If you’re like most people, when you think of the word “depression,” your thinking is clouded by a lot of misconceptions, such as, “If I’m unhappy I’m depressed.” Depression is not the same as unhappiness. You have bad days and get down in the dumps. Who doesn’t? Maybe you have lost a loved one, been laid off, experienced a relationship breakup or a divorce. You feel pretty rotten, but in these cases of situational sadness, a change in circumstances or your perception of events can soothe emotional upheavals and lift your spirits. But if you get into a chronic, persistent habit of avoiding troublesome events instead of facing them, then you begin moving from sadness and unhappiness to learned helplessness and depression. Like all coping challenges, the key is the degree to which you get swept up in the avoidance pattern.
Confusing unhappiness with depression is not the only thing that can make evaluating depression difficult. For instance, you might get caught in a chronic pattern of actions that involve disengaging from life. Church and Brooks call this self-defeating pattern subtle suicide in their book of the same title, and they note how the condition can be confused with depression. Subtle suicide, however, is characterized by ambivalence, apathy and a “Who cares?” attitude toward life, and can be distinguished from chronic depressive disorder. Still, many people who show this ambivalence toward life are often misdiagnosed as depressed and prescribed anti-depressant medication, which doesn’t work well with subtle suicide.
Another misconception is believing your primary care physician is best equipped to diagnose and treat depression. Unfortunately, in the medical profession most diagnoses of “depression” are not made on the basis of formal psychological assessment, and informal diagnoses can lead to diagnostic errors and inappropriate treatments. For instance, anxiety, anger, and other emotions brought about by life circumstances can easily be confused with depression. A psychologist can distinguish these conditions from depression with appropriate diagnostic assessment.
The reality of comorbidity in psychological dysfunctions can also present diagnostic problems. Comorbidity means the simultaneous presence of more than one pathology, such as when a client shows depression, but also anxiety attacks and post-traumatic stress disorder. If the diagnosis is depression, the other conditions are overlooked and the use of anti-depressants will likely not work. The client will be frustrated and the practitioner will begin trial-and-error applications of one medication after another.
Misconceptions also occur over the biochemical imbalance issue. Many psychiatrists believe that their client’s problem results from such an imbalance in the brain, and medication can restore balance. Other professionals say this type thinking is like saying a headache results from an aspirin deficit in the brain. Such controversy can be confusing to the client.
One thing we can say is that a lot of research has shown that psychiatric medications are generally no better than a placebo for low and moderate levels of depression, such as Persistent Depressive Disorder (PDD). This finding should not surprise you because there are no medications that will empower you, or that will develop an action plan for you to navigate the challenges of life and develop more satisfying and productive actions. In PDD, such things are crucially involved in dealing with the disorder. More severe conditions, however, like Major Depression and Bipolar Disorder do respond positively to medications. Once again, the accuracy of diagnosis plays an important role.
The bottom line is, be cautious and seek information from a variety of sources. If you feel you have a persistent, chronic problem with your mood that interrupts your daily activities, you should consult both a psychiatrist and a psychologist. This combination will provide you with a thorough psychological evaluation and diagnosis, decrease the risk of diagnostic errors, and help you work actively as a participant in developing a treatment plan that may include medications.
Psychology and Stress 