We may live in a society that prizes perpetual happiness, but changes in mood are actually healthy—and precisely what give our life dynamism, depth and flair.
At the same time, the growing rise of mental illness diagnoses—from depression and anxiety to bipolar and borderline—leads many to wonder if what they’re experiencing is “normal.” When does sadness transcend into depression? Is panic over a big presentation mere butterflies, or indicative of an anxiety disorder? And what are run-of-the-mill mood swings, and what’s symptomatic of a graver psychological condition?
As psychologist Peter Kramer says in Psychology Today, “Diagnostic labels are proliferating, and mental disorders seem to be annexing ever more territory...Ordinary sadness, critics say, has been engulfed by depression. Boyishness stands in the shadow of attention deficits. Social phobia has engineered a hostile takeover of shyness.”
And yet, as Kramer also points out, a proper diagnosis can save a life—and the health and well-being of a sufferer’s loved ones. Here’s a primer on what’s “ordinary” and when you should reach out for help or seek out mental health screening:
Is it the blues—or depression?
“I’m depressed” has become such a large part of our parlance that the distinction between sadness and depression has been obscured. But feeling vaguely down or genuinely sorrowful—whether from the death of a family member, a major life change, or from nothing, really, at all—is a completely different beast than clinical depression.
“Sadness is a normal part of the human emotional spectrum—we all experience it from time to time,” says Danielle Poole of Mental Health First Aid USA, which is operated by the National Council for Behavioral Health. “When we lose a loved one, go through a breakup or watch one of those heartbreaking ASPCA commercials, sadness is a typical reaction and a healthy part of the emotional process. But there is a difference between healthy sadness and the often-debilitating symptoms of depression.”
Often debilitating is key here. Sadness may darken part of your days, or some entirely; depression tends to impact every major domain of your life. Further, the difference between sadness and depression doesn’t come down to scale—or the depth of your grief—but rather the other issues that arrive with it. The DSM-5 Diagnostic Criteria for Depression states that an individual must experience five or more symptoms, out of eight, during a two-week period (and on a nearly daily basis), from feelings of worthlessness and fatigue to a diminished ability to concentrate.
In other words, sadness is unpleasant, even awful, but depression is a complex mental illness that “must cause the individual clinically significant distress of impairment in social, occupational or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.”
When to seek help: If your despondency persists for more than two weeks, you take little or no interest in things you used to love, you’ve experienced changes in your eating and sleeping patterns, or if you have recurrent thoughts of death and/or suicidal ideations, reach out to a professional immediately.
Is it nervousness—or an anxiety disorder?
Passing worries, to be frank, are a fact of life. Apprehension can be stirred by a variety of reasons, whether it’s an important report due at work, your child’s first day of school, or results from a medical test.
But, akin to the difference between ordinary sadness and clinical depression, there’s a vast difference between feeling “stressed” to feeling perpetually in fear. Impacting nearly one-third of American adults at some point in their lives (according to the American Psychiatric Association), anxiety can be all-encompassing, while quotidian worries and stress are a natural part of the human experience.
“From the outside looking in, it can be difficult to spot the differences between stress and anxiety,” says Katie Hurley, LCSW. “Both can lead to sleepless nights, exhaustion, excessive worry, lack of focus and irritability. Even physical symptoms—like rapid heart rate, muscle tension, and headaches—can impact both people experiencing stress and those diagnosed with an anxiety disorder. With symptoms that can appear interchangeable, it can be difficult to know when to work on deep breathing and when to seek professional help.”
When to seek help: (So glad you asked.) Also similar to depression, anxiety versus an anxiety disorder essentially comes down to three things: duration (excessive anxiety or worry that persists, on a daily or nearly daily basis, for six months); an impact on functioning, including work and relationships, and the inclusion of psychosomatic and physical symptoms, including but not limited to restlessness, fatigue, muscle tension, headaches, stomachaches and sleep disturbances. As Psycom puts it, an anxiety disorder is often characterized as “out of proportion to the actual likelihood or impact of the anticipated event or events.”
Sound familiar? Discuss with your physician to rule out any underlying health reasons, such as an overactive thyroid, and get a referral for a psychologist.
Is it a good old-fashioned mood swing—or is it a mood disorder?
You’re grumpy one minute, weepy the next and downright euphoric an hour later: Mood swings are some of the most dramatic experiences you can have, leaving you (and, most likely, your partner, children, family members and colleagues) feeling shaken, confused and tender. While highs and lows are also a standard part of the human experience, a mood disorder—those mentioned above, as well as bipolar disorder, seasonal affective disorder, borderline personality disorder and cyclothymia—manifests in more worrisome ways and often with larger consequences. As WebMD writes, “Many things can affect how your mood shifts throughout the day.
For example, because of body rhythms, most people feel upbeat and energetic around noon but tend to have more negative feelings during the early afternoon or evening.” As with the two conditions explored above, bipolar and related disorders impair your ability to function—in relationships, at work and school and in general. Those with bipolar disorder, for instance, endure vacillations that “are much more intense and longer-lasting than usual mood swings,” WebMD says. Depressive stages may lead to feelings of wanting to harm yourself, while manic spells may present in reckless behavior such as overspending, an unusually-high sex drive, speeding or having an over-inflated sense of confidence.
When to seek help: One of the biggest things to keep an eye on is changes in sleep patterns. An inability to sleep—or the need/desire to sleep far more than usual—is a hallmark symptom of bipolar disorder. If you’ve noticed that you’re drinking more than usual (or abusing another substance), you will want to promptly find professional help as well; many patients with bipolar disorder, for example, also have a substance abuse disorder (one in five, to be precise). Engaging in unprotected sex might also be indicative of something larger at stake than a mood swing, while outbursts of anger and reactions to issues that are out of proportion to the circumstances can be a telltale sign of a mental illness. Dissociative feelings—such as feeling outside of your body, or losing time—are also warning signs (and dire ones at that).
Whether it’s due to a hormone imbalance, stress or a mental health condition is rather irrelevant; what matters is that you seek medical attention straightaway. Treatment is available, and learning what’s causing these vacillations in your mood, thoughts, and behaviors is the first step towards achieving equilibrium. As Kramer puts it, a “diagnosis,” despite the proliferation of them, “can bring relief, along with a plan for addressing the problem at hand.”
