Depression is a word bandied around a lot – who hasn’t felt depressed from time to time? Who hasn’t complained about being low and grumpy to friends or work mates? It’s said that in the UK, it’s so much part of the national psyche to be a bit ‘depressed’ or ‘under the weather’, that the comedic catch phrase ‘mustn’t grumble’ has become a national ‘in joke’. 
Depression as a clinical illness is no gag. That ordinary every day low mood attracts the same name as the formal psychological condition, is just one of many problems that be-devils the field. Depression, as treated by doctors and therapists is extremely common. At any one moment in any modern Western society, it is estimated that one in ten women and one in fifteen men, is suffering from depression so severe, as to warrant a formal clinical diagnosis. By the way, this figure is widely acknowledged to be most probably an underestimate as to the true level of depression in the population.
To qualify for the kind of depression which doctors would recommend requires formal clinical management, the following symptoms should be present.
A key feature is markedly diminished interest or pleasure in all, or almost all, activities. So if you normally like a game of football once a week, or prefer to go to watch your favourite team – but now you have no appetite for these pleasures – this is a strong sign you could be suffering from clinical depression.
This symptom is referred to as anhedonia and is a very useful one to bear in mind as it’s entirely possible to suffer from depression and not personally realize it. This sounds an amazing claim to make, but I vividly recall one of my patients telling me they only realized they had been suffering from depression for some years, when they heard a strange noise they couldn’t recognize, and then realized it was them laughing! It was a sound they hadn’t heard for such a long time!
Other features doctors and therapists will be looking for in order to make the diagnosis include significant unexplained weight changes, appetite alterations, sleep disturbance, agitation or lethargy, low energy, feelings of worthlessness, guilt, diminished ability to think or concentrate, indecisiveness, recurrent thoughts of death or suicidal ideas.
It’s vital to understand that you don’t have to have all of these symptoms – just a couple or even one – and its likely you may benefit from professional assistance to overcome a depressive illness.
Many people don’t want to bother a doctor because they believe these symptoms are too trivial, or that they should ‘pull their socks up’ and sort things out for themselves. Depression for many is a sign of personal failure. Winston Churchill suffered the most severe bouts of depression for decades, and few would consider him a letdown, or many of the gamut of creative successful people throughout history, with depression, failures.
It’s important to realize that the doctors and therapists will have seen many hundreds of people reporting these self same issues. Clinicians are also aware that at the General Practice level, depression is probably one of the most commonly missed diagnoses. If you pluck up the courage to come and see a professional, they will be sympathetic to your predicament, not seeking to castigate you for wasting their time. Depression is a tricky illness to diagnose, so it’s better to err on the side of checking whether you have it, than assuming you don’t.
It’s vital to go and seek help, or at least a professional assessment because the latest research evidence is that the prognosis for depression following the correct treatment is excellent. However, the longer you delay getting assistance, the more likely a relatively straightforward depressive illness will transform into something much more resistant to help. Alcoholism, eating disorders, gambling problems and a whole plethora of other difficult psychological issues most often started, way back in time, as eminently treatable depression.
It’s not commonly realized that untreated depression is associated with a significant mortality rate – particularly as you get older – for reasons which remain mysterious. Marleen Hermens and colleagues from the Department of General Practice, Institute for Research in Extramural Medicine, University Medical Center, Amsterdam, reviewed all contemporary research into the mildest form of depression that doctors treat, and found that up to two thirds those over 50 years of age with so called minor depression at baseline, died within 2–13 years of the diagnosis.
Perhaps those with depression stop looking after themselves, or don’t take proper treatment when diagnosed with some other physical condition. Or maybe the direct stress of depression on the body, is responsible for such an astonishingly poor mortality rate.
Given it’s a recognized condition, it’s common, the prognosis is excellent with the right treatment, it makes no sense to delay seeing a professional if there is any doubt you may be suffering from any of the symptoms discussed above.
The prognosis of minor depression in the general population: a systematic review
General Hospital Psychiatry, Volume 26, Issue 6, November-December 2004, Pages 453-462 Marleen L.M. Hermens, Hein P.J. van Hout, Berend Terluin, Daniëlle A.W.M. van der Windt, Aartjan T.F. Beekman, Richard van Dyck, Marten de Haan