Mental Health 101: Clinical Depression

November 8, 2016

We all get down now and then. Downturns in mood are a part of life. But what happens when you can’t necessarily shake it off, when the things you once enjoyed no longer bring you joy and it seems the mental fog of unhappiness just won’t lift? What happens when that happens more and more frequently? Then it’s time to realize that you might have a brain concern that requires a little help. It’s called Clinical Depression, and it’s far more common than you think: The World Health Organization (WHO) estimates that 350 million people have depression. It’s a sign that you are not alone, nor do you have to suffer in solitude and silence.

We asked our friend, Dr. Elizabeth Fitelson, Assistant Professor of Psychiatry at Columbia University and director of their Women’s Mental Health Program, to help shed some light on this common mental health concern, and what can be done to help:


 What is Clinical Depression?

“We in the psychiatric community call it Major Depression or Major Depressive Disorder, and it’s characterized by people having one or more major depressive episodes. A depressive episode as we define it goes beyond getting sad because you got fired or your friend goes away and you’re bummed out for a little while; it’s depression beyond what we consider both the normal range and duration of how people react to sad events in the normal course of life. It’s longer and tougher; people with major depression get stuck in a sad or numb mode and can’t get out of it.

In order to be defined as a depressive episode, the period of sadness or numbness has to last for two weeks or more and cause significant problems in functioning. There are nine cardinal symptoms of major depression, and the first two are the most prevalent and descriptive of the condition:

  • A low mode or sad mood or tearfulness for most of the day more days than not; not just feeling sad for a while, but feeling sad most of the time with few exceptions;
  • A loss of interest or pleasure in the activities of daily living, no motivation to get up and out and loss of pleasure in things that usually give them pleasure like meeting with friends and going shopping or watching a football game. People describe feeling like they’re just wading through Jell-O, nothing sparks their interest.

The other cardinal symptoms are the more somatic or supporting symptoms, which include:

  • Changes in appetite that either lead to a loss of weight due to lack of interest in eating or weight gain due to increased appetite or binge eating
  • Deregulated, inconsistent sleep patterns marked by either terrible insomnia, trouble falling asleep where they’re exhausted since they can’t shut down their brain enough to fall asleep, waking up in the middle of the night and unable to get back to sleep back to sleep, or sleeping for 10 to 12 hours or more a day and really having a hard time being awake or functioning.
  • Psychomotor agitation or retardation, which is the physical manifestation of the disorder: inability to sit still, skin crawling, the feeling of being weighed down physically
  • Physical aches and pains that make it hard to move. Even people who feel agitated feel exhausted, like they just can’t get their bodies to relax.
  • Feelings of worthlessness or inappropriate guilt; people describing themselves as a piece of excrement or having feelings of guilt and really ruminating on negative experiences as a mark of their self-worth.
  • Profound loss of concentration. People describe times where they’re unable to read a page or even a magazine or to concentrate on a television program enough to follow the plot, which makes it hard to work, function and interact with(in) the world. It can also manifest as extraordinary indecisiveness, like going to the supermarket and being completely overwhelmed by what to buy and so paralyzed that you actually have to leave
  • Suicidal ideation and recurrent thoughts about death – wanting to be dead or hurt themselves, which can culminate in planning a suicide attempt.

These the nine cardinals of depression we look for to figure out whether they’re depressed or not.”


How do you treat it?
“There are many different ways to get through depression. Depending on the severity, psychotherapy and a few other evidence-based treatments be helpful, such as Interpersonal Psychotherapy, Cognitive Behavioral Therapy, and Behavioral Activation. But there are a lot of different, effective treatments.

Those with mild-to-moderate symptoms might experience improvement from recognizing and changing behaviour, like joining a support group, changing their diet to eat healthier, practicing yoga or adding an exercise program.  Studies have shown that exercise is very helpful for depression, but the condition really hurts your ability to get up and do things like that, so I want to be careful not to communicate a message that if you’re depressed and you’re not exercising that you’re making yourself worse. Depression is an illness, so acknowledge that fact and have no shame or hesitation when it comes to seeking help.

For those with moderate-to-severe depression, medications can be very effective. The most common ones now are specific serotonin reuptake inhibitors (SSRIs), medications like Prozac, or fluoxetine, or sertraline, or citalopram. They’re very common now, and can be quite helpful.


How do you help someone who has clinical depression?
“I think it about validating the gravity of what they’re going through. Be empathic. Pay attention to what’s going on with them, and help them deal with the isolation. Major depression is incredibly isolating, so just being respectful, willing to listen, and helping individuals connect with the help they need to get better, whether that be a psychiatrist, psychologist, a mental health clinic, or even a support group, can make all the difference to someone who is suffering from major depression. Reaching out is tough when you have depression; you have no feeling of motivation and the condition is truly cloaked in shame. Be an advocate for individuals who suffer from this illness. Be understanding that someone who’s depressed might not return your phone calls. Keep reaching out, and don’t take it personally when someone who’s depressed is acting in ways they might not otherwise.