Imagine yourself entering a shopping mall with your sunglasses on. Even though the lights are shining brightly, you cannot see them. Everything around you is dark and cold. But as soon as you remove your glasses, the world comes alive: the windows of the shops shine attractively, you see the brightly-coloured clothes, and the dazzling screen of your phone blinks with an incoming message.

Depression is like wearing sunglasses inside: even when life is colourful and bright, you cannot see it.

What is depression?

We are regularly confronted with sadness and disappointment—when we do not get the success or recognition we are expecting, when we are rejected by someone who is important to us, or, in the most painful cases, when we lose someone dear to us. However, it is a long way from sadness to depression.

It is believed that a major depressive episode is experienced when at least two out of these three symptoms are present, for most of the day, every day for two weeks[1]: profound sadness or a state of constant irritability; a lack of interest in activities which are normally pleasant; and a drop in energy, which leads to chronic fatigue and a reduction in activity.

Another classification[2] of depressive symptoms involves the existence of two major criteria: a depressive mood or irritability, and a lack of interest in pleasant activities (anhedonia), along with at least four of the following, experienced daily, for at least two weeks: changes in body weight (significant weight loss or gain without following a specific diet); loss of appetite; sleep disorders (insomnia, or the tendency to sleep too much); a lack of energy and constant fatigue; feelings of guilt without a clear reason, or the feeling that one lacks personal value; a lack of focus and memory difficulties; an inability to make decisions; and dark or suicidal thoughts.

Dysthymia is a light form of depression[3], a permanent state of sadness which lasts at least a year, which may or may not be accompanied by major depressive episodes.

A depressive disorder cannot be diagnosed by a person who lacks specialised knowledge. A psychiatrist is the person who can best identify, differentiate, and treat depression. Even so, if you notice one of these signs in yourself or one of your friends, it is probably depression.

Things get complicated when depression is accompanied by anxiety disorders. These are manifested either through a state of anxiety and anticipation for negative future events, or through an intense fear accompanied by palpitations, cold sweats, breathing difficulties, or digestive disorders. Anxiety is extremely hard to deal with, and one usually needs to seek help from an expert.

An oft-asked question: Why me?

The causes of depression, regarded as a biochemical imbalance in the brain, are frequently discussed. The complexity of the phenomenon, however, cannot be explained by the quantitative fluctuations of a single substance. We are talking about millions of chemical reactions[4] in which mediators and neurotransmitters are involved, which lead to the moods we have, and to the way in which we perceive and experience the world in which we live.

Studies on identical twins show that genetic factors are 30-42% responsible for the variations that cause anxiety and depression symptoms[5]. This means that, in stressful conditions, those who are vulnerable will suffer from depression and anxiety in the same way in which others suffer from high blood pressure or diabetes.

Difficult life situations do not bypass us, even at a young age: family problems (tensions, separation, divorce or abuse), school difficulties (unfavourable school situations, moral harassment or bullying[6]), conflicts with friends, or rejection in romantic relationship or otherwise. There are also cases in which biochemical changes in the brain appear without a definite cause.[7]

The society we live in generates favourable conditions for the development of anxio-depressive disorders. Individualism, loneliness, and family and community estrangement make us vulnerable to the trials of life[8]. The difficulty of finding a job that fits with what one has studied is followed by financial problems, and a feeling of helplessness and failure. However, it has been observed that people who have a satisfying social life, friends and family that live close to them, and an authentic faith in God are balanced, have a sense of purpose, and are more shielded from the storm of anxio-depressive disorders.

You are not alone!

In 2001, the World Health Organization estimated that one in four persons will have a neurological or mental health problem during his or her lifetime[9]. Approximately 350 million people suffer from depression globally, this being the main mental health problem found in teenagers and young people, according to the World Health Organization[10]. A study conducted in the United States of America shows that about 8% of young people between the ages of 18 and 22 have experienced a major depressive episode in the last year[11]. Suicide as a consequence of depression is the second highest cause of death for young people between the ages of 15 and 29.

A journey from depression to hope

The good news is that depression can be treated and controlled. The bad news is that there is no magical recipe for completely dealing with this problem. Each of us has his own temperament, and thus his own vulnerability. Each of us lives in a particular social context, close to or far away from family, with our own accomplishments and disappointments, and with our own past and future prospects. Julie K. Hersh, author of the book Struck by Living: From Depression to Hope[12], presents five stages of depression management.

The first step is characterised by a lack of awareness concerning the issue at hand. Although we are unwell, we cannot clearly explain what is happening to us or why it is happening. We often go to the doctor for tests and nothing is found to be physically wrong with us. In this stage we often need a “mirror”—a friend, a parent, a mentor—to draw our attention to the fact that we have changed, and that we are obviously going through a difficult season.

The second stage is denial: “No, this cannot be happening to me!” Although those around us can point to the symptoms on the list mentioned above, we ignore what is happing to us and believe we do not need help.

Resistance is the third stage. We accept that we have problems, but we feel we can deal with them on our own, without treatment and psychological help. It is true that a healthy lifestyle helps a lot. A good diet, physical exercise, rest and relaxation, time spent with family and friends, and a close relationship with God—all of these partly solve the problem. Proper professional treatment, however, is very important to re-establish the biochemical balance of the brain. Who would refuse a course of antibiotics if one knew he had a serious but treatable infection? Depression should be thought of in the same way.

The fourth stage is inertia. Although we understand what is happening, and know what the solutions are, it is hard for us to apply them. Julie Hersh unravels the secret to success: go slowly, taking baby steps, day by day, until new actions become habits. “Despite medical progress,” Hersh says, “far too many people do not understand how to protect their brain from mental illness. Rest, physical exercise, a healthy diet, diminishing stress and social support are as important for mental health as is giving up smoking for the lungs.”

The last stage is acceptance. This is when we know what we have to do, and do it. Depression may reappear, even after a long period of balance, but we are certainly on the path to hope.

“I had a black dog, his name was depression”[13]

This is the title of an animated movie directed by writer and graphic designer Matthew Johnstone to mark World Mental Health Day on October 10, 2012. The movie portrays the way in which the ‘black dog’ of depression progressively takes over each element of our interior life and our relationships until it becomes one with us. However, there is hope for any person wishing to get his life back: specialised helped provided by psychotherapy and pharmaceutical treatment, together with strong support from friends and family and spiritual counselling, can turn the black dog into a manageable puppy. Even if it never leaves us, we can learn from it and become more empathetic, more sensible, and more human.

Despite the fact that depression is a negative experience which makes us more aware of our vulnerability and transience, we can still learn something from it. We learn that we have certain limits which should not be crossed. We learn to give things their due importance. We discover how much we need each other. We form new habits which keep our bodies healthy and our minds clear. We understand that without God, we cannot be fulfilled. We gain the courage to live life to the fullest. We welcome the surprises it brings, and trust in a future as bright as a spring afternoon—seen without sunglasses.