What does “depression” really mean?

The impacts of chronic severe depression are so consistently underestimated. I think this is because “depression” has become a blanket term and many people do not realize there are actually multiple forms of depression. Here’s a brief thread of types and their differences.

While DSM criteria are hotly contested, it’s important to know key differences in how depressive issues can manifest.

One of the first major distinctions is the distinction between bipolar depression and unipolar depression.

Bipolar depression is usually shortened to “bipolar”, and can be especially difficult to cope with. This depression manifests as recurring episodes of severely depressed activity followed by severely elevated activity.

These episodes happen on a larger time scale and with a larger impact than “mood swings”. They are not someone flippantly changing their mind, they are manifestations of dysfunctional activity levels in the brain. All depression is.

The blanket term “depression” can be used to describe any disorder that is categorized by depressed activity in the brain. This doesn’t just mean depressed mood. People affected with depressive disorders experience fundamental dysregulation of all body systems. Depressed activity in the brain means dysregulation of sleep, metabolism, mood, stress, hormone levels, motivation, focus, memory, learning, cognition, reaction time, etc.

Depression literally means all activities managed by the brain are less active. It is devastating.

(Image description: side by side scans of brain activity in a depressed vs a healthy brain. The depressed brain shows markedly lower activity levels in all regions.)

Even within unipolar depression (all depressive disorders that only involve depressed activity in the brain, and do not involve hyperactivity episodes), there are many different types and many different ways symptoms can manifest.

What many people know of as “depression” is actually situational depression, which is a condition wherein the brain becomes depressed to cope with or react to stress. The myth that this is the only variety of depression is what causes the mentality that people can “get over it”.

Situational depression is the most common variety, and may happen to a majority of adults at least once in their lifetime. Situational depression will usually improve with time and an adequate emotional support network. Situational depression is highly treatable, and common treatment strategies include support groups, counseling, or short term medication. Common situations that can cause situational depression are major life changes, deaths, divorces, financial situations, etc.

The equating of all unipolar depression with situational depression is a massive issue in mental health care, as treatment targeted at situational depression is not nearly as effective for other varieties.

There are also forms of short-term depression that can be related to physical and biochemical factors. For instance, depression can manifest briefly and periodically for some people at certain stages of their menstrual cycle, or as post-partum depression after giving birth.

Another form of intermittent depression that is common is seasonal affective disorder, wherein a person becomes depressed each winter as their brain suffers from chronic lack of sunlight. This form can be treated with supplements, false sunlight lamps, relocation, etc. The care for periodic forms of depression is largely palliative; meant to reduce the symptoms in the meantime as the person’s brain returns to normal. These strategies are undoubtedly important, but fail patients who require more than just palliative care.

Chronic forms of depression can be either bipolar or unipolar, but are disabling and extremely destructive to all aspects of a person’s life. Chronic depression is usually defined as being present for at least two years. The life effects of the brain being chronically hypoactive can not be stated enough. Every system the brain controls, from hormone and metabolic regulation to mood and stress coping skills, are operating at reduced functionality for years on end.

Treatments for chronic depressive disorders are much less effective. Therapy and medication help manage symptoms, but there is no “cure”. This situation is exacerbated by the ableist idea (even among many medical professionals) that situational depression is the default.

This leads to the expectation, from medical professionals, from family, from friends, from strangers, that chronic depression will somehow magically go away. Those suffering from chronic depression are constantly encouraged to wean off of therapies helping to manage symptoms.

There is a constant expectation, an unreasonable expectation, for all those with chronic illnesses to somehow improve even without medical intervention. Chronic depression is no exception. Please be kind, and realize that chronic depression is a physical ailment of the brain.

Link to original thread: https://twitter.com/alexpetrovnia/status/1376580550094360576?s=21