Depression-Mild vs. Moderate

Dr. Holzmacher's Business LogoIn my last post on depression, I stressed the key points differentiating a bipolar disorder from a depression.  In this post, I will focus on the differences between mild and moderate symptom profiles, as well as normal mood swings and a Major Depression.

Moderate to severe Major Depressions are easy to differentiate from normal mood swings.  The significant difference is titled “vegetative symptoms.”  This may call to mind comatose people or someone drooling in a corner; however, the meaning is different.  Vegetative symptoms of a depression are the physical symptoms that emerge when one declines from a mild to moderate level of depression.  This is the stage where people seek treatment, or are pressured by others to do so.  Please keep in mind that the diagnostic rules of Major Depression only differentiate mild from moderate levels of severity based on functional impairment.  My contention is that this functional impairment is a direct consequence of the physical symptoms of depression.  Often the physical symptoms are so unexpected and alarming that many people believe it is another disorder entirely.

The vegetative symptoms of depression occur in polar extremes; sleep is minimal or too much,  appetite is reduced or hunger excessive, energy is decreased or a constant agitated fatigue sets in.  It is difficult for people to believe that a psychological problem could cause such physical disruption.  Often those who complain of chronic fatigue or general malaise are clinically depressed.  Most people expect a depressed person to be very sad and tearful, but a moderate Major Depressive may not have a subjective (personal) sense of sadness, nor may they be tearful.  Chronic irritation and general fatigue are often presenting complaints of the chronically depressed.  Men are more apt to experience irritation/anger as the prominent feature of depression than women.  In the mild phase of depression, a person may be aware of a lowered frustration tolerance, but it is able to be controlled.  The moderate stage may reveal rage reactions or simple frustrations that quickly spin out of their control.

Sleep disruption is almost always an important factor in moderate Major Depressions.  Few people perceive increased sleep as a problem, yet the increased sleep engendered with a depression doesn’t increase sleep comfortably or effectively.  The increased sleep tends to be debilitating.  Please note that sleep may be reduced in a Major Depression, but I am focusing on the increased pole, at the moment.  Missing work, missed children appointments and missing one’s own appointments are more common than not.  Getting out of bed and into the washroom may feel to the afflicted like an epic journey.  For example, the daughter of a close friend became moderately depressed.  Her nine year old daughter came home each day from school to find her mother in bed.  She no longer makes her daughter meals or takes her to school.  Increasingly, the daughter takes care of her mother.  This dynamic is often observed in families with substance abuse; the course of the treatment is different, but the danger to the family is similar.

As most of us wish for more sleep, we also desire less appetite for food.  Supposedly, in excess of a trillion dollars is spent on global weight loss strategies annually.  Weight loss secondary to depression is effective, though drastic, unpleasant and unhealthy.  The loss of appetite from depression is often gradual, such that it’s cause is obscured over time.  Often the sight and especially odors of food will make one feel nauseous.  A useful clinical rule is that a ten percent drop in total body weight in one month spells medical trouble.  As with sleep, please note that that appetite may also be increased by a Major Depression, but I am focusing on the decreased pole at the moment.  Women are more apt than men to be pleased with the weight loss-initially.  Others typically remark about the unhealthy appearance of this type of weight loss, decreasing the expected pleasure of hearing peers rave about the missing pounds.  This depressive weight loss also entails lower strength and energy, as well as lowered attentional resources.  There is little comfort or complements to be gained from depressive weight loss.  As with reduced sleep, medications to treat the symptoms tend to prolong or exacerbate the problems.  The only known way to combat the sleep and appetite disruption from  depression is to treat the underlying depression.  Please leave comments regarding this post in the space provided below.

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