It is a question I will occasionally ask myself. Am I depressed? When it comes to chronic pain, it can be hard to tell.
If you have a “blah” day or start to feel a bit sad, the easiest and most natural assessment is often to think, “I feel depressed.” We often jump to conclusions without considering there may be other possibilities and without considering the fact that it is important to know what exactly is going on.
Just because you “feel depressed,” does not always mean you have depression.
Why is this important? It’s important because it could be the difference between the ability to figure things out on your own and the need to seek further help. It the difference between treating and managing depression and treating and managing…whatever else may be the problem.
We have to know what the problem is to know how to address it. If we immediately assume depression is the problem and treat ourselves as though we are depressed when we aren’t, we will make little progress towards actually finding healing from whatever ails us.
This is actually a more common problem than you might think because the thing about depression in general is that it can mirror a variety of other problems. And I truly believe that this mirroring quality is exacerbated even further when chronic pain is in the picture.
We must first consider what depression is to be able to discern when it isn’t really the problem. According to the DSM-5, there are 9 symptoms of depression for us to be on the lookout for.
- Depressed mood nearly every day.
- Diminished interest or pleasure in previously enjoyed activities
- Significant weight loss or decrease or increase in appetite
- Insomnia or hypersomnia
- Psychomoter agitation or retardation
- Fatigue or loss of energy
- Feelings of worthlessness or excessive guilt (not merely guilt over being sick)
- Diminished ability to think or concentrate
- Recurrent thoughts of death
A diagnosis of major depressive disorder is given when at least 5 of these symptoms occur over the same 2 week time period. Furthermore, at least one of the symptoms must include depressed mood or diminished interest in activities. Check the ones that apply to you – because hypothetically speaking, if you have had 5 of these symptoms in the past two weeks (or any two week time period), you qualify for a diagnosis of major depressive disorder. Hmmmm is everyone checking five? I know I am, but I’m not yet convinced this means I have a concerning problem with depression.
Depression is not the Symptoms of our Chronic Pain
We are encountering an interesting problem. Almost every single symptom of depression could be a direct symptom of our chronic pain, but they are not one in the same, so this is getting confusing.
Fortunately, the DSM-5 includes an important rule for us to consider: “Do not include symptoms that are clearly attributable to another medical condition.”
Thank goodness, because if not, we are certainly all depressed!
Sometimes we are not depressed; we are simply extremely ill. We have another medical condition that also includes some or even many of the same symptoms as depression. The symptoms of chronic pain can lead to depression, but when the actual symptoms of chronic pain are the same as the possible symptoms of depression, sometimes this just means you have…chronic pain. Where the symptoms are coming from is extremely important.
I am sure you are putting this together for your own situation. Are you fatigued? Heck yes, chronic pain is exhausting. Unable to concentrate? Um yeah, chronic pain will do that to you. Not able to sleep? Can I say painsomnia? No longer engaging in previously enjoyed activities? Well, now that you mention it, I’m not training for marathons anymore. You get the point.
Here’s the difference: We all have tips and tricks for addressing our physical pain, strategies much different than the ones we may use if the symptoms are indicative of depression.
Depression is not Sadness
Here is another thing that depression is not. If you truly have clinical depression, you know that depression is not sadness. You can be sad and not be depressed. And you can be depressed and not be sad. Sometimes the defining feature in depression is a lack of interest in previously enjoyed activities, which often manifests as not feeling anything, a cold numbness and unresponsiveness to life. You don’t feel sad, you feel nothing.
When you have chronic pain, you will inevitably deal with sadness. That is pretty much a given. How can we not be sad when so much has been taken away? How can we not be sad when our lives have been so dramatically shaken and turned upside down?
Sadness is a normal and expected response to life. It is good and healthy and shows that we are appropriately responding to the severity of the situation we are facing. Emotional maturity is not avoiding painful emotions, but feeling emotions that are appropriate to the situation. And sadness is an appropriate response to chronic pain.
Here’s the difference: We can safely sit in our sadness, feeling and accepting this healthy emotion. But while sadness is safe to sit in, often fading away on its own, depression often requires much more work to safely emerge on the other side.
Depression is not Grief
We can take this a step farther and distinguish between depression, sadness, and grief. Grief is also an expected response to great losses such as chronic pain, but it is slightly different than sadness and can more easily turn into depression if not cared for properly.
The DSM-5 gives some clear thoughts on this: “In distinguishing grief from a major depressive episode (MDE), it is useful to consider that in grief the predominant affect is feelings of emptiness and loss, while in MDE it is persistent depressed mood and the inability to anticipate happiness or pleasure.”
When it comes to grief, we are more equipped to enjoy what life has to offer in the midst of our pain and sorrow. The grief is an underlying feature of everything that we experience, but we are able to experience it simultaneously with pleasure and joy. We grieve, but still we enjoy that meal, the laughter of our children, and the sunshine coming through the window. Our grief ebbs and flows, shifting in intensity throughout the days and seasons, while depression forcefully sits on our chest without relenting, without relief.
Here’s the difference: We mourn our losses, but mourning will not be enough in the case of depression.
Depression is not Boredom and Loneliness
This one trips me up all the time. I will be sitting at home alone thinking how depressed I am, when it hits me – I haven’t seen anyone in a week and I have barely been off the couch for the past few days. Now, this situation could certainly be the catalyst to lead to depression, but the feelings of boredom and loneliness that come from forced isolation are not depression in and of themselves.
When we are bored or lonely, there is practical work to be done. There is always something we can do even if we are homebound or bedbound for long periods of time. We turn to our online social groups, and when we get really desperate we beg our friends to come visit us in our homes.
Here’s the difference: There are fairly simple antidotes to boredom and loneliness. We have to get busy doing something and we have to get creative about seeing and interacting with people even when it is difficult. But depression doesn’t always respond to these simple antidotes.
Depression is a Common Response to Chronic Pain
Many of you don’t have depression; you’re just sad, grieving, lonely, or feeling the symptoms of your chronic pain. But, many of you do have depression. Depression is a common response to chronic pain, but we can’t fool ourselves into thinking it should be a normal part of our lives. We have to figure out how to move forward in the midst of overwhelming depression that goes beyond sadness and grief. This article I wrote awhile back is a good place to start. But it is only a starting point that I hope to expand on in the future.
So for now, the next time that darn doctor asks you if you are depressed when you have pickaxe protruding from your back, a hornet’s nest taking root on the bottoms of your feet, or a fire raging across your whole body…. You just give that doctor a piece of your mind!
Of course I’m depressed! Who wouldn’t be!
Or wait. Maybe I’m not?
Who can tell the difference?