Am I Depressed or Sad?

Mental health struggles are common for so many people living in the United States, and yet they can be very alienating. What depression might look and feel like in one person may not be the same in another person.

For some, intense feelings of sadness can be most evident, whereas others may notice more feelings of anger or irritability more often. Some of the signs can be even more subtle, such as a reduction in willingness or drive to spend time with others or having little interest hobbies or activities they previously enjoyed.

Recognizing the signs of depression

Professionals and patients will agree that mental health is just as important as physical health. Defining what a person is experiencing mentally can be the first step toward making progress toward healing.

Depression is a serious mood disorder that affects how a person thinks, feels, and experiences themselves, others, and the world around them. Depression may impact how someone functions socially, occupationally, and during daily tasks such as eating and sleeping.

Some symptoms include:

• Feelings of sadness
• Not engaging in activities you usually enjoy
• Increased or decreased eating and/or sleeping patterns
• Fatigue
• Feelings of worthlessness or hopelessness
• Difficulty concentrating
• Restlessness or moving more slowly
• Thoughts of suicide

To be considered clinical depression, the symptoms experienced must last at least two weeks and have impact on various areas of function. It is natural to experience depressive feelings based on life circumstance, but clinical depression should not be ignored.

Who usually knows first: others or myself?

Just as depression does not look the same for everyone, it is not always recognized in the same way for everyone.

Some people may notice changes in themselves and wonder if they are depressed. Others may have a close friend or relative come to them and suggest recent changes may be related to their mental health.

A person may know what their baseline is for their emotional and mental state and recognize some changes such as consistently isolating themselves or not reaching out to others.

These can go both ways; there is no “right” way to recognize potential signs of depression. It is also not a wrong or bad thing if a close friend or relative is the first to call out the signs. The simple recognition of symptoms can be the first helpful indicator to seek professional support.

Pre-screening process for depression

Once a person decides to see someone about their depression, they will usually sit down with a mental health professional and go through a pre-screening evaluation.

The evaluation or clinical interviewing process can take up to 3 sessions and focuses on gathering information about demographics, symptom onset and duration, mental health history, and other behavioral health data. This helps the provider provide the patient with the most individualized care and treatment needed. Cultural differences – such as social norms, environmental, and genetic predispositions – are very important to consider during this evaluation process.

“Every individual comes from a different walk of life,” said Jason Schlatter, MS, MA, LMHC, a pre-doctoral intern with Rochester Regional Health’s Riedman Health Center in Irondequoit. “We want to understand the whole person and not simply try to treat the symptoms. To do this, we take time in the initial interview portions to ask more about personal background while also providing assessment screeners.”

An assessment or screener allows a provider to numerically identify symptoms on a spectrum of mild to severe. For depression, some of these might include a Patient Health Questionnaire (PHQ-9), Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAM-D), or other assessments.

Following this process, a mental health professional and the patient will work together to:

• identify personal goals for treatment
• map out a potential treatment plan
• submit referrals to community-based resources
• potentially meet with a psychiatrist for medication management

Possible treatments for depression

There is a wide range of treatments for depression. These depend on the severity of symptoms and what the patient is comfortable with pursuing.

Talk therapy is one method that focuses on helping a person to identify possible negative feelings, thoughts and behaviors they may find troubling and work on changing them. Evidence-based therapeutic techniques, such as Cognitive Behavioral Therapy (CBT), help to address and shift these negative cognitions, emotions, and behaviors. This is often done between a mental health professional and a patient, although some providers may opt to collaborate with other professionals - such as a primary care provider or even a religious leader - in order to make treatment more culturally inclusive.

Medication management is another approach to treatment involving a patient collaborating with a physician for prescribed psychotropic medications. If a patient feels as though medications are beneficial towards improving their mood and overall well-being, this is a suitable option. However, it is recommended to participate in both talk therapy and medication management as it produces better improved and longstanding outcomes.

“Good and effective therapy is a collaboration between the patient and the provider,” Schlatter said. “The provider cannot simply prescribe treatment but must rely on the input and feedback from the patient to know what modes and techniques are supportive or helping bring about positive results. Because of this need for collaboration, treatment results also take time.”

Finding help for depression and sad feelings

It is important to remember that millions of people experience depression through different points in their lives. This experience is very common and normal.

If you are experiencing depression, you are not alone in this process.

“As isolating as depressive moods can be, finding a mental health provider is a great way to enter a therapeutic space that can provide a safe and private way to explore challenges without fear of judgement or strain on personal relationships,” Schlatter said.

Find someone who will work with evidence-based practices and help you to develop coping mechanisms that are specifically beneficial for you.

In conjunction, a patient may also be referred to community-based resources that may provide a more well-rounded approach to care.