almost everything grey, for practically the whole day, day in and day out, and it persists, even when there is actually no longer any direct reason for it. What is characteristic is not only the low mood itself, but the loss of resilience: you can no longer pull yourself up by the things that used to give you pleasure or energy.

A handy rule of thumb I often pass on: if things are still bad after two weeks, and it affects your daily functioning (work, relationships, taking care of yourself), then it is worth looking at seriously. Do you recognise that the 'grey' no longer lifts for you?

The nine signs we look at

In healthcare we speak of a depression when someone suffers for two weeks or longer from at least five of nine core symptoms, of which at least one of the first two. It is not a tick-list that lets you make the diagnosis yourself, but it does give something to hold on to about what a depression exactly entails.

The two core symptoms are: a low mood for most of the day, and the loss of interest or pleasure in almost everything. Around those play: changes in appetite or weight, sleep problems (too much or too little), restlessness or, conversely, slowing down, fatigue and loss of energy, feelings of worthlessness or guilt, concentration and decision-making problems, and recurring thoughts of death.

Do you see several of these signs in yourself over a longer period? Then that is not proof of a diagnosis, but it is a good reason to put it before your GP.

How a depression feels from the inside

Figures and lists do not capture what a depression does to you. People often describe it as a leaden blanket, a wall of glass between you and the world, or the feeling that the colour has been drawn out of everything. Not so much intense sadness, but rather a numbed emptiness: you feel almost nothing anymore, and that is, in its own way, exhausting.

What makes it so treacherous is that a depression lies. It whispers that it is your own fault, that you are a burden, that it will never get better. Those thoughts feel like the truth, while they are symptoms of the illness, not reality. That distinction is hard to make when you are in the middle of it.

If you read this and think 'that is how it feels for me too', then know: this is a familiar and treatable picture. You are not weak, and you are certainly not the only one.

Why 'just push through' backfires

One of the most painful misunderstandings is that you have to tackle a depression with willpower. 'Get over it', 'think positive', 'others have it harder'. Well-meant, but it misses the mark entirely, because it is precisely the ability to pull yourself up that the depression has damaged.

It is like encouraging someone with a broken leg to just keep running. Pushing through exhausts you further and adds guilt when it does not work: 'see, I even fall short at this.' That is how the spiral turns further downward.

Recovery therefore does not begin with trying harder, but with taking the pressure off and calling in the right help. Gentleness towards yourself is not a luxury here, but part of the treatment.

How a depression can disguise itself

Not every depression looks like a crying person lying in bed. In some people, and in some cultures more often, a depression expresses itself mainly physically: persistent fatigue, headaches, stomach and bowel complaints, pain without a clear cause. The mood is then only brought up in second place.

Irritability too is a frequently missed form. Not low but short-fused, quickly irritated, lashing out at everything, that can just as well be an expression of depression. In men a depression is regularly overlooked because of this, also by themselves.

And then there is the 'well-functioning' depression: someone who just goes to work, laughs at the right moment, and collapses at home. From the outside nothing seems wrong. That is why it is so important not to look only at behaviour, but also to dare to ask: how are you really doing?

When do you seek help, and when is it urgent?

The rule of thumb remains: if the complaints persist longer than two weeks and hinder your daily life, then make an appointment with your GP. They can, together with the practice nurse (POH-GGZ), assess what is going on and what suitable help is. The sooner you address it, the shorter a depression lasts on average and the smaller the chance that it returns.

Sometimes it cannot wait. If you have thoughts of ending it, or the feeling that life is no longer worth it, then seek contact immediately. During the day call your GP, outside office hours the GP out-of-hours service, and in case of immediate danger 112. You can reach 113 Suicide Prevention day and night via 0800-0113 or the chat on 113.nl.

That is not an exaggerated step. Dark thoughts are a symptom that calls for help, just as severe pain would. You never have to get through that moment alone.

What helps: the way out of a depression

The good news, and I say this after fifteen years with full conviction: a depression is very treatable. For lighter and moderate depressions psychotherapy is often the first step, with proven forms such as cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT). You learn to recognise and break the downward spiral of thoughts and behaviour.

For more serious or persistent depressions medication (such as an antidepressant) can be useful, sometimes in combination with therapy. In addition, lifestyle and rhythm really matter: regularity, movement, daylight and contact are not a replacement for treatment, but they do genuinely support recovery.

Which combination suits you we determine together, with an eye for your story, your background and your preferences. Treatment is not off-the-rack; it is tailored to you.

For loved ones: what you can do

Standing beside someone with a depression is hard, and you often feel powerless. Know that you do not have to 'repair'. What helps most is being there: keep inviting even at a 'no', listen without immediately solving, and remind the person that it is the illness that lies, not reality.

Practical support works wonders: going to the GP together, a meal, a short walk. And do not forget yourself; caring for someone with a depression exhausts you too. Seeking support for yourself is no betrayal, it keeps you standing so that you can keep being there.

Are you worried about someone? Say it, plainly and honestly: 'I see that you are not doing well, and I am here for you.' Sometimes that is the sentence that finally gives someone the courage to seek help.

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This article is informative and does not replace personal advice from a care provider. In doubt, or do you have questions about your own situation? Feel free to contact us.