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The Complex Line between Sadness and Depression

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September 17, 2019
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Boston Evening Therapy Content

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When Does Sadness Qualify as Depression

The questions about the causes of depression and how to treat this common and disabling mental health disorder continue.

When does sadness last so long that it’s diagnosed as a major depressive disorder? Generally, two weeks, but in terms of loss of a loved one, two months, or perhaps longer.

Has psychiatry over-diagnosed depressive symptoms, so that medications are prescribed for issues that might be better considered normal human sadness? “Yes,” according to the authors of The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Illness. The answer is “No” from many neuroscientists and psychotherapists who encourage anyone who might be in danger of harming themselves get help from a professional, because depression is a treatable illness and medication can save lives.

Is depression a psychological or a biochemical illness? Current research says it’s probably a combination.

Overdiagnosis of Normal Sorrow as Depression

Rutgers University sociology professor Allan Horwitz and New York University professor of social work Jerome Wakefield argue that many normal emotional
phases of sorrow are over-diagnosed as major depressive disorders.

In their provocative book, The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Illness published in 2007, the authors claim that with the third edition of The Diagnostic and Statistical Manual of Mental Disorders, called DSM-III, in 1980, treatment took what they view as an unnatural turn.

Horwitz and Wakefield agree that medication can be necessary for serious depressive disorders. But they take issue with using a few symptoms listed in the DSM-III and newer editions, such as sleeplessness, loss of appetite and fatigue lasting for at least two weeks as the time to write a prescription for an antidepressant.

Horwitz argues that even with the newest edition, the DSM-5, that bereavement only as it applies to the loss of a loved one can cause these depressive symptoms that last longer two months. He views other losses, such as financial ruin or loss of a romantic relationship, to be a form of bereavement that can also ause sorrow to linger.

In an interview with Scientific American, Horwitz and Wakefield suggest “watchful waiting” as a first step to allow the person to use common coping strategies to deal with emotional trauma and ease back into daily life.

Horwitz and Wakefield also suggest that people dealing with depression seek the help of a mental health professional to discover underlying causes of the depressive symptoms and develop a plan to move beyond them.

The authors suggest cognitive behavioral therapy, which examines a person’s negative thinking and develops ways to turn it toward a more positive outlook. They also suggest psychotherapy focuses on improving relationships.

Horwitz and Wakefield review the long history of what Hippocrates called “despondency” when it was a temporary reaction to troubling situation, as well as the more stubborn version, which was called “melancholia.” The authors’ point is that humans have been dealing with sadness for a long time and it’s a normal response to difficult and sometimes devastating situations.

Biological and Psychological Causes of Depression

Stanford University neuroendocrinologist Robert Sapolsky concludes that the interaction of biology and life stressors can cause depression. Research has found a genetic factor in depression related to the production of seratonin, a chemical that can contribute to a feeling of well-being.

Studies have found that the biological factor in itself does not cause depression, but may make a person more vulnerable when confronted by a combination of stressors, such as loss of a loved one and losing a job.

When person suffers any major emotional trauma or loss, they go through a period of mourning and eventually “come out the side,” Sapolsky said in a Stanford University presentation. But those who may be vulnerable to depression, possibly because of having that gene related to seratonin, may sink into a deeper and longer period of feeling fatigued and hopeless. If they don’t feel like getting out of bed for long periods of time, if they cannot put the melancholia behind them, this biochemical disorder can lead to a major depressive event.

The Critical Need to Get Treatment for Depression

Wakefield’s more recent book, All We Have to Fear: Psychiatry’s Transformation of Natural Anxieties into Mental Disorders, published in 2012, delves into the issue of common anxieties and how some are long-term and others change over time. For example, the mystery of life and death is an eternal human consideration, sometimes a fear, while a currently increasing anxiety is over food allergies, and now even growlingly intense fear of a random mass shooting. The challenge is to recognize the fears or anxieties and find ways to overcome them, or at least manage them.

Although there are differing and evolving views of the causes of depression, social science and mental health professionals agree that the first step must be to seek diagnosis. Treatment can include medication, psychotherapy, exercise, mindfulness training or meditation, or a combination of these.

***If you or a loved one are experiencing severe depression or considering suicide, immediately seek help from a mental health professional or call the national Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).


Lehrer, Johnah, “Is There Really An Epidemic of Depression?” Scientific American, Dec 4, 2008

Nesse, Randolph M., “The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder,” Psychiatric Times, May 2, 2008

Sapolsky, Robert, “Robert Sapolsky Talks about Depression and Its Origins,” Stansford News video, Nov 10, 2009

“Data on Behavioral Health in the U.S.: Depression,” American Psychological Association, 2019

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