Depression – as a diagnosis and how to cope

    “I feel depressed.”

    “I am depressed.”

    This is what I had been saying for the past year, up until recently.

    “One of those days.”

    “I’ll be fine.”

    “I’m used to it.”

    I check all the boxes, I have done excessive research on it, especially when I was feeling that way. I can easily recognize it, when it comes to me. I can feel it coming, I know it’ll come back, over and over again. I count the days I feel okay. Two days, three days, four days, five days, stop, zero, and we’re back.

    Very low mood, feeling like crying, though the tears won’t come out, difficulty breathing, panic, oversleeping, wanting to be left alone, feeling misunderstood, looking at strangers on the bus and wondering if they’re as miserable as I am. Shutting down, not wanting to socialize, not eating, being self-destructive (I’ll die, anyway, right? Why would I worry?). Feeling numb. Hardly being able to fake a smile, if it’s really bad. Always claiming that I am, in fact, fine.

    “I’ll die, anyway.”

    You’ve made a mistake, you can always just die, right?

    That band is triggering, don’t play it. I can’t cope with that. Definitely not Cigarettes After Sex. Whenever I hear Cigarettes After Sex playing, I am reminded of awful times in my life, times when I was at my lowest. Sometimes, I still do resort to them, but they are a massive trigger for my depressive moods, as is any sad song, for that matter.

    Don’t rewatch sad movies, regardless of the sense of comfort you might feel they are providing you with. You know they will trigger you. What if I watched The Virgin Suicides? Depression – activated. Nausea? Present. I could have done without that.

    What professionals say

    When should I worry I might be depressed, though? Mental health professionals analyze how you have been feeling for the past two weeks, at least. Depression can be triggered, or it could have no trigger, whatsoever. I used to affirm the latter and I still do find I feel the same way, only now, it might have a trigger, from time to time. According to Healthline, everyone goes through “periods of deep sadness and grief”, but they usually go away in a matter of a few days or weeks, as the circumstances vary. “However, intense sadness that lasts more than 2 weeks and affects your ability to function may be a sign of depression”.

    I spoke to psychologist Rodica Afrăsinei to better understand what might be happening to me and to other people who are able to relate to my struggles. She told me that a diagnosis is given based on standard criteria that a person exhibits and that it is important, in matters of correctly prescribed medication by the psychiatrist. “For counselors and therapists, symptoms are important in order to follow a pattern of reactions of the client’s system and to keep track of the progress”.

     If you have ever taken a quiz online to see whether you might be depressed, you might’ve noticed the exact same pattern. How have you been feeling for the past two weeks? What about your symptoms? Excessive sadness, loss of interest in activities you used to enjoy, withdrawal from friends and family, suicidal thoughts, lack of interest in school (in case this was formerly thoroughly enjoyed), not sleeping or oversleeping, lack of appetite, harmful behavior, such as drinking too much, taking drugs, drinking too many caffeinated beverages, not really caring about what happens to you.

    Rodica Afrăsinei is of the opinion that a diagnosis can often be a troubling label for the patient, especially in Romania, where there is a lot of stigma surrounding mental illness. She mentions a few aspects that need to be taken into consideration, such as the life history of the patient, their patterns of emotional and relational reactions, cognitive aspects, behavior, but also subjective experience (the way the individual narrates they feel). While this doesn’t guarantee a clear diagnosis for everybody, fitting on the spectrum is not mandatory in order to benefit from counselling or psychotherapy, she explains: “It can give the client clarity, but it’s not the focus of the intervention”.

    I’m fine, until I’m not. I’m having fun and then, I am suddenly hit by an overwhelming amount of sadness that clouds everything. I need to escape. I need to cry, hide away. Feel whatever it is that I am feeling. It’s become too much.

    Sadness vs depression

    What if I’m just sad? Sadness is normal, everybody feels sad, sometimes. Sadness has a trigger and doesn’t last for long. Sadness goes away, depression is always around the corner. Usually, people who are depressed don’t know what they are depressed about. They’re just depressed. Depression can be triggered, too. Death, loss of a loved one, divorce, inability to adapt, perhaps, and so on. They all play their part in an individual’s moods. What if I’m ignoring some kind of root to my overall mood? What if it’s my fault? It can be hard to make the right decisions, in order to be on the right track, the track to getting better. Baby steps, some say. Do something to escape it, do not let yourself drown any further. Go out with friends, have fun, forget about it. Sometimes, it works. Due to the desperate need of validating what I believe the problem is, I do a lot of research on depression, but what really got me thinking was this one video titled How To Cope With Depression, which I watched on the YouTube channel The School of Life. While prior to watching it, I had accepted that what I was dealing with was depression, that particular video felt deeply invalidating and it brought out information I may not have been aware of. And I do know quite a lot on the subject. It left me wondering whether I’m simply sad.

    The (lack of) diagnosis

    Afrăsinei states that when the focus is on the diagnosis (“as in, the care and process of growing and healing depend on the existence of a diagnosis”), it is likely that people have got to lose. I only half-agree. It would be so much easier if I knew just what was wrong with me and I wouldn’t obsessively search for “What is depression?” and “Am I depressed?” every single time I felt depressed. In the same way, I would not feel like I had to prove this is how I actually felt like when I’m told I can’t be depressed, as depressed people can’t hide their depression. Apparently.

    Annie (18) was diagnosed with depression in December 2020. Though she is much better now, she recalls what her depression used to feel like and how she coped with it. She says she needed to shut down and to avoid suicidal thoughts, she’d just sleep a lot. “I would barely be awake. That’s all I would literally do”. Annie is passionate about writing (especially poetry) and back then, she would’ve used it as a coping mechanism to feel better, but the lack of motivation showed. She was not motivated to take care of herself, either. “I was mostly just not motivated to take care of myself physically and mentally, whatsoever” and she would do “anything to postpone a shower or a meal”. She avoided interacting with people by spending her time in isolation, as she didn’t want to come across as annoying or feel like a burden. “I hated people feeling bad for me or having them worry”. Annie affirms that she used to pick people as reasons to stay alive. Despite still having “a bunch” of depressive episodes during winter, she states that she does love life. She didn’t think she could get better, that her life would ever change and that she was just destined to be miserable. “I guess I’m living proof that nothing is certain and there is always room for good”. Her experience has had a positive turn: “I thought so many times of just ending everything. I’m glad I didn’t, I love my life right now. Maybe it’s not the best and I haven’t fulfilled all of my dreams just yet, but it’s nice to know that I’m doing better and I’m with people who care and love me”.

    I feel unlikable if I cannot function properly, as I normally pretend to. From time to time, I shut down and overthink the way I must be looking. Off. Fake a smile, ignore the fact that you are feeling left out. Say something. I realize most of this can be visible, as my friends have asked me multiple times what the matter is, to just tell them what is up, whether I am fine, if I need a hug. I’m uncomfortable with that kind of attention. It makes me feel as if I am being treated like a baby, so I generally keep it to myself. I should be having fun, but instead, I’m suddenly overwhelmingly sad.

    I had accepted all of it, that I am depressed, regardless of all the good things I’ve got going on. I couldn’t explain it. I got gifts, I was sad. Christmas came, I was sad. Even now, as I am writing this, I feel off. What if I’m just sad? What if I can find triggers? Am I still depressed? Do occasionally sad people think about death, too? Do they also find it difficult to imagine themselves working until retirement? Not in a “I’ll be so tired. I won’t have time for myself” way, but in a “I don’t know how I would cope with it, how I’ll be able to run to the bathroom when I feel like crying” way.

    Different experiences and ways of coping

    Rowan’s (17) experience with depression is quite different. She believed things would get better, but for her, they didn’t. “Unfortunately, it’s been days, weeks, years of me feeling this way, so one day I just realized it’s either depression or I’m being dramatic. It’s been too long, and this feeling doesn’t go away, so it kind of became comforting”. She states she cannot remember her life without depression, so she is afraid of the possibility of it no longer being a constant thing. “A part of me doesn’t want to get help, and the other keeps ruining opportunities, cancelling plans, cutting people off and many other things because of depression and anxiety”. When Rowan’s school therapist asked her to describe what her pain would look like, she replied with “a big, black hole” that swallows her whole. She has started to lose hope and is unsure how she could achieve all her goals, as she finds it hard to get out of bed every day. She believes it doesn’t matter whether you have been diagnosed or not and that you can call it whatever you want, if you have the same symptoms, or you “generally feel bad”. Rowan explains that it would be possible for her to feel a bit relieved if she had a diagnosis. She’d have a confirmation on the fact that it isn’t “all in her head”.

    “Depression’s background consists of a cognitive mechanism, a conviction that I am not worthy of love or that I am not valuable as a person. This conviction ends up being reflected through different behaviors or choices that support it (‘I will not take care of myself, because that is normal, it is not like I am worthy or care and affection’). Likewise, when the reality of the life I live with a lot of sadness, lack of motivation and hopelessness is completed by a growingly unfulfilled life, the conviction that life is not worth living grows”.

    Rodica Afrăsinei, psychologist

    As seen on Our World in Data, a 2017 study estimates that 264 million people worldwide had been diagnosed with depression. That’s 3.4% of the global population.

    I had accepted the depression. That may have started to change when my psychologist advised me to keep track of whenever I felt depressed. Before trying that out, I felt as though I could be perceived as not having it that bad, since describing your depressive mood to somebody (my psychologist, in this case), for the first time, is not easy. It was scary to see just how often I felt depressed and looking back on it, the triggers seem irrational, if I had any.

    Something I find rather annoying is that when I do have a few good days, I can’t help but feel like an impostor. Didn’t I say I was depressed? Does a depressed individual happen to have three good days in a row? I’m highly aware of the times I don’t feel depressed. “I’m okay today.” I’ve just gone through this. I was relatively fine, until I started to hold back tears and I was feeling miserable. Death scares me, though I think about it. I saw a guy run across the street, as cars were coming fast his way. Scary.

    Possible explanations and mechanisms

    Due to scientifically proven information, Rodica Afrăsinei affirms that, in most cases, depressive symptoms show after a destabilizing event, but not because of it. It triggers imbalances that are already there. She says that the fact that we are trying to find a visible trigger actually makes us prone to depression and that it’s a mechanism we resorted to while growing up. We end up believing that “our feelings do not matter, because they are not validated by others”. For example, we grow up with the idea that we have everything we need and that we are not allowed to be sad or scared. “As a result, we understand that we are not seen, that we do not matter, and long-term, if depressive symptoms show, it is possible that one of the things we tell ourselves will be I have no reason to be depressed, as nothing extremely bad has happened to me”. The psychologist notes that there isn’t a way to tell which people are allowed to be depressed and that it is important to decide how we will carry the baggage that was left to us, as depression is a reaction to it.

    I cope with depression by going through it, feeling it, knowing it is there. Sometimes, it is so bad I can’t function properly. I don’t always manage to hide as well as I would like to. A coping mechanism could be simply not caring about things; ignoring my assignments, not wanting to get them done. Feeling as if I’m in a parallel universe. There’s the depression part and the reality I have to face. Sleeping it away, not eating, spending days in bed feeling like shit. I’m aware those aren’t exactly healthy coping mechanisms, but that’s just how it manifests. I find writing about what I am going through soothing, in a way. I used to make video edits of sad characters I loved, but now I resort to writing.

    Rodica Afrăsinei further goes on and explains that if our own system shows these signs and symptoms, it does it because we must stop and turn to our true selves and because we no longer need to believe all those negative things, such as “I’m not able to do this, nobody could ever love me, or “I can’t have positive things in life”).

    The psychologist states that we are now in the right moment to build a reality that is worth living, step by step and that we can receive help from those around us, or from a professional. It helps to think that “it makes sense that I’m carrying all this overwhelming sadness, as I have received so much coldness, absence, abuse, insecurity”. When we go through all these emotions, Rodica Afrăsinei advises us to actively give ourselves what we would’ve needed: “a hug, a quiet walk, a reassurance that I am safe”, or to simply sit with what we are feeling, as “the storm will pass, eventually”.

    While her advice makes sense, depression makes people not care about themselves and we are constantly fighting this battle. Often, I have to force myself to get out of bed, take care of myself, eat and it’s just very hard. Depression makes you feel as though we don’t deserve good things and that death is always an option, if life becomes even the slightest tough. Thankfully, some people have managed to overcome it, but for others, it is a daily struggle, even though they are trying.

    If you feel depressed or suicidal and wish to talk to a professional, call 0800 0800 20 (Romania).