Depression Symptoms: How to Recognize a Worsening Illness

Colette Dowling, LCSW

On the Emotional Struggle to Become Independent

                Author of the following article on depression symptoms, antidepressants and psychotherapy, NY psychotherapist Colette Dowling has written "You Mean I Don't Have to Feel This Way?": New Help for Depression, Anxiety and Addiction. Her book, The Cinderella Complex: Women's Hidden Fear of Independence, was a NY Times best seller t hat was published in 23 languages. 

"Are these depression symptoms?" someone sinking into a dark mood, feeling sleepless and hopeless, might wonder. Maybe it's just "the blues", they think, or, "Hopefully it will pass". But maybe, just maybe, there's something really amiss, and what you need is treatment.

Depression symptoms can be subtle.

Or, as in the case of Joann, the illness can hit you like a ton of bricks.

Joann was thirty-eight when she was freed of the depression symptoms that had plagued her, off and on, for her entire adult life. Before finally getting help, though, she felt lower than she'd ever felt before. "I was in agony, caught up in an excruciating, unrelenting mental anguish that worsened with each day. I could see no end to the blackness that engulfed me."

While a particularly stressful event can trigger the blackness of depression, it can also appear from nowhere.

Or, as in Joann's case, depression symptoms can creep up so insidiously that the illness is never fully seen for what it is.

"Nothing had happened to make me feel so terrible," Joann says. "Yet every drop of color had been slowly drained from my life--so gradually that I didn't notice it happening. Then, all of a sudden, there was no joy left in my day. There was no pleasure in getting up to a new morning, in being with friends, or in doing any of the million and one things I love to do. All that stretched in front of me was an aching loneliness and emptiness. Nothing had meaning. Nothing brought pleasure. I wanted desperately to laugh and have fun again, but the pain grew worse.

Even with her painful depression symptoms Joann kept working. At first, work was a distraction, a way of keeping her mind off her troubles. But eventually it became a trial in itself as she tried to keep up a pretense of normalcy. At the office, she avoided people. "It was terribly important to me to conceal my pain from everyone, especially since I couldn't explain it. I struggled to keep control of my emotions. I didn't understand what was happening to me, and I felt as though no one else would, either.

When depression symptoms go untreated the illness gets worse. After a while, Joann had to stop pretending that everything was okay. She was forgetting, avoiding phone calls, growing more and more irritable. "Mail, phone messages, and requests began piling up. I was so confused. I couldn't seem to clear anything away. I couldn't concentrate enough to read. Even minor chores began to seem difficult."

Joann says that dealing with people used to be one of her strong points, but now she was misinterpreting others and blowing small incidents out of proportion. Things would make her cry, right out in the open. Often this is the point at which people begin to recognize depression symption. They're crying over things that would never have made them cry in the past.

Eventually, self-hatred set in. "I began thinking of myself as a terrible worker who had managed to fool people for a long time but who was about to be exposed as stupid and careless, someone who couldn't do her job." Life became "one long, confused haze." At this point Joann was barely managing to get herself out of bed and to the office. At work she spent her days choked with fear and anxiety, and when she got home she felt exhausted. "I stopped cooking, cleaning and even walking the dog. I lost weight. Sleep became my only escape, and I tried to sleep as much as I could. I never woke up really refreshed. At my worst I would snap awake in the early hours of the morning with a terrible knot gripping my stomach."

                                            Depression Symptoms: A Confusing Experience

The term depression, used in so many ways, can be elusive. In common speech, it describes the "down" or blue state everyone experiences from time to time. But in psychiatry, depression refers to an inability to experience pleasure at all. The inability to feel pleasure is known clinically as "anhedonia". Those who experience it tend to be able to describe it only in metaphors. "It is like a black cloud," they will say.

Another depression symptom is trouble concentrating, which leads to loss of interest in things that were once stimulating. Boredom may be how the patient describes it, but that sensation--or, more accurately, LACK of sensation--is depression. "Objectively, it appears as a steadily increasing disinclination to take part in normal activities," explains Dr. Max Hamilton, in a psychiatry textbook. Work becomes harder to accomplish, concentration diminishes, decisions are put off, and the great pileup of untended tasks begins: laundry, bill paying, taxes. Interestingly, Hamilton says depressed women keep up with their tasks far longer than depressed men.

When Joann finally sought the help of a therapist, "she put the whole picture together." A lot of information had to be gathered before that picture could be seen clearly. The therapist found out about Joann's childhood and adolescent mood symptoms and also about mood, anxiety and addiction problems of her relatives. It came as something of a relief to Joann to learn that there were a lot of depressive threads in her family history. Certainly there was a depressive thread in Joann's own life. Hormone shifts seemed to trigger her depressed moods--at puberty and premenstrually. In fact, she might be at risk for another bout of depression when periomenopause sets in, but if that should happen, Joann will know what to do to get prompt help and prevent the symptoms from taking over her life.

In addition to continuing with her therapy, Joann began the antidepressant treatment her therapist recommended. Within a month her leaden symptoms began to lift and it wasn't too long before she felt in contol of her life again.

"It seems so weird, in retrospect," she says. "I'm an intelligent person. Why didn't I recognize my symptoms and why didn't I see the connection between this episode of depression and similar if not such serious ones I'd had in the past?" One reason might be that depression actually makes it harder for us to think straight, to remember, to "put the pieces together". Once the illness is treated, we seem smart again, with sharpened focus, and it's hard to imagine how we functioned during those days when everything was so blurry. The brain that's clear is the brain that's not depressed.

Author of the above article on depression symptoms, NYC psychotherapist Colette Dowling, LCSW, has a private practice in Manhattan. She has written a number of books, including "You Mean I Don't have to Feel This Way?": New Help for Depression, Anxiety and Addiction. Other books are The Cinderella Complex: Women's Hidden Fear of Independence, Red Hot Mamas: Coming Into Our Own at Fifty, and The Fraily Myth. Colette has a masters degree from The Smith College School for Social Work. I

In addition, she is certified in psychoanalysis and is trained in using EMDR and AEDP for the treatment of trauma.

Her office on Fifth Ave. is convenient to Brooklyn, Queens, Hoboken, and Jersey City, as well a Manhattan. She can be reached at, or by calling 718-594-0201.

To hear Colette speak about what it's like to think of starting with a new therapist, click the button.

For a description of Colette's approach to psychotherapy, click here.

For other articles on depression symptoms see Colette's website on the unique aspects of women's mental health.

Copyright Colette Dowling, 2006-2010