Clinical Depression versus Sadness

By on September 1, 2016

severe depression womanClinical depression differs from sadness.  We all experience periods of sadness in our lives. It’s part of the human condition; however sadness and grief should not be mistaken for clinical depression, which is a legitimate condition that requires professional treatment.

It’s common to hear the word “depression” to mean feeling down or low. Depression is different, because in addition to having a sad or low mood, there are symptoms that cause significant problems in a person’s ability to function on a basic level.

“Grief” would more accurately describe the feelings and symptoms after a loss such as the death of a loved one or a break up. Grief typically resolves on its own with time and support.   You can think of this, as the old saying goes, as “Time heals all wounds”.

Unlike situational sadness, clinical depression rarely improves on its own and it’s not necessarily caused by a life loss or difficult situation.  In fact, author Andrew Solomon in his book  The Noonday Demon: An Atlas of Depression describes his experience with depression as “lack of vitality.”

It is is a common misunderstanding that can leave family and other loved ones confused and frustarated.  To them it may seem that the person with clinical depression is lazy or lacks motivation.  People who haven’t experienced these symptoms may believe their loved one should “snap out of it”; however clinical depresion is a condition, a brain disorder.

In its most severe form, depression can leave a person unable to function.  It can be as devastating, if not moreso, than a physically debilitating illness. We should be aware of the signs and symptoms of severe depressive disorder for two primary reasons, 1. because there is help for people who are suffering and 2. some people who suffer from severe depression are at risk of hurting themselves or others.

This occurs because, when a person is in the midst of the severe episode of depression, they reach a point of feeling so worthless and hopeless they decide the only way to solve the emotional pain is to kill themselves.  Less commonly, those suffering from clinical depression, will have thoughts of harming others.

Harming others or oneself doesn’t necessarily mean intentinonal harm.  A person suffering from depression may neglect their medical care, which is particularly serious if they have a chronic condition such as diabetes.  Loved ones also suffer. Imagine a mother who is unable to provide basic care for her children, or the breadwinner of a family being unable to work and bring in a regular income.

On top of the emotional pain clinical depression causes, it can also lead to physical symptoms that vary from one person to another. Experiencing physical symptoms in addition to the depression can make it even more difficult to face basic responsiblities.

Let’s review some signs of clinical depression and examples of severe depressive symptoms.

Symptoms of Severe Clinical Depression


Suidical or Homicidal Thoughts

If someone you know is having thoughts of killing themselves or of harming someone else, it’s imperative you get them emergent care.  You can encourage them to go to the nearest emergency room.  They may feel more comfortable if you accompany them.  If the person is hesitant to get help you can call the National Suicide Prevention Hotline (800-273-8255) for support and referrals.  In a dire situation,  911 is always an option.

It can feel intrusive, unnatural, and odd to come right out and ask a person if they are feeling suicidal.  It may seem as though bringing up the subject will plant ideas in someone’s mind; however, this is absolutely not true. If you suspect that someone is thinking of suicide or of harming someone else, it’s best to go out on a limb and ask this directly.

If you are the person who is struggling with these thoughts- if you feel others would be better off without you or that things will never get better, you can reach the National Suicide Prevention Hotline via this link or call them at 800-273-8255.  The sneaky thing about severe depression is it changes our perception of reality.  What we see isn’t necessarily real.   What we believe isn’t necessarily true.  This is why it’s important to reach out before making acting on our suicidal thoughts.


People who are mildly or moderate depressed may feel as though they don’t matter, but people with severe symptoms may express feelings of guilt about what they’ve done in that past or what they aren’t doing in the present. Feeling guilty for things we have done wrong is normal and healthy, however people who are clinically depressed may experience guilt that seems out of proportion with whatever wrongdoing they believe they committed.

In some cases, a depressed person may feel guilty for existing, as if they are a burden on loved ones or there is point in their existing.

Helplessness and Hopelessness

Helplessness refers to the sense of having no control. In the case of a severely depressed person, he or she may act as though they are victims of circumstance and as if they have no power to change situations in their lives that they could normally effect.  Helplessness and hopelessness may come across as a “woe is me” attitude.  You may hear things like “What’s the point?”

Weight Loss

Due to decreased appetite, a person with severe depression may lose a significant amount of weight in a short period of time.  They may lose complete interest in eating.


Chronic Insomnia

Insomnia that occurs more on a regular basis may be a sign of clinical depression.  Insomnia, alone, doesn’t necessarily indicate someone is suffering from depression.  It can be triggered and sleep can be affected by many things, however insomnia is a hallmark symptoms of clinical depression.

Difficulty sleeping can show up as difficutly falling asleep, waking in the middle of the night and being unable to fall back to sleep, or early morning wakening.  All of these deprive a person of the normal number of hours and the quality of sleep we require. Too few hours or poor quality of sleep can make recovering from depression more difficult because sleep is one necessary element to maintain a stable mood.


When someone becomes socially isolated, avoiding people or things they used to enjoy, they may be suffering from clinical depression.  This would be especially significant if this person is typically social and enjoys interacting with others.  Sometimes the simple necessity of getting ready to leave the house, for example showering and getting dressed, can be too overwhelming for a depressed person.  It requires too much energy, more than they have. This may result in them becoming a homebody.

Psychomotor Agitation

Agitation means physicial restlessness, pacing, the inability to stand or sit still and pilling clothes (rolling fabric between the fingers). On the opposite end of the spectrum a severely depressed person can become practically catatonic, where movement is slowed or absent.  The person may cease to interact with others altogether.


It is not uncommon for a person with severe depression to experience hallucinations and/or delusions.

Hallucinations are usually hearing voices, though a person may hear other types of sounds that aren’t there, or visual hallucinations- seeing things that aren’t there.  Less commonly, people have other types of hallucinations like feeling physical sensations such as bugs under their skin.

It’s of particular concern if voices are commanding a person to kill themselves or hurt others. In this case, help should be sought immediately.

Delusions refer to false beliefs.  It can be any belief somone holds that is false and can’t be explained by their culture or religious faith.

When delusions or hallucinations are present, they can cause quite a bit of distress, as the person often has no awareness their experience isn’t real.

In summary, it is important to help someone seek help if they have any of these symptoms.  A professional evaluation would be warranted.  At times people who are severely depressed struggle with low energy and lack of motivation.  While this seems like something a person may be able to overcome through sheer willpower, this is not the case in depression.  For someone who has significant depression, you may need to step in and take the reigns early on to make sure they get to a health care provider.



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