By: Brian Warner
“Either everyone feels like this a little bit and they’re just not talking about it, or I am completely alone. Which isn’t funny.” Phoebe Waller-Bridge, Fleabag
When we think of depression, and definitely when we see it in movies or TV shows, it usually looks similar. Someone’s probably moping around, maybe wearing black, looking wistfully out a window while the rain patters down.
For people familiar with having depression rattle around inside their brain, though, it’s always more complex. It’s Mark Ruffalo in Infinitely Polar Bear checking the fridge in real time, while his kids go about their days in fast forward mode. Or Kirsten Dunst in Melancholia, a bride so disconnected from everything on her wedding day that it’s hard to get a sense of where or when she is in the party.
Depression is one of the most common illnesses in the U.S. – that’s right, among mental AND physical illnesses! – and somehow it’s still surrounded by myths and misconceptions (mythconceptions, if you will). Even if we think of coronary artery disease as feeling like chest pain, we know there are more nuanced symptoms involved than just that one, like nausea and arm pain. For mental illnesses, though . . . people usually have a little less familiarity.
Instead, some people are so busy looking out for depression that looks “the way it’s supposed to” that they have trouble even realizing they’re struggling with it, too. It’s easy to reassure ourselves of our mental wellness when we’re basing it off of the way things are “supposed” to look.
“I can’t be depressed; I get out of bed every morning.”
“I can’t be depressed; I’m doing great in all of my classes.”
“I can’t be depressed; I don’t have time for it right now!”
The thing about depression, though, is that it’s really, really good at finding a way to express itself on its own schedule, not ours. In an article for Psychology Today, psychologist Evan Parks, Psy.D. reveals that “On countless occasions, I have asked patients who just scored high on a depression inventory if they see themselves as depressed. The nearly universal answer is ‘no’.”
Dr. Parks’ clients aren’t special in seeing themselves this way; in 2020 (an excellent year for mental health, right?), a poll by GeneSight Mental Health Monitor found that a massive 61% of people 65+ who worried that they might have depression didn’t seek treatment because “my issues aren’t that bad.” Instead, about one-third believed that they could wait until they’d “snap out of it” on their own.
Similarly, only half as many men report suffering from depression as women (about 1 in 16 men versus 1 in 8 women) – but that number is likely much higher in reality. Partly this comes from fears around seeming weak or showing emotional vulnerability, but for many men the problem comes less from limiting views of masculinity and more from a simple problem: they don’t realize what they’re feeling is depression.
Because for every day where it feels like no amount of sleep will ever be enough, there’s often also a day full of stomach cramps and bathroom issues. And just as often as people feel so uninterested in anything that they might as well just stare out the window, they can be plagued by aches and pains that they can’t explain.
Common physical symptoms of depression can include:
- Unexplained chest, muscle, joint, and back pain
- Digestive problems
- Changes in appetite and weight
- Loss of interest in sex
- Changes to your menstrual cycle
- Thinking, speaking, or moving more slowly than usual
The common thread through many of the symptoms of depression, both physical and psychological? A serious serotonin and norepinephrine dysregulation. “Chronic pain seems to cause serotonin to be released by the brain into the spinal cord,” says Johns Hopkins neuroscience professor Xinzhong Dong, Ph.D., “even causing some non-pain-sensing nerve cells to start responding to pain.”
Similarly, Columbia University researcher Kara Gross Margolis, MD, says, “The gut is often called the body’s ‘second brain. It contains more neurons than the spinal cord and uses many of the same neurotransmitters as the brain. So it shouldn’t be surprising that [depression and digestive issues] could be caused by the same process.”
The problem when people only understand some symptoms, though, like low mood and feelings of hopelessness? Nearly 70% of patients who could be diagnosed with depression are only reporting the physical symptoms when they meet with their primary care provider – and are walking away without the full help that they need.
That doesn’t mean it’s not important to talk to your primary care provider, but that “If the exam and routine tests show no underlying medical cause, it’s [also] important to have a mental health evaluation,” says Carla Manly, Ph.D., a clinical psychologist specializing in the treatment of depression.
Because without addressing the whole issue, we leave people to deal with highly treatable issues on their own. And without personal experience, bigger conversations around certain topics are how we understand them.
In 1960, Psycho became the first American movie to show a toilet. That’s right – we built the computer, discovered Penicillin, and sent rockets into space before we stooped so low as to admit that other people have toilets in their homes, too.
If we were willing to make it all the way to 1960 hiding what everyone already knows, what are we only just now finally getting around to acknowledging about ourselves – and realizing that other people feel, too? How messy and needy and in pain is everyone else? And would we start to notice if we started noticing it in ourselves, too?
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