The low days: just feeling blue or something more?

The low days. You know the kind—the ones when you just want to huddle under the covers and escape the world. You don’t want to be bothered by anything or anyone. You feel listless, maybe a bit tearful or irritable or hopeless.

Everyone has been caught in the grip of the low days from time to time. In small doses, this is perfectly normal and a part of what it means to be human. Sometimes, bad things happen and we struggle with them. Sometimes, we just feel a bit blue for no apparent reason.

But, if you find yourself waking up on the wrong side of the bed most of the time, it could be a sign of something more.

The signs and symptoms of depression are varied. According to the most recent diagnostic guidelines for therapists, there are nine identified symptoms of episodic depression (also known as MDD or major depressive disorder). This list includes two cardinal symptoms of depression, at least one of which must be present for a diagnosis. To receive a diagnosis of depression, one must have at least five of nine possible symptoms persisting for at least a period of two consecutive weeks, with the symptoms being present more days than not.

There are more than 100 possible ways for these various symptoms to combine. In other words, the face of depression can look quite different from person to person. And, the symptoms are not always intuitive or obvious. For example, instead of feeling sad, some people struggling with depression are irritable or have a quick temper. This can present a confusing picture; people don’t always know what they’re looking at when they see someone who is depressed.

A person who has a hard time concentrating, has irritably withdrawn from his hobbies and social circle, oversleeps, and has lost interest in eating much could easily fly under the radar if someone isn’t paying close attention to him.

Further complicating the picture is that people struggling with depression may feel embarrassed or ashamed to talk with others about what is happening. They may conceal their struggles from others for fear of being judged. And, many people decline to talk openly about the red flags of depression that most people would recognize (i.e., persistent depressed mood, suicidal thoughts). If the depression is long-standing, they may lack insight that how they feel day to day is not normal, and that they are entitled to feeling better than they do.

A dangerous and tricky part of depression is how sly and incremental it can be.

I talk in pictures and images in therapy a lot, and the image I often share with my clients about this phenomenon is the story of the boiled frog. It goes like this:

If, for some reason, you needed to boil a frog, there’s a proper way of doing it. If you boil a pot of water on the stove and try to toss a frog in, it will hop out immediately. (Smart frog.) However, if you place the frog in lukewarm water and raise the temperature gradually, it will not detect the small changes. Lulled by the gradually increasing warmth of the water, it does not realize what is happening and it will eventually boil to death.

Clearly, I haven’t actually tried this out and I’m not even sure if this is true. If you’re really interested, there’s a Wikipedia article all about boiling frog lore. (Most scientists now claim that frogs do have the sense to escape.) But, the image is nonetheless a compelling one for our purposes.

In essence, depression often works in the same way as the gradual boiling of the water. The incremental and varied features of depression makes it that much harder to see—both for the person in that warming water and the people who care for her.

Typically, people don’t go from bright and happy one day to profoundly depressed the next. If there are rapid and extreme shifts in mood within 24 hours, that is not typically a sign of depression. Rather, depression usually involves a gradual deepening of a dark, hopeless or low mood. It creeps by degrees, an incremental erosion of happiness.

What is particularly troubling is that depression makes off with the stuff that makes people happy day to day. Clinically, this is known as anhedonia, or a lack of interest in activities or things that were once pleasing and interesting for a person. Once inside, depression also dismantles our internal alarm systems and healthy coping mechanisms, the ones that encourage us to reach out, to ask for help, to strive hopefully for a glimpse of the horizon. We no longer feel the water temperature rising. We just want to rest, to be left alone, to disappear.

Another common symptom of depression is hopelessness. Depression brings one’s present unhappiness sharply into the foreground and mutes memories of happier times. It squashes the “This too shall pass” mentality and forces the person to look at the world through storm colored glasses. Gray skies abound and there’s no relief in sight.

“It will always be this way,” depression says. “There’s no hope of improvement. You should just give up now. Stay in this dark room with me.”

The good news is that depression is a big liar.

It would have you believe that there’s no hope. That simply is not true. Even if you feel hopeless, bravely flagging down a concerned friend or family member who can intervene and provide aid can be the saving grace that rescues you from the boiling water.

I often tell my clients who are feeling bleak and hopeless that part of my job is to hold hope for them until they are able to have some of their own. Each week, they draw upon my hope and warmth and care for them until the darkness eases and they can rediscover their own warmth. Sometimes it takes a while. But, as long as they keep coming to see me, as long as they keep trying, there is hope.

If this sounds familiar to you, or it sounds like someone you know, please don’t go it alone anymore. There are so many people who want to help.

If you know of someone in a mental health crisis in Austin, you can call 512-472-4357 for immediate, on-site, free help from trained professionals. If you aren’t local, simply call 911 for emergency services and request the help of a mental health deputy.

Wherever you are, if you’re struggling with depression, please know it is a big liar and that we’re rooting for you.