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The different faces of depression



Depression is not a homogeneous entity. So how can we recognize its different manifestations? This article discusses its different expressions depending on the individual and their life context.




A global view of depression



Depression is, according to the WHO (World Health Organization), the second leading cause of disability, and according to the INSERM (National Institute of Health and Medical Research, 2019), over a lifetime approximately 20% of individuals will be affected.


The causes of depression are, like all diseases, multifactorial. Life events (such as loss, physical injury, changes or stressful events), biological influences (such as genetic vulnerability, changes in neurotransmitters), social influences (such as relationship problems or low socioeconomic status), cognitive and emotional influences (such as emotional blunting or guilt), and behavioral influences (such as agitation or apathy), all influence each other and can contribute to the onset and maintenance of depression.




Difficulty in identifying certain depressions



The term "depression" is used to refer to both a symptom and a disorder. This single word describes very different realities. Therefore, how can we recognize ourselves behind a label that covers such heterogeneous experiences?


Depression is not always easy to identify. If for some it strikes in the face, for others it is much more discreet, with the presence of less typical symptoms, such as sadness or the inability to feel pleasure in situations that used to provoke joy, which are not at the forefront of the clinical picture.


For suffering, although universal in its expression, differs in its manifestations according to the individual. Each person will develop symptoms that make sense, depending on his or her life history.

Depending on the variability of symptoms specific to each person and the intensity of the manifestations, we may encounter forms close to depression as conveyed in the media or shared in the collective imagination, but also others that are more atypical (Pasquier, 2021).


For example, what we call masked depression concerns situations where the classic symptoms of depression are not prominent. It is mainly marked by somatic complaints, pain, anguish or anxiety. Patients who suffer from this condition mostly turn to doctors rather than psychologists.





But then, what is depression?



It can be defined as an intense and invasive moral pain, almost permanent, which can seem irreversible. It can even overcome the physical pain. It can be characterized by motor, emotional and cognitive inhibition, but also by disturbed sleep and appetite as well as a decrease in libido. It is punctuated by feelings of inability and incompetence, disinterest, low self-esteem, guilt and ruminations.



Depression can occur insidiously or abruptly. Life events can play an important role in its onset, which is less the case when it becomes chronic. It can be more or less severe, depending among other things, on the presence of other disorders (such as addictions), the support provided by the environment, the isolation of the person or the presence of somatic diseases.



To speak of a characterized depressive disorder, the symptoms must be present almost all day and almost every day. They lead to great distress and an alteration in social and professional functioning or in other important areas of the person's life, such as family life.





The different manifestations of depression



While some symptoms are typical such as fatigue, loss of energy, decreased ability to think, focus, indecisiveness, worthlessness, guilt, feelings of emptiness, sadness, loss of pleasure, drive, and interest, as well as recurring thoughts of death, others sometimes vary from one end of the spectrum to the other (Agbokou & Allilaire., 2010). Some examples include:


  • Appetite that can increase or decrease drastically

  • An increase or decrease in weight without the presence of a particular diet

  • Sleep with hypersomnia on the one hand or insomnia on the other

  • Agitation or on the contrary a psychomotor slowdown

  • The presence of crying or great irritability


To illustrate this variability, let's take two patients suffering from depression: they will both present a loss of pleasure, interest and a dull mood, guilt and difficulty concentrating. But the first will sleep a lot, not be able to get up in the morning, be slowed down, lose weight and cry a lot, while the second will gain weight, be always agitated, very irritable and always exasperated, and will have a lot of difficulty finding sleep.


Depression can also be expressed differently depending on the age of the person concerned. An elderly person may feel boredom, guilt, the impression of being a burden to those around him or her or to society, and numerous somatizations, while a young person may have suicidal thoughts, a loss of libido and anhedonia. A teenager may have many risky behaviors such as massive alcohol consumption or scarification, and may have a drop in school results or absenteeism.





The importance of getting support


Although drug treatments may be indicated to treat depression, they are not sufficient on their own, and their effectiveness is diminished if they are not combined with psychotherapy. Prescription medication can be necessary and beneficial, but it is never anodyne and must be closely followed up with the prescribing psychiatrist to monitor the evolution of symptoms and adjust the dosage or the type of molecule prescribed if necessary.


Whatever the nature of the depression, psychotherapy, when the patient invests in it, allows to get out of this spiral of unhappiness and to find the vitality proper to life. Supported by the psychotherapist on whom the patient can rely, another path is then possible, where living takes on a new flavor and where the sometimes abysmal sadness, when it is taken in the arms and cradled, when a place is granted to it, ends up melting little by little under the gently recovered warmth.




Astrid Jullien

Clinical Psychologist and Psychotherapist

PBQ Therapist

Consultations in Paris and online




Bibliography:


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596


Agbokou, C. & Allilaire, J. (2010). 4. Dépression de l’adulte. Dans : Michel Goudemand éd., Les états dépressifs (pp. 26-34). Cachan: Lavoisier.


Inserm. (2019). Dépression – Mieux la comprendre pour la guérir durablement.


Organisation Mondiale de la santé.


Pasquier, A. (2021). Psychologie et psychopathologie des émotions. Dunod.



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