Most of us know what depression looks like, but often, it’s used to portray only a sad mood.
“I’m depressed, I had a bad day.”
What really is depression? Well, according to the the DSM-5 (like, THE guidebook for psychology) depression is defined as having at least five of these symptoms:
- Depressed mood
- Diminished interest or loss of pleasure in almost all activities
- Significant weight change or appetite disturbance
- Psychomotor agitation or hinderance
- Fatigue or loss of energy
- Feelings of worthlessness
- Diminished ability to think or concentrate; indecisiveness
- Recurrent thoughts of death, recurrent suicidal ideation
- The symptoms cause significant distress or impairment in social, occupational or other important areas of functioning
These symptoms must have been present during the same two-week period, and at least one of the symptoms must be diminished interest/pleasure or depressed mood.
That sounds pretty intense, doesn’t it? To have five or more of those at one time, it’s got to be pretty debilitating. In fact, according to the National Institute of Health, major depressive disorder (MDD) is the leading cause of disability globally. Millions of people suffer from depression, but we don’t talk about the ones that have to take disability or can’t do basic tasks.
Everyone is different when it comes to depression. For me, symptoms include lack of focus and concentration, fatigue, brain fog, insufficient memory recall, lack of thought processing, oversleeping, lack of motivation, suicidal ideation, and a negative perception of reality. So basically, everything you can imagine that’s associated with depression. While I struggle with multiple symptoms, others may only have two or three.
Reading this, I know what you’re thinking. “I understand the symptoms, and it’s debilitating AF, but what the hell actually IS depression?” Allow me, a totally untrained, nonprofessional in psychology and neuroscience, explain.
Depressed brains basically have less brain activity than a non-depressed brain. What are the parts that are lit up? The hippocampus, in charge of memory, shrinks, impairing — you guessed it — memory recall and comprehension. Not only the hippocampus, but the prefrontal cortex also shrinks, meaning that thought processing is thrown out the window. Just when you thought it was understandable, the amygdala, the emotional part of the brain, is more active. “No duh,” I say, crying uncontrollably into my ice cream. In a depressed brain, it’s also common to see higher cortisol in the brain, which creates higher stress levels.
All of this makes sense, right? No? Okay, moving on.
Let’s look at it on a more molecular level.
We get the parts of the brain that are lighting up. What about the ones that aren’t? More important than levels of specific brain chemicals — nerve cell connections and the functioning of nerve circuits have a major impact on depression.
Neurotransmitters are chemicals that relay messages from neuron to neuron. During a depressive episode, neurons transmit less substance between the synapses. With a chemical imbalance in the synapses, the brain lacks the ability to retrieve memory, learn, sleep, and motivate.
So yes, depression is a real condition inside your brain. It’s not something you make up, and it’s not something that you can snap out of. You can’t just shake your head and pick yourself up by the bootstraps and expect it to go away. Only therapy, medication, and other coping mechanisms can help.
In a work setting, you have certain legal rights. I recently went on short term disability for my depression and learned this first hand. I was really nervous doing so because I didn’t know what that meant for a work context. So I did some googling (and I talked to HR).
It is illegal for an employer to discriminate against you simply because you have a mental health condition. This includes firing you, rejecting you for a job or promotion, or forcing you to take leave.
This was pretty big for me because I’m a pretty motivated person. I have big goals and I usually want to perform and do a good job. When I don’t, it’s depression. It is so relieving to know that as long as I have proof that this is a medical condition and it is documented with HR, I cannot be discriminated against. I can’t get fired, and I can’t get rejected for a promotion because of my mental health. Yes, from time to time, I have a hard time focusing on work, and I have a hard time concentrating in meetings, and the brain fog is so bad I can’t remember most things and I have no energy after noon, but I can’t get fired because this is a legitimate illness. Mind blowing.
If you have a debilitating mental illness, you may also have a legal right to a “reasonable accommodation,” which would help you do your job. A reasonable accommodation is a change in the way things are normally done at work. Things qualified as reasonable accommodation in terms of mental illnesses include altered break and work schedules, time off for treatment/therapy/psychiatry, and working from home.
When it comes to my mental illness, I need more than the basic “hang in there” or “get well soon.” What do I need from you?
Understanding: I can’t stay out of work or cancel every plan every time I have a depressive episode. I need understanding and cooperation when I am suffering through a flare up.
Communication: I need to feel that I can communicate when I have flare ups and having open conversations about my disability.
Reorganizing priorities and goals: My goals may not be the same that they once were. I’ll need to work them out with my boss and set new, obtainable, goals.
Work from home: Commuting is hard. It can be draining for someone suffering with a mental illness. Working from home let’s me put more energy into work before I’m too exhausted.
You can help people working with a mental illness. Try to understand what they are going through. Communicate with them through open conversations about mental health. If they’re okay with it, ask them questions. While some people aren’t comfortable talking about it, many, like me, are trying to break the stigma behind mental health. We don’t have to pretend it’s a scary thing we don’t talk about. Most importantly, trust the person. People with a mental illness are still goal-oriented. They still have a need to succeed. Trust that they are motivated, and if they aren’t, they are struggling. Trust that they are doing their best.
Breaking the stigma starts with those struggling with mental illnesses, but it is carried on through our allies willing to stand hand in hand with us as we spread our voices.