The Difference Between Just Feeling Down and Depression
Hello!
We are halfway through Golden Week. Daily life is approaching, isn't it?
It would be best if you could feel like, 'I've rested, so I'll do my best,' but aren't you feeling a bit like you have what's called 'May Blues', where you don't want to go to work or school?
Last time, I also thought about depressive tendencies caused by May Blues based on research papers.
In the medical field, people talk about depression as a matter of course, but a question suddenly occurred to me here.
Everyone feels down sometimes, but what is the difference between that and 'depression'?
It's difficult when you think about it again.
This time, for new medical professionals and beginners standing at the threshold of depression, I will explain the basics of 'Mood Disorders (Depression/Bipolar Disorder)'.
I will deliver textbook knowledge along with the reality of the field recently!
1. The boundary between 'just feeling down' and 'depression'
Anyone will feel down if they make a mistake at work or have a broken heart. That is a natural reaction.
So, what are the differences from depression? In the world of psychology and medicine, we consider whether it is 'depression as an illness' based on the following points.
Duration: Is it not temporary, but continuing almost every day for more than two weeks?
Severity: Is it interfering with daily life (work, eating, bathing, etc.)?
Resilience: Even if you do things you like, does your mood not brighten at all?
In textbooks (such as the DSM-5), when these meet certain criteria, it is diagnosed as a 'depressive disorder'.
2. The big picture of mood disorders: Broadly divided into two!
Mood disorders are states where emotional waves exceed the 'normal range' and you cannot control them yourself.
Broadly speaking, they are divided into these two.
Depressive disorder (so-called depression): A state like being at the bottom of a deep valley all the time. It is also called unipolar depression. It is about 6 to 8 people out of 100. That is quite a lot, isn't it?
Bipolar Disorder (Manic-Depressive Illness): A state characterized by alternating between "depressive" lows and "manic" highs. Since the prevalence is 0.4–0.7%, it affects roughly one in every 100 people.
Incidentally, unipolar mania is said to be extremely rare, so it is excluded here. In the nearly ten years I worked in psychiatry, I never saw a patient with that diagnosis.
The important point here is that "if you only prescribe antidepressants to someone with bipolar disorder, it can have the opposite effect (triggering a manic episode)."
That is why the initial assessment is extremely important (though assessment is the doctor's job).
3. The Reality of [Depression]: What is "Atypical" Depression, which is on the rise?
The textbook image of "depression"
Feeling down all the time.
Losing interest in everything.
Loss of appetite, inability to sleep.
Current Reality: The Increase in Atypical (New-Type) Depression
Recently, a common topic in clinical practice is "atypical depression". Perhaps "new-type depression" is a more familiar term. It is often confused with "May sickness," but it has the following characteristics.
Mood Reactivity: You feel too miserable to move at work, but you perk up when invited by friends or during fun events.
Overeating/Oversleeping: Eating too much or sleeping like a log for over 10 hours.
Leaden Paralysis: Arms and legs feel as heavy as lead, making it impossible to move.
You might wonder, "They seem happy sometimes, so isn't this just laziness?" but this is also a modern form of depression.
It is easily misunderstood by those around them, and the individuals themselves tend to blame themselves.
4. The Reality of [Bipolar Disorder]: In a manic state, "the person doesn't feel troubled"
The difficult part of bipolar disorder is that when in a "manic state," the person feels so great that they do not think they are "ill."
Signs of a manic state: Feeling energetic without sleep, talking incessantly, and going on massive shopping sprees.
In clinical practice, it is common for patients who seek help for depression to have actually experienced a manic state in the past.
The key is to carefully ask if there was a past period where they felt 'too good' and ended up failing.
There are also patients who experience a rapid mood elevation (manic switch) from a depressive state during hospitalization.
Conversations with patients in a manic state are very lively (or appear to be), so they can be a welcome presence for anxious new medical professionals.
However, since this is strictly a symptom, the medical staff must properly set appropriate boundaries.
5. Sleep is the 'Lifeline' of Mental Health
As mentioned in the materials, mood disorders and 'sleep' are closely related.
Initial insomnia (difficulty falling asleep)
Middle insomnia (waking up in the middle of the night)
Terminal insomnia (waking up early in the morning and being overcome with despair)
According to textbooks, the standard approach is to 'first ensure they can sleep well with medication,' but recently, approaches that visualize life rhythms using 'sleep logs' via smartphones and apps are increasing.
Using a smartwatch can be somewhat reassuring because even if you aren't sleeping, you can see that your 'body is resting.'
I have written about this in a previous article, so if you haven't read it, please check it out here.
Cognitive behavioral therapy, which removes the 'fear of not being able to sleep,' is also highly valued in clinical practice.
Summary: Start by Knowing Your 'Current Location'
Textbook knowledge is, of course, important. Just having the knowledge makes mysterious anxiety feel a little lighter.
If you are currently worrying, 'Is this May sickness? Or is it depression?', please start by grasping your current situation.
Has the distress been continuing for more than two weeks?
Are you sleeping soundly at night?
If you feel something is wrong, please consult a professional first. It is difficult to cure mental illness on your own.
New medical professionals, too, while holding onto basic knowledge, if you listen carefully to patients' stories, I am sure you will encounter situations where you think, 'This is different from usual, perhaps it is a symptom.'
It might look cool and be important to handle work quickly like your seniors.
On the other hand, while you are a new staff member with time to spare, if you gain experience in listening to patients slowly and noticing changes, it will become a valuable weapon for you in the future.
Well, this time we covered psychology, or rather, psychiatry. I have compiled psychology-related topics in a free magazine, so please feel free to read those as well if you like.
Let's continue learning together!
See you in another article.
📚 References and Sources
World Health Organization (WHO): "ICF (International Classification of Functioning, Disability and Health) Model" (2001 edition)
American Psychiatric Association (APA): "DSM-5 Diagnostic and Statistical Manual of Mental Disorders" (2013)
Japanese Society of Sleep Research / Ministry of Health, Labour and Welfare: "Sleep Guidelines for Health Promotion" (2014 / 2022 revised edition review materials)
Beck, A. T. et al.: "BDI (Beck Depression Inventory)" (1961, 1996)
Radloff, L. S.: "CES-D (Center for Epidemiologic Studies Depression Scale)" (1977)
Yuriko Doi et al.: Report on "Current Status and Countermeasures for Sleep Disorders" (2012)