Do people with depression always feel sad?

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Does depression always make people sad?

by Cassie White It's often assumed that depression and sadness go hand in hand. But could someone be struggling with depression and not appear to be sad?

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We all feel sad at times. Whether we've experienced a traumatic event, are having trouble with our relationship or just had a bad day at work, sadness is a normal human emotion.

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Graetz, general manager of Research and Child, Youth and Families at beyondblue, says while sadness is a key factor in diagnosing depression, and clinically depressed people are more likely to feel sad, it's just one symptom people need to have.

But what if these feelings of sadness don't pass? Does that mean you are depressed? Conversely, if you're depressed are you going to exist in a permanent state of sadness?

"Sadness alone isn't depression and there's more to depression than just feeling sad," says Dr Brian Graetz.

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For someone to be diagnosed with depression they must show five or more of the following symptoms, including at least one of the first two, for at least two weeks *:

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an unusually sad or irritable mood that Emergency on 000 (or 112 from a mobile does not go away; phone) loss of enjoyment and interest in Lifeline on 13 11 14 activities that used to be enjoyable; Kids Helpline on 1800 551 800 lack of energy and tiredness; MensLine Australia on 1300 789 978 feeling worthless or feeling guilty when they are not really at fault; Suicide Call Back Service on 1300 659 467 thinking about death a lot or wishing they were dead; difficulty concentrating or making decisions; moving more slowly or, sometimes, becoming agitated and unable to settle; having sleeping difficulties or, sometimes, sleeping too much; loss of interest in food or, sometimes, eating too much. Changes in eating habits may lead to either loss of weight or putting on weight. (* From Mental Health First Aid – Depression First Aid Guidelines)

What does depression feel like?

Often those diagnosed with clinical depression don't even report sadness as their dominant emotion, explains Associate Professor Josephine Anderson, consultant psychiatrist and director of the Black Dog Institute Clinics.

24-Hour Telephone Counselling If you or someone you know needs help, call: Emergency on 000 (or 112 from a mobile phone) Lifeline on 13 11 14 Kids Helpline on 1800 551 800 MensLine Australia on 1300 789 978 Suicide Call Back Service on 1300 659 467

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"People do describe feeling sad when they're depressed, but, particularly in severe depression, they can also feel numb and cut off from their feelings," she says.

"I've had patients say it'd be nice to feel sadness or rage, but a feeling of emotional flatness is actually something that's more commonly described.

"They can often use more concrete terms to explain it, too: it feels like there's a weight on them, or there's a black cloud. They can't enjoy the things they usually do – everything's coloured by that feeling of blackness."

Graetz says for many people with depression it feels like an overwhelming sense of despair and hopelessness.

"There's no energy, no spark – life is incredibly bleak. For people who are clinically depressed, that's pretty much what it can look like," he says.

It's common for people to also feel very slowed down physically and it takes a lot of effort to move. They liken it to wading through wet sand or treacle, Anderson explains.

"On top of that, people say their thinking has really slowed down or they have cotton wool in their brain, or it's really cloudy," she says. converted by W eb2PDFConvert.com

"They can't think clearly and it takes a lot of effort to make conversation because it's hard to get thoughts out."

Less obvious signs The problem is that depression can present itself in many ways – some less obvious than others.

While we expect depressed people to look miserable, sad, lose their appetite and become socially withdrawn, there are other signs that often go unnoticed.

"There might well be other symptoms that are much more obvious than sadness, such as irritability and grumpiness, which we tend to see often in men," Graetz says.

"They are angry and fly off the handle easily, and that's often a manifestation of being sad.

"Historically, men have been more externalisers – they act out. Women are more withdrawn and quite often show over-controlled behaviour; they don't lash out and are careful to manage their feelings in front of others.

"They also tend to ruminate – although all these things can happen to both men and women."

Complicating it even further is that depressed people might not even recognise the signs because they believe that what they're feeling is normal.

Quite often clinically depressed people can't verbalise what it is they're actually feeling, Graetz says. In fact, a study by the University of Michigan found that they find it difficult to distinguish the difference between negative emotions.

They know something is wrong, they just can't articulate what it is.

Depressed people may not show much facial activity either, Anderson explains.

"Instead of looking obviously sad, they might just look very blank and not smile in the natural, easy way we usually do in conversation," she says. "They might not even have much reactivity in the way they look – it's a really flat expression."

So can people who have severe depression ever feel happy?

Not usually. They might experience slight shifts from the numbness or periods of feeling better, although this is generally temporary.

"Part of the treatment is to get people to see that there are actually shifts in their mood and it has lifted, because it just doesn't register with them," Graetz says.

Dr Brian Graetz is general manager of Research and Child, Youth and Families at Beyond Blue.

Associate Professor Josephine Anderson is a consultant psychiatrist and director of the Black Dog Institute Clinics. They spoke to Cassie White.

If you, or someone you know, needs help, you can call Lifeline 13 11 14, Suicide Callback Service on 1300 659 467, Kids Helpline on 1800 551 800, or MensLine Australia on 1300 789 978. For an extensive list of national and state-based counselling contacts go to our Emergency Contacts page.

Published 10/10/2014

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Michael :

10 Oct 2014 6:45:45pm

I have depression, a couple of periods of melancholia now. I now know when things are starting to improve - I feel sad. Just feeling anything is better than the emptiness that engulfed me, first for six months and then on a relapse for three. I couldn't write, thinking was almost painful, and the things that would once make me happy, being with my sons or, while still married, my wife, were bland. The recovery stage is dangerous for me - it is when you can start doing things, and the thing I most wanted to do was to stop the growing pain. But it passed - I've learnt that it always passes. So sadness is not that bad - it is an emotion which is almost welcomed. And then I get the not so infrequent bouts of deep sadness - I don't mind them as they are better than the alternative.

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mehbah :

10 Oct 2014 9:02:45pm

It's nice to see mention of agitation/irritability/anger as ways depression can manifest, as a woman with many anxiety disorders and clinically diagnosed depression (have had to deal with them since age 8 on-wards, diagnosed age 12 now aged 31) I have had more agitation and (sometimes extreme) anger more then tears etc.But being a woman this was for some reason overlooked with my new psychiatrist who decide I have BPD, I certainly do NOT fit even 2 criteria for this personality disorder.

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Pamela Murray :

10 Oct 2014 9:50:37pm

Thank you for an excellent week of TV. Informative and well produced. Mental illness has not effected our family so for, but your focus on this subject has been an eye opener to the issue. Tonight's program excellent. So many talented Australians putting their time to a worthy cause. Have donated what I can to add to total effort.

Thank you.

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