Really depressed or 'just stressed': how to tell the difference
By psychologist Angie Willcocks
Years ago I did a study with a group of teenagers to see if they were able to recognise the signs of depression in one of their friends. Results showed that they generally did understand when something was wrong. However, many were likely to the name the problem as 'stress' rather than depression.
In my experience, adults also frequently misinterpret symptoms of depression, very often labelling signs of depression as stress. This seems to particularly be the case for men. I suspect that part of the reason is because it's easier for men to admit to being stressed than it is to being depressed. "I'm just stressed" is perhaps easier to say than "I think I might be depressed" or "I'm really struggling".
So what is the difference, and how do you recognise if someone you know is depressed, anxious or stressed?
While depression, anxiety and stress do share some similarities (they may all affect sleep for example) each has 'classic' signs or symptoms.
Depression can be summed up as feeling sad and low for most or all of the time and losing interest or pleasure in things that would usually be interesting and pleasurable.
Depression often results in people feeling physically 'heavy' or weighed down, tired and lethargic. One of the common signs is feeling and thinking as though everything is an effort or hard work and nothing is fun or easy anymore.
Common thoughts are ones like: "What’s the point?", "I can't be bothered", "I hate my life", "Everything sucks", "People suck" and "I’m boring". People who are depressed may also notice they are thinking more than usual about death and dying. These thoughts are not necessarily suicidal but may be thoughts like "It wouldn't be so bad to be dead" or "when will I die?"
Outsiders may notice the person withdrawing from things they would usually enjoy, as well as a generally negative tone about almost everything. The person in question may look sad or grumpy a lot of the time and joking and laughter are often absent.
Sleep may be disrupted - a classic sign of depression is waking in the early hours of the morning for no apparent reason. Appetite can either be increased or decreased. Some people certainly increase their alcohol intake to try to avoid the sad feelings and to try to increase some good, happy feelings.
Depression might come after a life event (divorce, job loss, illness or major disappointment) or seem to come out of the blue with no apparent trigger. People who have experienced depression in the past, or with a family history of depression are more likely to experience depression.
Anxiety can be summed up as feeling or nervousness or uneasiness with accompanying worry. Anxiety is a normal human emotion and often comes before an event that is likely to be challenging in some way (exam, job interview or public speaking engagement). Anxiety becomes problematic when it is persistent, excessive and difficult for the person to control.
Anxiety often results in people feeling a number of physical symptoms such as shortness of breath, tightness in the chest, dizziness, trembling in the hands, racing heart, shakiness, feeling sick and an overall feeling of fear or being close to panic.
Common thoughts are things like: "There’s something wrong with me", "I can’t breathe", "I can't cope" or "something dreadful is going to happen". Worries may be general, such as "something might go wrong" or quite specific "I will make a fool of myself at the party".
Outsiders might notice the person worrying about every little thing, or excessively worrying about relatively 'small' events or situations. The person in question might look worried or uptight a lot of the time and have difficulty relaxing. They may pace around and appear agitated by constantly moving a part of their body (shaking their leg up and down while sitting or rearranging their hair or clothes).
Sleep might be disrupted and the person might have difficulty getting off to sleep or staying asleep. Appetite, if affected, is often reduced. Some people certainly increase their alcohol intake to try to avoid the uncomfortable feelings and thoughts related to anxiety.
Like depression, anxiety may appear for the first time after a life event (illness or negative experience) or may seem to come out of the blue with no apparent trigger. People who have experienced an anxiety disorder in the past, or with a family history of problematic anxiety are more likely to be diagnosed with an anxiety disorder.
Stress can be summed up as feeling keyed up and finding it hard to relax. Being stressed often relates to external factors going on, such as a busy and demanding time at work, financial pressures, moving house, changing jobs, a sick relative or relationship difficulties. Stress often results in people feeling physically tense and 'wired'. People who are stressed often experience a 'racing mind' (going over all that needs to be done), muscle tension and difficulty winding down.
Common thoughts are things like: "I've got too much to do", "How will I possibly get it done", "I’m not sure I can cope with all this".
Outsiders might notice the person appearing busier than usual, having difficulty settling to do something (watch a movie or read a book for example) and regualry appearing tense. They may also notice that the person is unusually impatient or irritable about 'normal' life events (waiting in line or at the traffic lights).
People who are stressed might withdraw from social activities and this is usually because they think they are "too busy", "have too much on" or "have more important things to do" rather than thinking they "can’t be bothered" or that they "won’t enjoy it" (as in depression).
Sleep may be disrupted and the person might find it difficult to fall asleep or go back to sleep after waking because of their busy mind. The person may feel as though they have had a restless sleep.
Sometimes people eat more or less than usual when they are stressed, and some people do increase their alcohol intake. In the case of stress people often drink more to help them 'wind own' or 'relax'.
Long periods of poorly managed stress can lead to depression and/or anxiety.
What to do if you think your partner may have depression or anxiety
Talk to him about your concerns and ask specific questions about symptoms. That way you'll help to determine whether what's going on is "just stress" or not. Questionnaires like those available on the beyondblue website (see below) are very useful as they ask about specific symptoms, and the frequency of them.
If you think he might be depressed or anxious, or even stressed and not managing it well, encourage him to have a look at the beyondblue website and ideally talk to a GP. If a referral to a psychologist is warranted, the doctor will be able to organise this. Medicare covers part or all of the psychologist’s fee (for up to 12 sessions a year) in cases where a GP suspects their patient might be experiencing depression and/or anxiety (as well as other mental health concerns).
To read other columns written by Angie Willcocks during her six years with Mining Family Matters, please click here. And remember that we offer a free email Q&A service with our psychologists, so just click here to ask a question about relationships, parenting or your career. All advice on Mining Family Matters is for general information only and should never be regarded as a substitute for professional health services or crisis services. To talk with a trained volunteer telephone counsellor at any time of the day or night, call Lifeline on 13 11 14. To contact the info line at beyondblue: national depression initiative, phone 1300 22 4636.