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Sadness and Depression Are Not Synonymous
by Ian Magill, M.D.

Many use the terms sadness and depression interchangeably, as if they were synonymous. But they are profoundly different. Whereas sadness is an emotional state of mind; depression is an illness, a mood disorder, and a constellation of symptoms.

Confusing depression and sadness can lead to estrangement, strife, turmoil, even death. Learning the differences between the two can increase our feelings of empathy and compassion, and perhaps save a life.

We've All Been There

Sadness affects us all from time to time. It is part of the everyday human repertoire. Sadness has many names and descriptions-people have "the blues," they are "long-faced" or "under the weather." Sadness is familiar to us, easy to approach. Depression, on the other hand, can be a paralyzing affliction that has a drastic impact on daily living.

Speaking metaphorically, we might say that sadness is a superficial scratch, while depression is more like a wound that may require a tourniquet. Sadness can distort our vision, so that rich colors are dimmed, but depression blots out all light and leaves a blackened, desolate landscape. And while sad people may need to be comforted, depressed people need to be treated.

Sadness is the easier condition to understand; we've all "been there." There is no stigma associated with being sad. Sadness is seen, heard and discussed everywhere. We can talk about it over dinner, at a sporting event, even at work with our colleagues. It is found in novels and on the silver screen, and television actors suffer through it on our favorite situation comedy. Because its reach is short, sadness always remains above the surface, never penetrating through to the depths of the human psyche.

In addition to the dimensions of sadness, we know its origins. It started with a bungled interview, a perceived humiliation, some added stress at work or a disappointing blind date. We mull over the source, and shortly the unhappiness goes away. We reveal our discomfort to an intimate, and we rebound. We are like emotional clones of Charlie Chaplin: we trip and fall, then dust ourselves off and start all over again.

Even when we are sad, we can continue to parent our children, function at work and still enjoy our hobbies. We may not be moving at the same pace, but we arrive at our destination just the same.

In some instances, sadness can even be a positive or motivating force. It can nudge us to reevaluate our circumstances and empower us to view ourselves differently. Sadness can prompt us to challenge our reactions to life's events and trigger a new perspective.

Depression is a different entity altogether. It is a serious mental health problem, and fortunately not as commonplace as sadness. Depression, sometimes called melancholia, is referred to in lay terms as a "nervous breakdown." Depressed people are not actually broken, but they are bending downward. And if sadness is like walking through a muddy swamp, depression is like flailing helplessly in quicksand. When it overtakes us, we feel powerless, lost, with no options.

Roots of Depression

Depression is a biospsychosocial disorder that can be caused by diverse psychological and physiological mechanisms. Environmental factors may include a deteriorating marriage, a threatening or abusive relationship, or the loss of a close friend or family member. Depression can also be triggered by the chronic abuse of alcohol or sedatives, or by the use of certain prescription medications. In addition, a medical condition such as thyroid disease, stroke or hormonal imbalance can directly lead to depression. A physical condition such as arthritis, cardiac impairment or cancer can also indirectly cause depression due to impaired functioning. There are instances in which a brain neurotransmitter deficiency is the culprit-a "chemical imbalance." Moreover, a combination of those or other factors may contribute to a depressed condition.

Regardless of the cause, depression is always recognizable in its appearance and presentation. Depressed people are typically lethargic, tearful, reclusive and less inclined to interact socially. They may have difficulty with memory and concentration. Their sleeping patterns and eating habits change, and they may feel helplessly defeated-useless to others and themselves. This mental disorder is agonizing and painful, and may lead to thoughts of self-harm.

Many people unwittingly deny or fail to distinguish depression from common sadness. While sad people do not experience shame or embarrassment about their condition, depressed people often view themselves as weak or deficient, and thus force themselves to look away from their own anguish. Some depressed people assume the role of the happy entertainer and feel too awkward to disclose any genuine discomfort. Others are caretakers who subjugate their own health needs, feeling obligated to manage the emotional affairs of others. Some just don't have the time for depression; they are too busy or important-as if depression can be brushed aside, willed away or easily lifted. Still others may be too fearful of channeling their anger at the appropriate target and instead unconsciously redirect their guilt-ridden rage inward.

This mental condition is not only denied by the sufferer but often minimized by others. Some of society still perceives depression as a problem afflicting the feeble, the unambitious and the dim-witted, though in reality no such linkages exist. Well-meaning parents sometimes vehemently challenge the diagnosis of depression in their children.

Witnessing depression in others can incite strong and unpleasant reactions in us. We may feel powerless and impotent over not being able to effect change in a loved one. Because of the isolating effect of depression, we may also feel alienated, unwanted and betrayed. And finally, we may experience anger if unfinished tasks and increased responsibilities are foisted on us as a result of the depression of a loved one. But denying the reality of depression does not erase it.

Many people adopt the attitude of "Pay no attention, and maybe it will go away." Few talk openly about the qualities of depression; they are whispered about with a hand cupped beside the mouth.

Depression unconfronted, however, will not go away. Fortunately, with proper treatment it can be overcome. For this to occur, the disorder must be addressed professionally through psychotherapy and medication. Without these interventions, depressed people can be robbed of their ambitions and consigned to an aimless, dreamless state.

To those who suffer from depression, therefore, we should extend ourselves and listen carefully.

Dr. Magill is a graduate of Thomas Jefferson Medical College in Philadelphia. He is in private practice in Jenkintown, Penn., specializing in the treatment of outpatients suffering from mood disorders, work-related psychological injuries and posttraumatic stress disorders.