Understanding depression

Depression is a term that is ill-defined, often used too broadly, and consequently misunderstood.

To better grasp what depression really is (and isn’t), BeWell caught up with Dr. Ian H. Gotlib, director of the Stanford Mood and Anxiety Disorders Laboratory.

Is mental health a necessary precursor to physical health?

The short answer is probably no. You can have physical health but lack mental health. On the other hand, when you are depressed, you may not eat, exercise or go to work. You may not do the things you would normally do to take care of yourself. It is certainly easier to develop and maintain physical health if you are healthy mentally.

I’d rather focus on the bi-directionality of this question. Not only can mental health improve your physical health, but you also need physical health for mental health; best example — exercise has been found to reduce symptoms of depression. Therefore, mental health and physical health are mutually beneficial.

How can I tell if I’m depressed?

Depression is a problematic term because it has so many meanings. We can wake up any morning and say, “I’m depressed today,” but we won’t wake up and say, “I’m schizophrenic today.” We have to distinguish between depressed mood and the clinical disorder of depression.

We all experience sad moods, but people with severe depression experience impairment in their day-to-day functioning: they can’t go to work or school. This impairment is usually time-limited. To receive a clinical diagnosis, an episode of depression must last at least two weeks (more typically it lasts six months); the depressed mood can be accompanied by a profound inability to experience pleasure, and by disturbances in sleep and/or appetite.

The diagnosis of depression is met when at least five of nine symptoms are present, at least one of which is either depressed mood or loss of interest or pleasure.

Is there time when being depressed should be accepted, such as after the death of a loved one?

Yes. Being depressed in this situation is called bereavement — a normal response, time-limited, and not considered a clinically diagnosable episode of depression.

What is the biggest challenge for a person with clinical depression?

The good news is that depression is among the most effectively treated of all emotional disorders. Cognitive therapy, interpersonal therapy and anti-depressants (SSRIs) all can have an ameliorative effect. The difficulty is in preventing recurrences. People often have five or six depressive episodes over a lifetime. In our lab, we focus on preventing the first episode in children and adolescents (intervening before the first episode occurs).

How do you do that?

We know that there is a gender difference in depression: women are twice as likely as men to be depressed. We also know that 14 or 15 is the median age for the first occurrence of depression. Thus, being young and female is a risk factor for depression, and this is why we are focusing on understanding and preventing depression in young girls.

Why is it important to tackle this problem?

Depression is debilitating and the societal cost is enormous. Depression costs us over $80 billion per year and the mortality rate is three times higher for people with depression — higher rates of suicide, an increase in accidents, and high rates of comorbidity with heart disease and smoking.

Are there any special challenges at Stanford?

While Stanford is a wonderful place to work, it is also a high-pressure institution with all the stress that comes with a high-level job. We need to ensure that we pay attention to emotional as well as to physical health.

How do you suggest we do that?

We need to normalize feeling sad; we all feel sad from time to time, and we shouldn’t beat ourselves up for feeling sad for a few days. Nevertheless, there are things we can do about it. When sadness develops into clinical depression, it is important to understand that there are remedies. Depression is treatable. We should not have to suffer.

Are you, or someone you love, feeling sad? Start with these self-care tips.

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