Are you depressed or just sad?

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0:42Kimberley Wilson:Hello and welcome. I'm Kimberley Wilson, I'm a psychologist, and this is Complex. I want Complex to help you navigate the multitude of content and oh my goodness, there is so much of it that's out there about psychology and mental health, so that hopefully you can feel calmer and more reassured. In this episode, I'm exploring depression. Like a lot of mental health terms, depression is used and misused quite a lot. So today I want to get to grips with what it really means. What's the difference, for example, between feeling low and being clinically depressed?

1:32Kimberley Wilson:It's an important distinction for two reasons. Number one, because it's easy to miss depression and just think that you're feeling a bit sad. And vice versa, because it's often the case that depression is not taken seriously enough early enough and people think that they should just push through it alone. And on that note there's one more thing that I'd like to add and it's that there's a common misconception that depression can be a life sentence but please hear me when I say that that is far from the truth. In this episode you're going to hear some helpful advice for the things you can do if you think you are or someone close to you is suffering from depression.

2:13We'll

2:13Kimberley Wilson:be hearing a story that's come to us from a listener and I'll be inviting an expert guest to join me. So let me be your guide from the closed window of misinformation to the open door of understanding.

2:30Kimberley Wilson:Okay, so let's get going. My guest today is consultant psychologist, Dr. Kevin Vento. He's a clinical psychologist with a lot of expert experience of depression. So hello and welcome to you, Kevin.

2:44Dr Kevin Vento:Hi, Kimberly.

2:45Kimberley Wilson:Thank you so much for joining me today. Can you tell me a little bit about yourself and about your work?

2:51Dr Kevin Vento:I'm a consultant clinical psychologist and I work in a clinic that's located in a shopping centre. Fantastic. And the real beauty of this service is that anyone who lives in the area, who has a GP in the area, is able to just pop in and ask for support. And it's quite interesting because I feel like there's actually been an increase in the number of people presenting with depression.

3:19Kimberley Wilson:I think that's really important because you're really on the ground in a very real way in a topic that is so, so familiar and common to psychologists. And so I think this is going to be a really important episode for our listeners.

3:35Kimberley Wilson:Depression is a term that we hear a lot. There's a lot of talk about it on social media. You might have found yourself recently saying something like, you know, I'm feeling a bit depressed or turning to a friend or family member and saying you're feeling a bit down. So the question is, when is low mood indicative of a healthy, appropriate human emotion like sadness or grief? And when is it something that needs to be taken more seriously in a psychological sense? And I say that because I don't think it's an easy distinction to pin down. so in this episode we're going to work out where that line is we're going to look at how to tackle it because the good news is that depression while it is challenging and can be very difficult is highly treatable yeah and i do want to clarify here that depression in the clinical sense is a very broad and very complicated condition it has a wide range of symptoms and different drivers But what I want to focus on today is how we distinguish it from other mood states.

4:38Kimberley Wilson:And to help me do that, I have a story that's been passed on to us, which I think sums up this confusion actually very clearly, quite beautifully. So Kevin, I'm going to read it out and let me know what you think. It's an anonymous story, but we're going to call this person Jamie. Jamie says, I'm normally really sociable, but I find myself wanting to be alone a lot and skipping lectures. I can't be bothered and I feel lazy. But I've been wondering if I'm actually depressed. I don't feel sad, but I also never feel happy like I used to. I just feel sort of numb and detached. Can you be depressed without feeling sad?

5:20Dr Kevin Vento:I think it's a really interesting question and I'm sure that Jamie's not the only one who's had that experience. And I suppose the things that I would pick up on as a psychologist is that loss of enjoyment in everyday activities. so if there are things that Jamie used to do that he would normally find enjoyable and rewarding and he's not finding that anymore then that's maybe an indication that he is moving into more of a depression often I'd look at the duration as well so if someone has been struggling for more than two weeks with a loss of enjoyment in their everyday activities and that's another factor.

6:06Dr Kevin Vento:Often combined with that, there might be problems with sleep. So I'm not sure if Jamie's struggling with his sleep. And then there's also that kind of desire to disconnect from others. He talked about feeling detached and numb. And these are sometimes not obvious symptoms of depression.

6:25Kimberley Wilson:Yeah. And I think it really makes the point, all of those little specific details and the nuances that you've described there, you absolutely can be depressed without feeling that sadness. So really important for people to hear that. And you mentioned earlier on, seeing in your service that there seemed to be a rise. And certainly the research seems to show that as well, that there seems to be this increase, particularly in younger people. And I think maybe we'll get into what might be causing that later on in the episode. But let's see if we can help Jamie to navigate his experience and get into the complexity.

7:06Kimberley Wilson:Okay, so Kevin, you've given us this sense of what depression looks like. And what I like to do on Complex is also to explore some of the origins of the condition. And we know that's not an easy thing to do with depression because it has its roots in many different things. and that's why it can be so hard to pin down and it's why we use the biopsychosocial model. And for the benefit of the listeners what we mean by that is we think about the biological factors so things like genetics and family history, the psychological factors so there might be things like your tendency to focus on the negative, your tendency to rumination and also on social factors So we know that things like adverse childhood events, poverty, other forms of deprivation, racism, prejudice, all of these factors play in to someone's risk of experiencing depression.

8:00Kimberley Wilson:And so when I'm sitting with someone, these are the things that I'm looking for and assessing for. What about you, Kevin? How do you think about it when you're meeting with somebody?

8:10Dr Kevin Vento:I do think of it from as many different perspectives as possible. so where I'm based in the clinic we have a lot of people maybe who are struggling financially and that might be one of the reasons why they are presenting maybe with depression I think Covid had an enormous impact on people lots of people had losses not only in terms of loved ones but also in terms of jobs and security and etc but also just of a sense of

8:43Kimberley Wilson:safety and predictability because that was one of the things I saw in clients and also people on social media around COVID was this sea change in anxiety and I don't know what's coming and I can't be sure and everything feels so much more unpredictable and overwhelming.

9:01Dr Kevin Vento:Yeah and we are seeing more younger people coming in and I do think one of the things that often isn't talked about is the lack of job opportunities, the struggles in terms of whether people should study further, go to uni or whether they should try and get into employment as quickly as possible. I think that's so important because it's sometimes difficult for people to hold in mind that your

9:24Kimberley Wilson:mental health isn't simply what's happening in your head. It's this interaction between you and the environment and the rest of the world. And if you're a young person and you can't find a secure job and you can't find secure housing you can't make any plans for your life and if you can't make any plans for your life then you feel hopeless I think you're right in terms of that

9:45Dr Kevin Vento:feeling of hopelessness there's also a feeling of helplessness as in I think the communities and families struggle to work out how to help their young people to get through that depression

9:58Kimberley Wilson:okay thank you Kevin I think that's really helpful and you spoke earlier and you gave a really lovely description of some of the features that we think about when we're thinking about depression. And we know from the DSM, which is the Diagnostic and Statistical Manual of Mental Disorders, which for the listeners is a kind of practitioner's Bible that we use to classify and diagnose mental health conditions. So we know that there are nine key diagnostic criteria, but what would you think, if we're going to distill it down into maybe three or four absolutely essential or really common ones, what would you say they are?

10:33Dr Kevin Vento:I think sleep disturbance is one that is universal with depression. When people are maybe ruminating or feeling quite low in mood and struggling, then that impacts on their sleep. And when we don't sleep, that's when the symptoms of depression get worse. And as I said before, that loss of pleasure in doing things, we sometimes use this technical term called anhedonia to describe that. And then also there's that kind of feeling that you're a failure, that everything you do isn't worthwhile, isn't effective, isn't meaningful.

11:15Kimberley Wilson:That harsh inner voice makes an appearance. So we have sleep disturbance. We have this loss of pleasure in things that you used to find interesting. And then the hopelessness and the inner criticism.

11:28Dr Kevin Vento:I mean, there are some other bits as well, like loss of appetite, which is either people just lose the desire to eat and to look after themselves in that way or they might overeat and then there's also the loss of energy as well possibly if you're not eating so much then you have a general sort of you've got less energy less food to burn off to be energized and that might actually mean that they achieve less throughout the day and then that reinforces It's that feeling of depression. Yeah.

12:02Kimberley Wilson:And as you talk, I'm reminded also we need to include the physical symptoms, whether that's constipation or gut issues of other kinds, physical pain. So neck pain, headaches, lower back pain is often a physical symptom of your depression. And I think that's really important because, again, we so often think about all mental health conditions, but certainly depression is just neck up and we ignore the rest of the body. Yeah. So for people to really look at themselves holistically.

12:30Dr Kevin Vento:Yes.

12:30Kimberley Wilson:And though it's been with us for thousands of years, and though we're seeing a rise in younger people, there is still a stigma attached to depression.

12:40Dr Kevin Vento:Yeah, I think that stigma sometimes gets in the way of being able to ask for help. And actually, I think although there's a lot more information out there now about depression, my experience is that people still struggle to open up.

12:58Kimberley Wilson:What are people saying instead of saying they're depressed or what is stopping them from saying, hi, I'm really struggling with my mood?

13:05Dr Kevin Vento:so sometimes people maybe describe it more as a worry as opposed to it being about their mood sometimes people externalize it and they become angry with the system it could also come across as a very low self-esteem everything i do doesn't work i'm not good enough etc so there are lots of

13:27Kimberley Wilson:ways in which it comes across and sometimes you have to see it in the ways people have tried to help themselves. I'm thinking about alcohol and substance use, which can be an indicator that someone's already struggling with their mood or how they feel. And they've found these other ways to kind of self-medicate, to feel better or to feel nothing. Yeah, yeah.

13:47Dr Kevin Vento:That is one of the challenges, I think, with the way in which people try and manage their depression. And from the medical perspective, alcohol is actually a depressant. And it also impacts on people's sleep etc so it often makes it a lot harder for people to overcome and recover from depression if they are using say alcohol or other substances to manage and then obviously the substance misuse then impacts on relationships in the family or with the people around them and now those

14:20Kimberley Wilson:supportive relationships are fractured and more difficult and culture whether it's the culture of your family whether it's your kind of ethnic culture can be a real barrier yeah and i think

14:32Dr Kevin Vento:one of the really nice things about having a clinic in a shopping center is that the feedback we've got from some of our patients is that they've been able to say they're just popping to the shops and then come in and come and meet me have conversations and make some steps towards improving their life.

14:58Kimberley Wilson:Let's just think back to Jamie at this point and that question of what are my feelings meaning? Am I depressed? Am I not? And really when do our normative behaviors, our sadness, our blues, our grief tip over into what we would consider to be a clinical diagnosis? So perhaps the easiest thing for the listener is if we try to put depression on a scale. So from mild to more severe at one end. And the reason I think this is really important is because early intervention is so important. The earlier that we can intervene with a psychological condition, the more effective the treatments, the less severe the experience, the less chance of relapse later on.

15:41Yeah.

15:43Dr Kevin Vento:So the mild symptoms might be noticing problems with sleep, loss of appetite. Sometimes there's a restlessness or an agitation. They can't feel settled. They feel like they should be doing something or whatever they're doing isn't quite working. I remember someone describing it that it wasn't just that they felt sad it's just that they felt