Understanding depression

This guide is psychoeducational content. It does not replace a consultation. If you are thinking about dying, if you feel that others would be better off without you, talk about it the same day to your doctor, to someone close to you or to a suicide prevention line; in immediate danger, call the emergency services in your country. Never change a prescribed treatment on your own: any decision to increase, reduce or stop a medicine is taken with the doctor who prescribed it. Allow sixty-five minutes to read.

1. Before you begin

The alarm goes off. You have already been awake since four in the morning, eyes open in the dark, with that thought going round. You get up because you have to. The shower calls for a negotiation. The journey, another one. At the office, you read the same paragraph three times. At midday you are not hungry. In the evening someone suggests going out and you hear your own voice reply that you are tired, when the true answer would be: 'I do not see the point'. And the worst of it is that you cannot even cry.

Perhaps you tell yourself that you lack willpower. That other people have more serious problems. That it will pass.

Three things, straight away.

Depression is not sadness on a larger scale. It is a state that affects energy, sleep, appetite, concentration, the body and thinking all at once. You can be depressed without feeling sad, and feel mainly empty, irritable or anaesthetised.

It is not a failure of will. Asking someone to pull themselves together amounts to asking a person with a cold to stop coughing. Will is precisely one of the functions that depression affects, and that is why the method consists of acting differently, not of wanting harder.

It can be treated, and most often treated well. It is the mental illness for which we have the greatest number of treatments that have proved themselves. The difficulty is not that nothing exists: it is that the illness itself discourages you from going to find them.

Who this guide is for

For you if you are going through a dark patch that has lasted several weeks and you want to understand what is happening to you.

For you if a diagnosis of depression has been made and you want to know what the proposed treatments are worth.

For you if you have come out of an episode and you fear relapse.

For you if you are supporting someone and you want first to understand it from the inside; our programme Helping someone close who is depressed is then the natural continuation of this one.

2. Sadness, low spirits, depression: telling them apart

Sadness is an emotion

It has an object — a loss, a disappointment, bad news — it varies through the day, it gives way in the face of a pleasant surprise, and it eases with time. A sad person remains capable of being distracted, of laughing at something silly, of being hungry. Sadness is useful: it slows you down, it calls for support from others, it gives you time to absorb the blow.

A patch of low spirits is a dip

A few days of low morale after a difficult week, a gloomy Sunday evening, a heavy November: these dips are frequent and they pass by themselves, especially when you carry on living normally. They disorganise neither sleep, nor appetite, nor work.

A depressive episode is something else

What distinguishes it comes down to four elements, and these are what a doctor relies on.

• Duration. The features are present almost every day, for a large part of the day, for at least two weeks — and most often for far longer by the time the person finally seeks help.
• Extent. It is not only mood: sleep, appetite, energy, concentration, memory, libido and the relationship with the body are affected together.
• Loss of desire. The things that used to give pleasure no longer do. This is often the most specific sign, and the most baffling for those around the person.
• Impact. Work, studies, family life and daily self-care all suffer. The person functions below what they know they can do, and knows it.

'But I have reasons to feel bad'

Almost always. A bereavement, a break-up, a redundancy, an illness, exhaustion at work. Having a reason does not rule out depression: it explains how it started, not why it persists. Beyond a certain point, the episode sustains itself, through withdrawal, inactivity, insomnia and rumination, independently of what set it off. That is rather encouraging news: you can act on what is sustaining it even when you can do nothing about what caused it.

Grief is not depression

After a loss, the pain comes and goes in waves, memories can be sweet as much as heartbreaking, and self-esteem remains broadly intact. In depression, mood is permanently flat and the person judges themselves harshly. The two can coexist, and a bereavement can set off a depressive episode: our programme Grief: understanding it, getting through it, and knowing when to ask for help sets out in detail what distinguishes them.

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