We all feel sad sometimes. It may last only a while — after we have an argument with a loved one, are passed over for a promotion, watch a particularly touching movie, or nobody bothered to throw us a birthday party, for instance. Sadness can also last much longer — after we lose a loved one to death, after a breakup, because life is hard and there isn't much to give us joy, because we feel lonely, or for no apparent reason at all.
When does this longer-term sadness cross the threshold into depression? Are you "just" sad, or are you clinically depressed? Recent research suggests that the difference between the two isn't as great as we used to think, and that sadness and depression exist on the same spectrum. We're left with two possibilities in differentiating between depression and sadness, then:
- We may look at depression as a long-term sadness that isn't proportional to the event or situation that triggered it or for which there is no apparent trigger,
- Or we may look at just how sad a person is, what their other symptoms are, how intense and long-lasting those symptoms are, and to what extent they interfere with normal, everyday, life.
Depression: What are the diagnostic criteria?
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, people have to meet a whole bunch of diagnostic criteria to be classified as depressed, and these criteria are separated into five parts (A through E). The first part, A, looks at the symptoms you're experiencing — you have to have at least five of them, and they must include either of the first two, for at least two weeks:
- A depressed mood or significant sadness and irritability on most days, for most of the day.
- Loss of interest in activities that previously had meaning or brought you joy. This often includes social withdrawal, as well.
- Increased appetite or a loss of appetite, often in conjunction with weight gain or loss you weren't trying to achieve.
- Persistently being unable to sleep well (insomnia) or sleeping more than normal.
- Being fatigued or not having any energy.
- Feeling disproportionately worthless or guilty.
- You can't seem to think straight, may be indecisive, and can't concentrate — again, persistently.
- You think about death a lot, may be feeling suicidal, might have planned to commit suicide or attempted it.
The rest of the diagnostic criteria look at what depression isn't — to be diagnosed with depression, your symptoms can't be caused by a "mixed episode", a feature of bipolar disorder that includes both mania and depression, by substance abuse, by other mental health concerns such as schizophrenia or delusional disorder, or by physical health conditions such as hypothyroidism.
Depressed or sad? Telling the difference
If you are not sure whether you're sad or depressed, even after reading the diagnostic criteria for depression, and you have been feeling very down for at least two weeks, you can't go wrong by consulting a doctor or psychologist. Though depression can and does strike without an identifiable trigger in many cases, having an objective reason to be sad doesn't necessarily mean you're not also depressed.
The diagnosing doctor will take this into account when you attend your appointment. Diagnostic criteria note that it's completely normal to feel really sad when you face a major stressful life change like a bereavement, medical condition, or job loss, but if you feel more than sad — if you are suicidal, can't sleep, can't concentrate, don't feel much of anything exception for emptiness, hopelessness, and irritability and believe things can never get better again — you are probably also depressed. Depression, in turn, prolongs the period of grief as well as making it more severe.
We'd strongly encourage anyone who feels suicidal to seek help immediately. If you're not feeling suicidal and aren't sure whether you might be depressed, here are some things to consider:
- If you're sad or grieving, it usually feels good to lean on other people for emotional support. If you're depressed, on the other hand, you might not feel like seeing anybody.
- If you are sad, your mood is often interspersed with feelings of hope — how things might be or could be given a different situation, which you can work towards. If you're grieving, you'll feel sad and empty, but are also likely to think back to positive memories of your loved one. Despite your feelings, you'll usually still be able to carry out your daily tasks. Depression, on the other hand, overshadows everything and often robs you of the ability to engage in everyday responsibilities.
- People who are sad or grieving tend to experience these feelings with their self esteem intact, while depressed people often feel useless or worthless.
No matter whether you're sad and grieving or depressed, therapy like cognitive behavioral therapy can help you cope and feel better. If you are diagnosed with depression, antidepressants are another treatment that can help you.