25 thoughts on “Am I Still Depressed If I Don’t Act Like It?

  • April 28, 2010 at 10:58 am

    Well, I don’t see it as being any different from those with chronic pain, in the process of dying from cancer or being blind. These are conditions. They can disrupt your life or you can teach yourself to use them to have you be more flexible and open so that they do not have a visible negative effective. I can be dying from cancer and live to the fullest. I can be blind but fully aware. I can be depressed yet not let that condition impact my purpose.

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  • April 28, 2010 at 12:19 pm

    With almost every disorder in the DSM-5, it states that the symptoms must bring distress and interfere with your life. In fact, if you want to be technical, there usually needs to be more symptoms present – fatigue, aches and pains, weight loss/gain, concentration difficulties, etc. It states feeling sad is only a SYMPTOM, not the disorder itself. So, by technical definition, even if you do have other symptoms you didn’t mention, if it is not interfering with your life, it is not a disorder.

    But most people don’t follow the exact wording.

    So, if you go by what is generally used, not technically, you are depressed and have depression. I don’t agree with that at all. An emotion, such as intense sadness, is not a disorder. At most, it is a symptom of one; but cannot diagnose someone by itself. Other symptoms and reaction (though they are wrongly clumped), and an interference in your life, need to be there. If are extremely sad, yet function perfectly, you are depressed; however, you do not have the disorder of depression. This is both technically true and true to my own opinions.

    To answer your question then, I will say you are depressed without a doubt; but you do not currently have depression.

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  • April 28, 2010 at 12:21 pm

    I can understand how the mind can make the body do all kinds of things. Unfortunately I’m far from being capable of such acts. I have cyclothymia and my depression isn’t under control yet/it’s nearly crippling for weeks at a time.

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  • April 28, 2010 at 12:37 pm

    I don’t get it? Why would you say you are the most “depressed” you’ve ever been, even worse than your suicidual depression, and be productive and not overwhelmed? If you are able to handle the emotions and physical sensations, then I don’t think that’s classified as “major depression.” Honestly, I think at least for me, saying you are “the most depressed you’ve ever been” or “severely depressed” means that you are hopeless, sinking into the depths of despair with no end in site. Why else would someone say and write that? There is some “power of suggestion” with depression. If think of yourself as having Major Depression or severely depressed, you will be. If you say you are fine, productive, and not depressed, then you aren’t.

    Maybe you are just sad? I believe that depression by definition and Major depression as outlined in the DSM, involves some level of reduced functioning.

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  • April 28, 2010 at 1:23 pm

    Hi Erica and LS,
    Thank you for sharing your thoughts. As I said in the article – I wonder if I am depressed at all. I am clearly way beyond sad. If I look at the criteria as found on PsychCentral or talk to a doctor I am supposedly a textbook case of depression except for my behavior:
    http://psychcentral.com/lib/2006/types-and-symptoms-of-depression/

    Symptoms of Depression
    Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Severity of symptoms varies with individuals and also varies over time.

    Persistent sad, anxious, or “empty” mood – got that
    Feelings of hopelessness, pessimism – that too
    Feelings of guilt, worthlessness, helplessness – yep
    Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex – definitely
    Decreased energy, fatigue, being “slowed down” – yep
    Difficulty concentrating, remembering, or making decisions – yep
    Insomnia, early-morning awakening, or oversleeping – yep
    Appetite and/or weight loss or overeating and weight gain
    Thoughts of death or suicide; suicide attempts – thoughts, but not attempts
    Restlessness, irritability – some
    Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain – yep

    I definitely have depression according to the criteria above. I would even say it is extreme based on intensity of the experiences. The fact that I can experience those symptoms and not be overwhelmed by them is the conflict. I can perform my duties as well as normal, find meaning in my experiences, learn from them, and even go as far as to say that they are equally valuable to any other experience. I don’t even care to make them go away. It confuses those who hear me say it while seeing me act differently than their expectations.

    The point is: can we be depressed and have a choice of how we react to it? Or is depression defined by an inability to choose? Can we have reduced functioning in some areas and increased functioning in others? Is depression the feelings we have or is it our inability to choose how to react to them?

    My work with thousands of people has shown that we mostly believe that it is not possible to be depressed and function. The definition is not only confusing, it feeds the false belief that it is impossible to function while depressed.

    I am not saying I know the answer, just that my experience and that of many others does not match the assumptions. We teach people how to get depression “In Order” and have been very successful with it, so perhaps it is something that we can all learn once we accept that it is possible.

    I am hoping that more people will share their thoughts. It is only through sharing our experiences that we can all learn to better define and understand our condition.

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  • April 28, 2010 at 1:31 pm

    Hi Joye,
    I didn’t mean to skip over your comment. I agree with it completely as I so often do when you share your thoughts. You are a great example of what I talk about. I appreciate your input and hope some day we get to meet in person.

    Reply
  • April 28, 2010 at 1:40 pm

    I suspect depression is more existential than most would admit. Seems to me life can be very depressing at times and manic at other times. I believe there is value in surviving a deep depression, because “that which does not destroy us DOES make us stronger.” As noted in previous posts, it does not mean we will not be threatened again (chronic pain, chronic depression), but rather, our body and mind have learned to cope with whatever malady affects us. I think there is a degree of natural selection in this. In some instances, perhaps survival and the will to live can trump depression.

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  • April 28, 2010 at 6:06 pm

    I found the whole discussion quite interesting and I thank everyone for their comments. I have been depressed now for a year but I still manage to get up and go to work. I see it as just “going through the motions”. Over time, I have become very good at hiding how I really feel: irritable, negative, sad, hopeless. I am really pretty good at doing this out in public, but my true self comes out once I get home. I am despair. And this is disappointing to me as I want so badly to feel upbeat with my family. It takes so much energy at work to appear “fine”, that when I get home, it is hard to keep it up. I used to paint and create all the time…as relaxation when I returned home from work. I don’t have the motivation to do that. Art is my passion, too. Yeah, depression is a continual thing alright…to me, it never lifts its ugly head. (quite infrequently) Try living with someone like this. I am sure it is very hard on my child and husband. I feel so bad about it, and that fuels my sadness even more. I wish I could change my way of thinking. It is hard to change an existing pattern deeply embedded within the dyndrites (sp?) of my brain. I think we are stronger in some ways because we endure it….but in the long term, what does it do to our quality of life?

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  • April 28, 2010 at 6:52 pm

    Who cares if you are “depressed” or meet “criteria” for Major Depression! If it is bothering you despite being able to function at a superior level, seek treatment or work with your current mental health professionals on the problem. If you need a diagnosis for insurance or personal reasons, then ask your therapist or psychiatrist for one.

    I don’t think you have to be completely non-functional to be “depressed.” I’ve actually been quite functional, but your functioning has to be significantly reduced. For example, a student who could easily handle 4 classes, can barely handle 3 classes. Even in the non-mental health definition, depression refers to a decline in economy. But it’s also just labels.

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  • April 28, 2010 at 6:58 pm

    Mike-
    Definitely depends on the person. I know plenty of cases where the depression devoured the will to live and survive and the person only got better through therapy and/or medication. Also, I don’t know if depression makes you stronger. The increases cortisol levels cause brain damage, not to mention all the damage you likely did when you were seriously depressed. The depression usually comes back. However, if it’s not “major depression,” but more mild stemming from a tragedy or problem and you learned how to deal with it, then that might make you “stronger.”

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  • April 28, 2010 at 7:03 pm

    Also, I think that mental illness in general is defined by your inability to choose, in varying degreed. OCD takes away a person’s ability to stop preforming a ritual (among other things), ADHD takes away your choose to pay attention, psychosis takes away your ability to make coherent decisions, etc. People may not agree with it, but that’s how modern western psychiatry defines it.

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  • April 28, 2010 at 7:07 pm

    Also, I don’t agree that the main exceptions to this rule, sexual fetishes and personality disorders, are actually mental health disorders (sorry going off-topic).

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  • April 28, 2010 at 7:18 pm

    “A. Five (or more) of the following criteria have been present during the same 2-week period and *represent a change from previous functioning*; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.”
    http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=45

    That is what creates a conflict. You show almost every symptom of depression, yet are acting fine. I think to answer the question, you have to define functioning. According to dictionary.com, it means “the kind of action or activity proper to a person, thing, or institution; the purpose for which something is designed or exists; role.” In other words, how you are supposed to act. So, be definition, you are functioning. Yet you have symptoms and thoughts of mental illness. A huge contribution.

    These are certainly things the DSM needs to better address and clear up. For now, there are no black and white answers. For now we have your terms to go by – you are IN order and not DISordered.

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  • April 28, 2010 at 8:33 pm

    Hi everyone,
    I am new to blogging and as I learn I decided on this post to start interacting with the comments. I find that I am overwhelmed and unable to function. I have developed bloggers disorder 🙂 I want to answer everyone’s comments and am afraid that if I miss one I have slighted the person by not acknowledging him/her. I have to figure out how to get it “In Order.”

    LS, I really like your idea that “mental illness in general is defined by your inability to choose.”

    Erika,
    I love your idea that we should call it two different things – “you are IN order and not DISordered.”

    You two, and the other comments have me thinking along these lines:
    There is an ILLNESS called depressive disorder (and bipolar disorder), but there is also a CONDITION called “Depression In Order” (and Bipolar In Order, Schizophrenia In Order, etc.). Perhaps the ILLNESS or DISORDER is our inability to function. Depression and mania IN ORDER share the physical, mental, emotional, and spiritual characteristics while maintaining cognitive functions and ability to choose how to react.

    There are so many people talking about disorder that it has become the dominant belief. I am looking for people who want to explore In Order and how we can develop it.

    My own condition is a combination of disorder and in order, as I am sure many of us are if we look for it. I think the best place to start looking is to try to separate our moods from our reactions to it. I plan to do a post about that next, so I will not go into it here. I would love to hear what others have experienced. Can you share a time when depression had you in bed crying, yet later the same feelings didn’t affect you as much? Would you consider yourself depressed during the crying episode, but not in the other one?

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    • July 15, 2015 at 8:22 pm

      Tom

      When I bring up the way I handle my bipolar condition I often get blank stares and hostility from members of my DBSA group. I too like you feel I have control of my reactions to my bipolar conditions. I was not diagnosed until I was in my 50s but I have been being treated for anxiety and depression for about a decade. I remember manic and depressed episodes back into my childhood. I feel that I know when my state is changing and can take steps to continue functioning at a fairly high level most of the time. One way I deal with depression state is to just somewhat except that I feel bad but continue in my daily routines. I do take Xanax if my anxiety is bad but often when depression iis the issue I continue on with aches and pains and the fog in my Brian. I don’t try to feel better or fake feeling better. I plan to read more of what you have written as I am glad to hear other bipolar people have methods of continuing functioning at some level through tough times. Thank you for your writing.

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  • April 28, 2010 at 8:43 pm

    LS,

    Exactly! My point was, “it definitely depends on the person.” When depression “devours the will to live and survive” the individual does not “live and survive” – therapy and/or medication aside. I did not mean to imply “depression makes you stronger.” YOU “make you stronger” (or weaker). Why does on species survive in certain environments, while others perish? We are all subject to “increased cortisol levels”, etc., so why do some survive and others not? I don’t know that “depression usually comes back” so much as it really never leaves. Either you deal with it, or it deals with you.

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  • April 30, 2010 at 3:32 pm

    My problem with this kind of thinking is, that it seems as if by mere choice you can stand above your episodes or Depression, or whatever, which suggests that we can deal with it by will power. Belief ye me, if I could decide not to have this illness interrupt my life, I would!!

    At the same time I do agree that it is important how we react to what happens in our moods. This, however, needs to happen early on, in my experience. Once my mood catches me, I have to ‘ride it out’ so to speak. Maybe this is also because I am dealing with some major traumas.

    I have only been diagnosed since January 2007 after being severely suicidal for over a year. However, looking ack I have manifested it since I was 15. When well into 2007 I realized that suicidal thoughts were part of my illness, I decided I was done with them, it wasn’t part of who I am. This doesn’t mean those thoughts never enter my mind, they do. But I refuse to entertain them, also knowing that it is not my desire to die in as much the wish for the pain to stop.

    So I am still out there in this ‘choice’ of being In Order thing…

    I do believe, though, that I have a disorder, it is not who I am. I don’t rally care how it is labeled, as long as I learn to deal with it and get better in doing it. I have a good pdoc and a wonderful counselor helping me. I could’t do it without them.

    I’m glad to have found this site. I hope to get more food for thought and share my part.

    The Crazy Rambler

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  • May 1, 2010 at 7:17 pm

    Hi,

    Interesting stuff. I work in disability and the diagnostic criteria may apply here. When a person has a physical disability that impairs functioning, it is called a disability. However, if they are able to compensate for their physical abilities such that it does not impede function, it’s called a condition. That distinction is the key. For example, the deaf community are very proactive in terms of advocacy. They do not consider their hearing loss a disability as their other senses more than compensate for the hearing loss. They have skills and abilities that those with hearing do not. The same applies for depression. If you can function such that others are not even aware of the condition, it’s no longer an illness or an impairment. It’s still there, of course. Tom explains this quite clearly in ‘Bipolar In Order’ when making the distinction between ‘disorder’, ‘impairment’, ‘condition’ and ‘in order’. It seems really clear to me – maybe that just says more about my dichotomous way of thinking!

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  • May 1, 2010 at 7:33 pm

    Hi Collette,
    Thank you for sharing about physical “conditions” and the deaf community. I had not heard of those perspectives as comparisons to mine about bipolar in order. I will do some research and use them in my future talks and maybe even the next book. I greatly appreciate your input.

    Crazy Rambler,
    Thank you for sharing your issues with my perspective. They are understandable and I was hoping someone would be willing to challenge what I say. The point, which you make very well is that it is good to hear different perspectives, get food for thought, and share our perspectives too.

    I hope you can at least entertain the possibility that some day we can all grow to be able to choose how we react to all stimuli. It is far from a “mere” choice, but the result of incredible work sustained over a long period of time. The good news is that even a little effort will result in measurable improvement within six months or less. I think you have already proved that in your own life. You clearly have learned to recognize it when it is coming and sometimes at least head it off before it gets too strong.

    I too could never have made the progress I have without help.

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  • May 13, 2010 at 3:32 pm

    Okay, I’d like to throw a question out here:
    Would you then say that once you have learned to deal with your mental illness; meaning your functioning is hardly impacted despite your changing moods; you are not mentally ill any longer?
    Is this what you, Tom, mean by being bipolar In Order? Because I have a genetic and chemical component, I guess I’ll always have the predisposition…

    I must say that I like the idea. I do believe that I can come to a point where my bipolar will not impact me to the extend that it immobilizes my live.
    Actually, I do believe that I can pick up my live as a social volunteer worker with youth in schools and the streets in Ukraine.
    I am too afraid to voice it too loudly around me, though, because I am afraid I have been labeled, stigmatized and deemed unsuitable. I am blessed, though, with a counselor who believes in me and my desire to do the work I am passionate about.
    Not saying that I feel it all the time like that, but I do know that it still is my passion and that it is what I want to do.
    When I was diagnosed and even now, I am concerned I won’t be able to do it because of the meds and the check ups with that and/or the availability of meds in Ukraine and such. My goal would be to be on no meds, but at least on as few as possible.

    Another question I’d like to ask you Tom: are you sure you don’t have a mixed episode? I understand that you have quite a lot of the symptoms of the depression, but what about the mixed state, where you are depressed ánd active. (I happen to be in such a state right now. Super weird.)

    Also: Any comments or experiences with getting your bipolar In Order when rapid cycling?
    Since April I have had the following episodes: 2 weeks manic/hypomanic (had to take additional meds); about 10 days mixed; a couple of days more or less normal; couple days depressed and now mixed again. When I look at it, I feel crazy already! lol
    The switching and adjusting to all these different emotions / feelings is hard work as is keeping your head above water.

    Looking forward to any resonse! Thanks.

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  • July 8, 2010 at 12:01 pm

    I think I know what you mean. Ten years ago I tried to take my life. The depression and feelings of anxiety and despair seemed never ending. I wanted nothing more than it to stop. Now I’m older, perhaps wiser, when I get depressed it doesn’t have the same control over me anymore. I just feel numb, like I don’t really care what happens. I know that eventually I will come out of it. I have a great support group and I try my hardest to rid myself of any pressures or stress. I have felt depressed now for 7 months, things are getting on top of me, but not to the same extent. I can still go to work, go out with friends, all things I couldn’t do ten years ago. I know soon the numbness will fade, and I’ll be stronger for it. It’s like every depression I have gets a little easier, but sadly never shorter. I do still cry, but I think it’s the thought of coming out of it gets me through, the thought of having fun when I’m high. I thought that I may be in a mixed episode, but it really doesn’t feel the same. Just numb.

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  • December 24, 2010 at 6:13 am

    Well,
    Dysthymia, for instance, is greek for ill-mood, ill-humour/dysfunctional thinking/feeling.

    No one mentioned Dysthymia with its potentials for double depression.

    I have read that Dysthymia can be embedded in you in such a way that you can still have a sense of humour which appears etc and perhaps enjoy and feel energised by eating out etc, but the sufferer’s life is tinged by “why bother, does anything matter?” feelings, low enthusiasm and all of the symptoms of depression.

    So, to those who have dysthymia, how does this fit with the author’s feelings “am I even depressed?”

    I consider myself dysthymic, but sometimes I wonder as my mind is sharp as a tack and my sense of humour dry, considering myself realistically minded (well, these days)
    However, it’s possibly my entire outlook, humour, lack of socialising is due to early onset dysthymia and I never noticed.

    When I see what people can manage, I just think “what the hell am I doing with my life”

    Then again though, a consultant psychiatrist believes that my problems are caused by a possible autism spectrum disorder and I see PDD-nos as a perfect representation of me.

    Maybe some people just exist in a pessimistic state?

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  • December 24, 2010 at 6:56 pm

    Well, I can see this article has sparked a lot of controversy. However, as one can put up a good appearance, sometimes, for short spells, with the sucking whirlpool of depression trying to pull me under and coloring my life with a hopelessness and dread that is only partially bearable, I can attest to being better than I was in the past, but far, far from well. I always figured that if I could fake it pretty good and if I wasn’t actively seeking my own demise, than I should “man up” and not allow for being ill. It’s interesting the intensity this topic has generated. I, for one, am grateful for the distinctions made here.

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  • December 27, 2010 at 4:39 pm

    Hi Mark,
    It sounds like you are well on your way to changing your relationship to depression. One important point: Faking it is not what I am talking about. I feel the experience perhaps even more intensely and do not hide that from anyone. I am not faking like I am experiencing happiness, but choose to react to pain by acting appropriately to each situation. If someone asks how I am doing I tell them the level of pain that I am experiencing. It confuses them, but helps them to understand something much deeper than if I was to fake it and say everything is great or that I am happy.

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  • December 5, 2015 at 7:36 pm

    This article explains what I have been thinking, word for word. I have been diagnosed with bipolar disorder and have attempted suicide a few times. But I function well when it comes to working and taking care of my son. Is it hard? Yes, very. But I push through my feelings of wanting to climb under the covers and sleep forever. Do I wish I was dead at times? Yes, all the time. I function, therefore I am not depressed at times?? That is an ignorant statement. People who are depressed and function have to work twice as hard but the feelings are always there.
    Second of all, what about those (such as myself) that hide behind their smile?? They function and pretend everything is ok. Do they not have a churning knot inside their stomach and a heavy heart from pain? No one knows who is suffering. No one should judge another. Just because we function, does NOT mean that we are NOT depressed.

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