Mild Depression

Excerpt from:  WHY YOU DO THAT, by John B. Evans, PhD, LCSW

This description covers multiple levels of depressive patterns of thought, emotion, and behavior. Those with fewer or milder traits as well as those with the symptoms of a serious disorder may readily identify some of their thinking, as well as emotional and behavioral tendencies. A more comprehensive understanding of self usually requires an ongoing self-observation and self-reflection over time. These traits are found in both men and women.

Mild or moderate depression is commonly overlooked as a cause of distress and impairment in the lives of many people. What follows is a general discussion of the milder forms of depression. Mild depression is a very common, and usually temporary, response to difficult life situations, and usually resolves itself within a short period of time. But for some people, mild depression may have been a part of the sufferer’s life for many years—or most of their life. Unfortunately, most people suffering from mild depression are not aware of the problem and therefore do not seek treatment. When someone has suffered mild depression for a long time, the individual is usually accustomed to the depressed feeling, and he believes the way he feels is normal. It may not occur to the chronically depressed individual that other people do not feel the way he does. Although mild depression can make most aspects of life more difficult, mild depression typically does not prevent the sufferer from functioning well enough to get by and appear somewhat normal on a day-to-day basis.

The following is a list of commonly recognized symptoms of mild to moderate depression:

• Feelings of inadequacy
• Worries—brooding
• Sadness—dejected, gloomy, unhappy
• Overly serious
• Loss of interest or pleasure in things generally
• Low self-esteem
• Viewing oneself as not very interesting, or incompetent
• Sensitive to rejection by others
• Social withdrawal
• Feelings of guilt or remorse—brooding about the past
• Irritability / Excessive anger
• Pessimistic
• Low energy or fatigue
• Lower activity level
• Lower effectiveness and productivity
• Poor appetite / weight loss
• Overeating / weight gain
• Alcohol/drug abuse
• Too much sleep / not enough sleep
• Poor concentration / difficulty with decisions
• Feelings of hopelessness, discouragement, despair
• Self-critical / self-blame
• Critical and judgmental of others
• Problems at work / poor relationships with coworkers
• Frequent unemployment

Don’t let the word mild fool you. Mild depression can cause severe problems in the social, family, work, or academic life of the sufferer.

VIGNETTE:  Chronic Sadness

Not much in life was enjoyable for Craig, and he does not remember ever feeling really good. Craig has long known that he tends to be a loner, and he can now see very clearly that a lack of self-confidence has always played a major role in his life. Until recently, Craig never knew that the main culprit in his life was a milder, yet destablizing, depression. Only now, at the age of 38, is Craig learning to understand the effect that his lifelong depression has had on the evolution of his personality. Craig never had many friends during his high school years, and he dropped out in the 10th grade. Craig is still single, rarely dates, and until recently would spend most of his time by himself. Craig does recall being interested in things, such as music and photography, but he never pursued these interests. Craig’s basic outlook on life has always been one of chronic pessimism, which also affects his social life. When Craig would happen to meet someone he was attracted to, he would ignore her with a pessimistic expectation of guaranteed rejection, a common self-fulfilling prophecy. The more Craig worried about failing at something, the less likely he was to pursue the person, object, goal, etc. in the first place. In social situations, Craig would come across as withdrawn, awkward, and stilted because he had never routinely practiced social skills. When new acquaintances would withdraw from his negative view of the world, this would, of course, only confirm his low opinion of himself and reduce his self-confidence even further. Craig would go home more depressed than when he left—over and over again, year after year.

After dropping out of high school, Craig began a series of menial jobs during which he gained considerable weight, and his self-esteem descended to ever-lower depths. Craig never tried to promote himself or work his way up in an organization. He recalls the awful feeling from seeing so many people with good careers and raising families, while his life seemed to drift endlessly without meaning. The only times Craig thought he felt good were when he would sit in a small tavern after work and drink one beer after another until he could hardly feel anything at all. Unknown to Craig was that alcohol had become his antidepressant, and a very ineffective one at that.

Craig did eventually get his GED, and he attended night school for training as a medical technician, even though poor concentration plagued him the whole time. Even with a decent job in the medical field, Craig remained very self-critical and continued to blame himself for everything that did not go right in his life, and he rarely noticed the things that did go right. Craig was not only self-critical, but frequently criticized other people, things, situations, etc. Craig was not aware that his negative, critical side was driven by sadness, so he was unable to overrule his critical nature and consider more logical perspectives as part of a broader effort to combat his depression.

Finally Craig met a coworker who had been seeing a very knowledgeable therapist for his depression, which surprised Craig since the coworker was very outgoing and seemed to have a great social life. Craig went to see the same therapist and finally began his journey toward understanding the underlying causes of the symptoms that had plagued him for so long. With a better understanding of his parents’ critical nature, and recalling stories he had heard about his grandparents, Craig now believes depression has been a part of his family history for generations, and that genetics may have played a role in his long-term depression. Craig now understands that when other people appeared to reject him, it triggered the depression and low self-esteem he had suffered while growing up with critical parents that he now believes also suffered some level of depression.

Since   experiencing   the   relief   offered   by   today’s   antidepressant medications, Craig has become involved in group therapy, developed new social skills, and found the confidence to enroll in a four-year college with plans to work toward a nursing degree. Therapy in conjunction with antidepressant medications have allowed Craig to develop his social side, and he is now able to meet new people, join study groups, etc., and his concentration has improved dramatically. One of Craig’s friends at school told Craig that she initially thought he was a snob because he always seemed to ignore other people. Craig wonders how many people in his past have thought he was stuck-up because they did not recognize his distant personality as a symptom of a depression that undermined and compromised his true self. Recognizing the sadness he has lived with all of his life. Craig is not sure if his shyness, lack of self-confidence, and low self-esteem are symptoms of his depression or vice-versa. Craig also recognizes that his parents probably never knew they suffered some level of depression accompanied by a negative, critical nature.

Not realizing they are suffering a serious problem, mild depressives may wonder why life does not seem to work for them very well. They just cannot seem to get it right in their career, social life, or academic work, and they may be in an endless cycle of descending self-esteem. With little self-confidence, and poor social skills in some cases, depressed individuals may have few social relationships. The relationships depressives do have may be dysfunctional, not only because of their role in the dysfunctional dance, but also because they attract other emotionally unstable people. For example, the depressive may attract a caretaker type of personality who will make it her job to finally bring the depressive out of his misery for all time. Some depressed individuals are overly critical and sabotage their relationships with their negative mindset. Other depressed individuals may fear the pain of rejection so much that they just remain loners who avoid relationships altogether. Another problem for depressives is that other people may misinterpret the depressive’s behavior. Symptoms such as sadness, unassertiveness, irritability, etc. may be considered by others to simply be the depressive’s eccentric nature, or the depressive may be viewed as a snob because she is not sociable and keeps to herself.

The conventional wisdom is that depression may be triggered by stressful events or life situations, including major life transitions, although a genetic connection where depression seems to be in the family history is common. Major events or life transitions that can trigger depression include problems at work or unemployment, having children, poor parenting skills, marital discord, divorce, physical illness, retirement, or the physical and emotional problems related to the decline from aging. Milder mood disorders, including depression, that run in families may go unrecognized for generations, although there may be family stories about the unusual or eccentric behavior of some aunt, uncle, grandparent, etc.

Depression is a serious problem for many children and adolescents, and they are seriously underdiagnosed at all socioeconomic levels, especially among minorities. In the adolescent age group, only traffic accidents cause more deaths than suicide.⁵⁴ Up to 15 percent of children and adolescents may suffer from some level of depression, and 3 to 5 percent are affected by major depression. By age 14, twice as many females as males suffer from depression.⁵¹ Growing up with parents that are impossible to please, or with alcoholic parents, can trigger depression during childhood or adolescence. Children may react differently to depression than adults, and depression in children may be difficult to separate from the usual turmoil and angst that can be a normal part of growing up. Depression in children usually begins quietly, may come and go, and, of course, the child or adolescent does not know depression is the problem.⁵³ Depression in children may go unrecognized because many parents are not even aware that children can suffer from depression. More than 70 percent of children and adolescents with mood disorders, including depression, never receive an adequate diagnosis and treatment.⁵¹ The problem of underdiagnosis and treatment is greatest for children younger than seven years of age.⁵¹ Common symptoms of depression in children include irritability and boredom, but children may also withdraw into a lonely existence with little desire for social involvement with other children, teachers, or even their parents. Schoolwork for these children may become a burden or a complete impossibility.³¹ Children may also put themselves down, such as saying, “I’m just stupid,†or they may complain about headaches, stomachaches, or other physical ailments. Depression during adolescence may show up as irritability, anger, difficulty with concentration and attention, or self-medicating with alcohol or drugs.⁵¹

Mild depression that is long-term—at least two years in duration, or one year for children—is called persistent depressive disorder or dysthymia. Dysthymia is sometimes the beginning stages of a much more serious major depression or bipolar disorder, which is also referred to as “manic depression.†Symptoms of dysthymia appearing prior to the age of 21 are more likely to develop into a major depression, and individuals who suffered dysthymia prior to the onset of major depression are more likely to suffer recurring bouts of major depression. Individuals who suffered from dysthymia before descending into major depression are less likely to have a complete remission of depressive symptoms between bouts of major depression, but will likely return to a state of dysthymia. It is common for depression to be associated with other personality problems, although it may be difficult to diagnose other personality issues since many symptoms, such as problems with relationships or low self-esteem, may be attributed to the depression.

While the big breakthroughs in depression have been the modern antidepressant medications now available, many people find relief from depression without resorting to the use of medication. Especially with milder levels of depression, many people find relief with psychotherapy, couples therapy, or family therapy combined with lifestyle changes. Daily exercise is an excellent antidepressant in its own right and should be embraced if at all possible.

Fortunately for individuals who do not respond to other treatments, antidepressant medications may be the treatment that works. The debate about whether antidepressants are effective for depression seems very strange to those who have found such remarkable relief with the right medication. There are those who view medication as a sign of weakness, and some people believe antidepressant medications are addictive, a false but common assumption. Some depressives may simply apply their usual pessimistic view of the world to the possibility of successful treatment. Others may view our society as overly medicated, but with chronic depression, I have seen modern medications make a profound difference in the lives of many people, especially where depression seems to be a part of the family history.

Mild Depression in Relationships

Since mild depression frequently goes unrecognized for years, or a lifetime in some cases, the continuing impact of depression on a relationship and family life may be severe. Depressions that are more temporary may also damage family relationships unless recognized and treated. Just as an individual suffering mild depression may appear to function somewhat normally from day to day, albeit with greater effort, relationships with a depressive may also seem to get by on a daily basis, but usually with some dysfunction in the relationship and family. Neither partner may understand the underlying dynamics of their problems. The depression may go unrecognized because of its mild nature or because the family became habituated to the depressed environment as the depression emerged gradually over time.

Life with a depressed person may also be depressing for the partner and children. The depressive may have little interest in, or receive little pleasure from, things generally. If the depression goes unrecognized, the depressive will believe that there is simply nothing interesting or fun out there for him and his partner. The depressive may tend to see only the negatives in his partner and children or in their life together. Low self-esteem may have the depressive questioning his own abilities and competence, but he may also discouragingly question the competence of his loved ones without realizing it. The depressive may simply show little interest in his partner and their children, or he may criticize them, their goals and aspirations. Both partners may remain unaware that it is actually his depression that is being projected onto their relationship, their children, and the world. The couple may interpret the depressive’s problem as just being one of anxiety, low energy, or chronic fatigue. If the depressive suffers from insomnia, a common symptom of depression, the insomnia may be blamed for the low energy and activity level, and treated with sleeping aids rather than treating the depression directly. Some depressives sleep too much and, over time, the couple may have to deal with the tendency of the depressive to lose weight or gain weight. The couple may have to deal with chronic financial difficulties, as the depressive’s mood may create problems with coworkers and management. His complaining and critical nature, combined with low energy, fatigue, and low self-esteem, may result in few promotions and frequent periods of unemployment. The partner of a depressive may find herself to be the only driving force in the family, and feel a need to constantly motivate the depressive by pretending to be upbeat—all with the additional responsibility of checking on him to see that things get done. Since opposites can attract,³ the partner may be just the “get things done†kind of person almost designed for this caretaker role. Even with considerable effort, the partner’s attempts to relieve the depressed individual’s worries, and uplift his sad, gloomy, and overly serious nature, may fall flat as the depressive always seems to be able to explain away his discouragement and despair.

Depressives may blame their job, boss, dysfunctional childhood, or their partner for the problems in their life. The partner may remain hopeful that some change will occur or some event will happen that breaks the depressive’s pessimism about the future. With longer-term depressions, the atmosphere created by the depressed individual may eventually cause the partner to also experience some level of depression. This may be the case even if the partner did not previously suffer any instability, although mutual instability is common in relationships. Needless to say, the depressive makes for a poor sounding board when the partner wishes to discuss her own personal problems or family issues.

The couple may find themselves spending considerable time alone as the depressive seems to withdraw from social activities and events. At the same time, the depressive’s uninteresting and un-fun demeanor may drive away potential friends and acquaintances. Wearing depression glasses, the depressive may be highly critical and judgmental of others. With low self-esteem, the depressive may also believe people avoid her because she is not very interesting or just socially incompetent. These feelings may increase the depressive’s sense of guilt about the couple’s lonely existence.

It is common for depressive symptoms to show up as irritability and anger. Therapists frequently fail to recognize the depression that underlies irritability and temper tantrums and may see these couples for long periods of time to work on their “communication problems†and “anger issues.†Work may be needed in these areas as well, but comprehensive treatment must include some recognition of the underlying depression and its effects. Treatment for depression is especially important in family situations, since the depressive’s negative mood may misinterpret his children’s behavior and he may severely punish them for minor infractions or no infraction at all. With hindsight, the partner may look back and see the red flags that were missed when first getting to know the depressive. The partner may wonder why she was initially attracted to the quiet, socially withdrawn, or irritable person she first met. Of course, the depressive’s mood may have been elevated initially via honeymoon-stage brain chemistry, and there just always seemed to be some explanation for the problems and unhappiness that showed up later.

If the depressed family member is a child, the parents may not even recognize the depression. The parents may just assume the child will eventually grow out of his problem or “childish behavior.†Parents may seek band-aid solutions without attempting a more comprehensive approach, including some recognition of their own role in creating the child’s depression.

Finally, keep in mind that depression may have negative effects prior to the birth of a child. According to Louis Cozolino,¹²² professor of psychology at Pepperdine University and author of numerous books about the neuroscience of human behavior, high levels of stress experienced during pregnancy may cause chemical imbalances that can have negative effects on a child’s development. These imbalances may cause emotional problems including depression, irritability, anxiety, and problems with attachment, as well as physical problems. After birth, a stressed or depressed mother’s emotionless or withdrawn expression may create distress in the infant. When mothers become depressed, their children may become depressed. The child may respond by unconsciously trying to care for the mother in a role reversal that may damage a child’s normal emotional development, and the child may grow up with depression and/or a caretaker personality.