I never realized how little I knew about depression until I became depressed. I didn't know, for instance, how depression can snatch away your sex drive, leaving you feeling newly—and involuntarily—asexual. I didn't know that depression attacks your attention span, your energy, and your ability to finish things. During a recent bout, I had trouble finishing magazine articles and movies. The number of emails I sent plummeted. Everyday errands felt like Herculean tasks. But perhaps most surprising was the emotional numbness. Nothing about hearing the word "depression" prepared me for having a moment of eye contact with my two-year-old niece that I knew ought to melt my heart—but didn't. Or for sitting at a funeral for a friend, surrounded by sobs and sniffles, and wondering, with a mix of guilt and alarm, why I wasn't feeling more. Sign up for Coping,_ Tonic's weekly newsletter about anxiety, depression, and dealing with it all_ During my recent depression spell, I experienced this kind of numbness for weeks. Political news that would have previously enraged me left me cold. Music had little effect beyond stirring memories of how it used to make me feel. Jokes were unfunny. Books were uninteresting. Food was unappetizing. I felt, as Phillip Lopate wrote in his uncannily accurate poem "Numbness," "precisely nothing." And this was new to me. Because while I had been in and out of depression before, I still, like many people, didn't fully grasp an illness that affected 16 million Americans in 2015. (That's more than the combined populations of New York City, LA, and Chicago.) "It's ubiquitous," the author of The Noonday Demon: An Atlas of Depression, Andrew Solomon, tells me. "[And yet] I think the public doesn't really understand it well at all."
The Diagnostic and Statistical Manual of Mental Disorders says, for a person to be diagnosed with Major Depressive Disorder, they need to experience "Depressed mood most of the day, nearly every day" or "markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day" for a period of two weeks. But this is just the baseline. For a diagnosis to be made, the person must also report at least four additional symptoms from a list that includes significant weight loss or weight gain, an inability to sleep or excessive sleepiness, physical restlessness or slowness ("psychomotor agitation or retardation," in clinical terms), frequent fatigue or energy loss, feelings of worthlessness or excessive guilt, indecision or a diminished ability to concentrate, and recurring thoughts of death or suicide.
"It's truly amazing to me, the longer I've been in the field, how many manifestations of depression there can be in the body," says Jennifer Payne, a professor of psychiatry and director of the Women's Mood Disorders Center at Johns Hopkins School of Medicine. These can range from headaches to GI issues to various pain syndromes, and depression can also exacerbate existing conditions, like diabetes or high blood pressure. "If you take two women with the same breast cancer, one's depressed [and] one's not, the woman who's depressed has twice the chance of dying from her breast cancer," Payne says.
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During my conversations with Payne and other medical experts, I began to understand just how vast and multifaceted this illness can be. Depression can be visible or invisible to a person's loved ones. It can last for weeks, years, or even decades. It can affect sleep, concentration, appetite, energy, memory, movement, and—as I know well from trying to write while depressed —a person's facility with language.
A particularly scary aspect is the fact that hopelessness and helplessness are actually symptoms of the illness. Stanford University's David Spiegel, a professor of psychiatry and behavioral sciences and director of the school's Center on Stress and Health, tells me that depression is a common, treatable mental disorder, but people it afflicts can blame themselves for things that aren't their fault. "And so depressed people often feel guilty about being depressed and not performing the way they should," he says. "And that's part of the disease…[that] keeps them from digging their way out, or getting help from people to dig their way out." And the causes of the illness can be as varied as the symptoms. Emory University's Nadine Kaslow, a professor of psychiatry and behavioral sciences, tells me that, with some people, depression is more genetically driven, while others experience it as reaction to external stress. She runs off a long list of the circumstances that can trigger depression: loss of a loved one, job, or key identity; things that cause feelings of failure, shame, or humiliation; a natural disaster that overturns your life, like the recent hurricanes in Texas, Florida, and Puerto Rico; financial woes and anxiety; child abuse; domestic violence. We also know that depression can be devilishly impervious to happy events. Readers of William Styron's Darkness Visible: A Memoir of Madness, may remember how he describes receiving a prestigious literary prize in Paris, a check for $25,000, and royal treatment from his hosts, all while feeling what he describes as "panic…dislocation, and a sense that my thought processes were being engulfed by a toxic and unnameable tide that obliterated any enjoyable response to the living world." The more I dug into my reporting, it also became clear how many things depression is not. It is not the fault of the person afflicted, nor is it necessarily in their control to "snap out of it" or "pull themselves up by their bootstraps." (These two points really can't be stressed enough.) And it certainly is not merely feeling sad. "People who have never experienced depression think, 'Well, I pulled myself together after a rough time,' and they don't understand the intense physicality, the immediacy, and the incontrovertibility of the condition," Solomon says. It's tempting to envision depression as an extreme point on a mood spectrum, he adds, but it's really the mood spectrum shutting down altogether. The word he used frequently in our conversation was a feeling of "nullity." And in his TED talk on depression, he repeats the sentence, "The opposite of depression is not happiness, but vitality."
The British author Matt Haig recently tweeted, "Everyone is comfortable so long as you talk about mental illness in the past tense." And I admit, it's easier for me to write this piece after my recent bout of depression passed. When I share it with people I know, I can truthfully say, "I feel much better now," and spare us both a less comfortable conversation. But being outside of a depressive spell (at least for now; I have little doubt I'll return at some point) also allows me an interesting journalistic perspective. One point worth making—and I say this as a mostly non-religious person—is that emotions are a sacred, miraculous thing. You realize this when you lose them. I don't think I've ever felt so happy to feel angry as the recent day when, after reading about some recent political horror, I felt my first stirrings of moral outrage in months. I was offended again—and it was beautiful. Other revelatory moments followed, like household appliances flickering back on after a power outage: the return of that almost-crying lump in my throat during emotional movies, or the burst of spontaneous laughter when I heard a joke. A few weeks ago, I drove home after an errand and stayed in my car for a minute just to soak in the old-but-new joy I from a song I had recently discovered. But even as I exit my latest depressive spell, I remain mindful of the people who are still there. I know what it means to smile for a photo and feel like you're lying. I know what it means to feel a vague sense of sadness over not feeling sadness. I know what it means to comb the Internet for a video, an article, a book, that explains what's going on inside your seemingly broken brain. To know depression is to become familiar with one of its paradoxes: the feeling that you're missing out on the full human experience is, in fact, a large part of the human experience. This is where friends and family can help. Odds are that you know someone who has been, or will be, depressed at some point. And so being a vigilant friend and family member means keeping an eye out for the person who's less and less socially active. Stay aware of the co-worker for whom it appears, as one expert told me, "like the light in their eyes is gone." Check in with them. Call them. Visit with them.
The brain is a complex and crucial organ that represents humans' major evolutionary advantage over other animals, Spiegel tells me. And sometimes it has problems working. When this happens, it's not a judgment on the person affected, he says. "It's a problem that sometimes comes up when you're dealing with using a complex organ to deal with complex problems in life."
It's easy to fix a bike or a car when they break, he continues, but your brain is complicated. "So get help with it if it's not working right."
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