One of the biggest problems about depressive episodes is that they can be insidious. They can sneak up silently and slowly, staying underneath any surface awareness until they’re well and truly entrenched. Mine are that way a lot; although I have a long list of items that I watch for as signs, I don’t catch them all. This happened recently, and was extremely distressing to not just me but to several of my friends and co-workers.
Fortunately, when it finally manifested itself openly, I hadn’t yet gotten down far enough to be unable to recognize what it was; thus I was able to take (and did take) immediate steps to address it.
There are any number of lists of depressive symptoms out there, and they’re fairly similar:
- Changes in sleep, appetite or weight
- Lack of concentration and ability to make decisions
- Loss of energy, both physical and mental
- Loss of interest in usual activities
- Feelings of sadness, hopelessness, or even suicidal thoughts
This isn’t a comprehensive list; nor is it a bad one. But it makes it clear one of the biggest problems when it comes to spotting a depressive episode: most of the symptoms are self-reported, and the rest are the kind that might not be spotted together. For example, co-workers might notice a lack of concentration but won’t realize there’s been a change in sleep; friends might notice that a person doesn’t come out with them as often, but won’t spot a sad mood.
Making things worse is the fact that these symptoms can look different in different people, and even in the same person at different times or stages of life. The signs of a previous depressive episode often aren’t the same signals that precede a new one. People who suffer from depression have to be constantly vigilant about any sort of change.
Complicating the matter is that other disorders can masquerade as depression. This is frustrating for those of us who have depression because people “offer to help” by trying to explain the depression away as something else entirely. The insidiousness sneaks in when someone with depression thinks they’re going into another episode and it turns out to really be something else. This has happened to me too; it took years for my treating providers to figure out that I also have a vitamin D deficiency (I now take supplements).
The final complication, and the one that did me in this time, is that sometimes depressive episodes really do have an external trigger. In my case, there were internal triggers, but I also went through some external ones: a major announcement and change at work, a change in the location of the cat room where I volunteer (leading to me dropping off the calendar), and the purchase of a new car. This combination doesn’t score particularly high on the traditional stress inventories, but it was still three major changes in a very short time, which can lead to a bout of situational depression.
All of these factors contribute to making depression a complicated disease; the symptoms are constantly changing, the manifestations are different; and sometimes even normal life events can serve as a trigger. This constant flux is another reason why depression is so insidious: just when you think you’ve got yourself worked out, it finds another way to attack.
I don’t find it odd at all that many people with depression use demonic imagery to describe the disease. Demons aren’t easily defeated; they can adjust and change over time in response to the defenses against them. They’re insidious. Depression is the same way, and that makes it a lifetime struggle instead of a simple event to be worked through.