Economically Stressed or Clinically Depressed?
Sutter Center for Psychiatry

This health tip is brought to you by Richard Bermudes, M.D., board-certified Psychiatrist and Medical Director of Sutter Center for Psychiatry.

The US economy has entered its most severe downturn since the 1930’s. Sacramento was among the first in the nation to fall victim to the real estate collapse and has consistently scored in the top 10 US cities for foreclosures. The unemployment rate in the Sacramento region is 11.3 %, the highest it has been in decades.

Clinical depression is so common that it affects 1 in 5 of us sometime in our lifetime. By 2020 the World Health Organization estimates that depression will be only second to cardiovascular disease in terms of worldwide health burden. In mental health circles depression is referred to as the “common cold of psychiatry.”

For many of us, the economic downturn has brought emotions of sadness, loss and nervousness at levels we have not experienced before.

So what is the difference between just stressed or clinically depressed? Here are some ways in which professionals make the distinction.

Depression affects our thinking
Clinical depression clouds our view of the world. The process of thinking in depression is characterized by a set of pervasive negative biases. Themes of loss, devaluation and hopelessness overtake the thinking of depressed individuals. Researchers in cognitive neuroscience find that depressed individuals have negative views of themselves (e.g. “I am worthless”), the world (e.g. “Everything is a hassle”), and the future (e.g. “Things will never change”).

When depressed we often attribute problems to ourselves that are in fact attributable to other people or events. Recently, I was speaking with a client struggling with depression and she went into elaborate detail of how she was 100% responsible for her recent layoff at work. She listed the many instances that she could have done projects differently or said just the right things to the right bosses. When asked about the other 20 employees who had also received pink slips she had a double standard, as she was able to identify unfortunate changes in the local economy beyond their control that led to their layoff.

In depression positive or neutral experiences are often perceived as negative. In cognitive neuroscience this is referred to as discounting the positive. Thus a compliment may turn into a burden for the depressed individual.  For the depressed individual, “You did a great job on this project at work” means “to work here and keep your job, you have to be perfect.” Seemingly positive experiences turn into negative experiences and the depression grows.

Depression affects us physically
Clinical forms of depression typically affect the way our body feels and our pain levels. Our sleep and appetite can change as well. Individuals with depression report more aches and pains, decreased energy and overall a decreased sense of well-being. When we are depressed we have more visits to the doctor and unexplained medical problems.

Some key questions to consider about your physical health include the following:
Do you have trouble getting to sleep, staying asleep or waking too early? Depression often first presents with changes in our sleep architecture.

Have you had an increase in appetite or decrease in appetite? Has your weight gone up or down recently by more than 5 lbs? Neurobiological changes from depression cause changes in the centers of the brain that regulate our appetite.

Do you feel healthy? Are you having more aches and pains? Have you visited your primary care doctor in the last month and had unexplained medical problems? Changes related to depression also help regulate our pain system. When depressed our bodies often feel worn down and achy.

All of us feel stress from the economy. Knowing if the stress has triggered a clinical depression could be critical for your own recovery.