Therapy Note: Depression

Too often, myths and misconceptions about mental health services prevent people from seeking support.  My goal is to provide a space where these myths and misconceptions may be examined.  The blogs titled “Therapy Note” dispel or provide clarification to some of the more common myths for the population/topic listed in the title of the note. 

Depression is common and not just a “first world problem.”  World-wide the incidence of depression is more than 300 million.[1]  In 2016, within the U.S., 16.2 million adults had at least one major depressive episode.  Of those, 37% received treatment. [2]

Myth 1:  Depression is just a person “being sad.”
Reality:  Although a person may experience sadness as part of depression, depression is a clinical diagnosis with a set criteria of symptoms. 

According to the Diagnostic and Statistical Manual for Mental Disorders V (DSMV), five (or more) of the symptoms must have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.[3] In addition, the symptoms must also cause distress and impairment in functioning. Here is a partial list of symptoms:  

1.     Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). 

2.    Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation.) 

3.    Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.) 

4.    Insomnia or hypersomnia nearly every day. 

5.    Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down). 

6.    Fatigue or loss of energy nearly every day. 

7.    Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). 

8.    Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others). 

9.    Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. [4]

Myth 2:  If a person is depressed, they can’t function. 
Reality: People do not always meet the “typical” presentation (ie someone in a robe in a dark room unable to get out of bed.) Although, this is one presentation it is not the only one.  Many people go to work and are quite busy.  However, they may withdraw from friends and family and not find pleasure in activities that were once enjoyed 

Myth 3:  You can “shake off” depression.
Reality:  Clients have described depression as a shadow, sinking in quicksand, drowning, being trapped in their own body etc.  During a depressive episode, the feeling of “heaviness” and the inability to process emotions in a way to feel “better” may also be present.  Imagine if your inner critic was on auto replay saying negative things and you were unable to do anything to shut this negative self-talk off.  

Myth 4: Taking medication for depression means you are weak.
Reality: There are no “weak” ways of addressing depression.  The physical component of depression is something that cannot be reached through talk therapy alone.  Medications are designed to intervene on the physical level.  If medication is necessary, taking medication means that the person is addressing the physical aspect of depression.  





[3]Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

[4]Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.