How Do You Know If You Really Have Depression?

by Henry Emmons, MD

The numbers of people diagnosed with depression are staggering. There are now 44 million adults in the US with a mental health condition, according to the 2019 State of Mental Health in America Report, with a 10% rise every decade. On the positive side, I think this reflects less stigma regarding mental illness. On the other hand, I fear that we are over-pathologizing normal human reactions to adverse events.  And we may be missing the real cause of what appears to be depression.

There are only so many ways that human beings can manifest distress. Because we’re wired differently, we show it in different ways, but everyone I’ve ever met will develop some sort of imbalance when sufficiently stressed. In other words, we each have our Achille’s heel, a genetic weak link that gives way when conditions are bad enough. For some, it shows up as anxiety, for others it’s a sleep disturbance, for some it’s a purely physical problem. And for many, it shows up as depression. But is it really depression?

Currently, mental health diagnoses are made simply by looking at symptoms. We don’t have good blood tests or brain scans, so we are left with lists of symptoms like a depressed mood, loss of interest or pleasure, trouble sleeping or eating, low energy, negative thoughts, suicidal feelings. But there are many things besides depression that can cause these same symptoms. It could be that you’ve just taken antibiotics which have knocked out the good bacteria in your gut. Without them, you can’t make enough serotonin. Or maybe you’re having a negative reaction to birth control pills, or simply your own hormone fluctuations. Or you aren’t sleeping well, which can very quickly cause a cascade of these depression symptoms.

The most common cause is stress, and I have come to believe that roughly 80% of people diagnosed today with depression don’t actually have clinical depression. They have an “adjustment disorder” which is stress-related. It looks and feels like depression, but it is something different.

Why does that matter? Because the best approach to treatment, and especially to preventing it from coming back, is very, very different.

Because it looks and feels like depression, most people with a stress-related problem are prescribed antidepressants. They might actually help, and I do sometimes prescribe them myself if the symptoms are bad enough. But they do not solve the real problem. They only offer some extra support which is temporary at best. To address the underlying cause you have to either remove yourself from the source of the stress (when that is possible), or learn new skills to deal with current and future stress, because one thing you can be sure of is that stress is not going away. 

Of course, there are some people who do have a strong genetic predisposition to depression and develop a biological illness that requires long term treatment. In that case, I believe that treatment should include medication. Even then, I strongly feel it is a mistake to rely solely on medication, because it so often poops out over time. I think there is an important role for diet, exercise, and nutraceuticals (nutritional supplements that act like medication), even if it is just to keep medications working.

At Natural Mental Health we use a subtype system to help target those natural therapies (and in my practice, I use the same subtypes to choose the best medications).  In broad terms, depression shows up as mostly anxious, mostly agitated, or mostly sluggish. There is often some overlap, where people have symptoms from two or three of the subtypes, but still there tends to be a predominant pattern. Knowing that helps me suggest specific nutritional supplements, along with recommending the best diet, type of exercise, or form of mind-body practice. 

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