When Sadness Is Something More: Recognizing Major Depressive Disorder
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Welcome to the WebMD Health Discovered podcast. I'm Dr. Neha Batak, WebMD's Chief Physician Editor for Health and Lifestyle Medicine. We often say, I'm depressed when life piles on too much stress. But how do we know when those day-to-day worries and low moods cross the line into something more serious? In this episode, we're going to talk about how we can help people with health and lifestyle

We're digging into what really defines major depressive disorder, how its symptoms overlap with everyday stress, and the red flags that suggest it's time to seek help. We'll talk about the influence of modern life, from the pressures of social media to the loneliness many of us feel in remote work settings, and why it's still possible to miss the signs of depression even when you're surrounded by family, friends, or co-workers.

We'll also explore the journey of diagnosing depression and finding a treatment plan that fits your unique circumstances. What factors tip the balance between therapy alone and therapy plus medication? And what if you're juggling other concerns like anxiety, chronic stress, or even substance use?

If you've been wondering how stress ties into depression, why you might keep quiet about feeling off, or how to get started on the path towards relief, this conversation will offer helpful insights and encouragement.

First, let me introduce my guest, Dr. Jessie Gold. Dr. Gold holds the esteemed position of the first chief wellness officer for the University of Tennessee system. She also serves as an associate professor of psychiatry at the University of Tennessee Health Science Center.

Internationally recognized, Dr. Gold is a speaker, media advocate, and mental health consultant with a special focus on college students, healthcare workers, and the entertainment industry. She's author of the bestselling book, How Do You Feel? Welcome to the WebMD Health Discovered podcast. Thank you so much for having me. So I'd love to sort of talk about the words we use because...

The word depression is used colloquially. We say that in conversation where we kind of throw out, yeah, I'm depressed or she's depressed. And then there's clearly a clinical diagnosis. How do we define the term medically? And what do you think about its use sort of colloquially? Yeah.

Yeah, we use a lot of mental health words like that. We say we're anxious, but we don't mean we have an anxiety disorder. We say we're depressed, but we don't mean we have depression. Most of the time when people say I'm depressed, they mean they're sad. And we would maybe use a word like the blues or something a little more clinically sounding than using the same word we already use. But all it is is a feeling.

right? Like all of us have feelings. Sometimes we feel sad, but when the sadness lasts for at least two weeks, when it comes with other symptoms, when it interferes with your life, that's very different than a feeling. And I think we get used to using the word and it makes it almost hard to know that it's a problem or there's an

over usage of the desire to be diagnosed with something, which I think comes from social media in some way, where you just actually want to be treated, have a diagnosis, have a label. And so it's either way, I've felt like it helps normalize the conversation. And we talk about

feelings more because we're using the word depressed, depression in regular sentences, but also people then think, I have depression. Let's talk about that. And it might not be what you have because not every feeling is pathologic, just like you might have worries and they're not anxiety, right? I think we need to be able to differentiate that as a

culture and be okay with our feelings and not necessarily assume that all feelings need to be treated or to be sent away. And that's something I work on a lot with patients, but honestly, even myself, I don't like big feelings. They scare me. They interfere with life. And so you're sort of like, hey, feeling, how can I make that go away? Right? And that's not the way we should approach them. We should sort of be like, I guess I'm sad today. What's

about things is making me sad today, what could I do? But if that sadness sticks around, gets worse, interferes with your life, comes with these other symptoms we think about with depression, starts out more severe, those are when you sort of go, huh, this might be something more than just a feeling. So talk to us a little bit more about those other symptoms that come along with a diagnosis of depression.

Yeah, so depression affects our whole body in a lot of ways. So we think about things like change in sleep patterns. And so that could actually be increased sleep or decreased sleep, which I think confuses people. But you might sleep more because you feel sad, but you also might be up all night because you're thinking about things that are making you sad. A big one is loss of interest. We use a fancy term called anhedonia to describe that.

But really what we mean is like, is there this thing you like to do and you might still be doing it, but you don't care as much about it anymore? Sometimes that's work because we get meaning in work. But sometimes that's like you like to go running. You're still running, but you don't get that same like

yay, I'm running. Or maybe you watch TV shows and usually you laugh at the humor in the shows and you're not anymore. Like that's a change. And that's kind of what we mean by loss of interest. Concentration comes into play here. I think people often just assume all concentration related things are something like ADHD. But I think it's really important that you recognize if you're sad, it's hard to concentrate. If you're not sleeping because you're sad, it's also hard to concentrate. And so that's something we think about. We think about change in aptitude.

appetite. Same way, could be less, could be more. I'm sure people listening can think of times where that's happened to them either way. Sometimes we take to food to cope. Sometimes we avoid food because our bodies feel affected by what's going on, like our stomach hurts or we have a headache or whatever and don't want to eat. And so that makes sense, I think, to people. Sometimes our whole body just feels slowed.

We use a fancy term for that too called psychomotor retardation, which just means it kind of feels like you're moving slower, moving through molasses, but it's just really like you are not at that speed that you thought you were and you can kind of tell that your whole body feels slowed.

We think a lot about guilt with depression too. So that's a big symptom. And then I think sort of finally is suicidal thoughts. So thoughts of not wanting to be around anymore, including plans and intent. But that doesn't always have to come with depression. When we think of it diagnostically, the two things that are the most obvious, like you're going to do the first two screening question signs are depressed mood and that lack of interest.

If you have one of those, then we sort of jump to the rest of the things to see if you're having a major depressive episode. But those two are the first sort of screening tools that most people use when they're kind of thinking about depression.

Can you talk about the spectrum of what seeking care can look like? For sure. I think it's a bit of a cruel punishment that a symptom can be lack of interest, which also can be low motivation. And we're like, hey, figure this out on your own, right? Ideally, we'd have thought about it before. But if we've never struggled with it or no one in our family struggled with it, why would we?

right? And so we're really kind of set up to be in an unfair situation dealing with our mental health in the moment. And so the easiest place to go is always going to be your primary care doctor. Hopefully you have one, but that will be the fastest place you can get in. And a person who can hopefully suggest a psychiatrist, if that's what you need, I

think it can be hard for people to just go right to psychiatry unless they know one, they feel like their symptoms are worse, their family history is bad, and they know that their family always took meds, so they might as well talk to someone about it. They're concerned about other things happening at

the same time. But it can be hard to make that leap on your own. Sometimes you kind of need a primary care doctor to be like, I could start you on something or I think that this is too severe for me to be managing. We should get you in, but I'll also start you on something in the interim. So it's a good place to start because of access.

And I think that primary care doctors are very used to dealing with mental health, especially sort of basic mental health things. And they can say, this is beyond me. You take it from here, psychiatrist. And I think that that's an important thing that patients don't know, right? Unless you're so severe that you're coming in through a hospital where somebody is going to immediately give you a psychiatrist. How do you know if you are at a place that you shouldn't be seeing that in primary care?

But, you know, you can go try to find a therapist in your community without going to your primary care doctor through something like Psychology Today where there's a big listing and you can search and read their bios sort of like Facebook of therapists in a way where you can see if you relate to what they're saying, their identities, the things you might be looking for. That's a good search place.

Your insurance company is also a great place to start just to make sure that they're covered. But also you could take those names and bring that to Psychology Today and see more about them there. Outside of the sort of bigger ways of doing that through insurance and figuring out what's covered, you know, there are a lot of apps that do teletherapy. There are a lot of apps that will get you in pretty quick.

I often say to patients to think about that as if you want to get in pretty quickly, it can be an option. But sometimes the quality is not as high as you'd like it to be. And that's OK sometimes if you're sort of biding time or, you know, you're trying to make sure you can get seen quickly about something you're struggling with in the moment. But.

You might not feel like that's the best long-term solution. Like if a patient calls and the wait list is like five weeks to see the person they want to see or more, I might say that an app could be a good decision for the interim. There are apps that are more sort of self-helpy and you can work yourself through them and their coping skills. But again, if you're at the point where you are

meeting more diagnostic criteria for depression, you're not going to be able to do those apps very well because you're not going to be able to, right? So part of the reason like meds and therapy sometimes go hand in hand is like you can't be a great therapy client personally.

patient if you're a person who is really struggling. Like you will just sit there and you won't retain anything. You won't do the things that they're asking you to do. You can't really interact in the same way. But if meds start to help, then you could. And so they do have a good interplay in that way. You know, if you're in a school,

going to the school counselor is an access point just like going to the school nurse or going to your primary care doctor, right? Like you could go. They're overwhelmed too, just like everybody, but they're used to that stuff and they usually have a pretty good view of the kind of community, right? So they might say,

oh, I'm not the right person for this, but these are the psychiatrists we like, or these are the therapists we like because they've been working with them in their school district and know it really well. Or if you're in college, same thing. Like you might go right to a college counseling center because that's your school-based one. And they might say, we only do short-term care. So if you want to go more...

more like regularly, we would recommend these folks in the community. And at least you have a curated list that someone you trust curated. So again, just like kind of going to your primary care doctor as an option for a list,

those people also often have good recommendations with partners in the community. So let's talk about the treatment side first. Can you talk us through the step-by-step approach that you take in starting someone on a treatment journey?

I will have a very long conversation. So psychiatrists still get like an hour intake with people, which is probably makes you jealous as a primary care doctor because you're probably doing my job in 15 minutes. But, you know, I think we still get an hour. We have a long conversation about your history, what your mental health symptoms have been like, ruling out other mental health conditions, what your family history is, what you're doing socially, what substances you use, like all these things that

could change my mind of a diagnosis and could affect maybe what I'm thinking about treatment wise. I will then decide kind of based on severity and what

what makes sense. Like, is this the first time or episode like whether they should go right to therapy with no med or whether we should talk about meds. The first line medication for depression is often an antidepressant. That's why they're called that. I mean, some of our meds are named that, but we use them for other reasons too, right? Like they're still used for anxiety, but

That's where the name came from. But, you know, those are selective serotonin reuptake inhibitors are like the most common kind. You've probably heard them called SSRIs. Those are the ones that I think of immediately, but not always, right? So sometimes people have other reasons why they might try something else. Like they have chronic pain and there's a med that we have that is good for depression and chronic pain called duloxetine.

And maybe they have been really sleeping all the time and eating all the time. And so we go to ones that are more, we call them activating, like something like bupropion, right? Because that's a symptom that that medicine is particularly good at targeting, right? And so we look at you holistically, but I will say like for the most part,

The first line is that just based on evidence, but we kind of look at what other meds could help given other things that are going on with you, given your symptom profile. And we try our best based on that to come up with a first option. I mean, not everybody needs medication. Let me just say that, right? So I'm a medication prescriber, but I also know the value of therapy and do it myself. So I am a practitioner and I go every week as a humans.

So I very much value therapy as a part of this. A lot of the studies would say therapy plus medication is the best, but not everybody needs that medication. But again, it's sort of about severity, genetics. Has this happened before? Things like that that might make it just make

sense to have a med in the mix kind of early. You know, for me, I do a lot of conversations around what have you heard about medicine? What scares you about medicine? Who told you that, right? And I think because mental health meds, like the buy-in matters in a lot of ways, like you have to believe that it might be able to help you for me to keep giving it to you. I do believe in some of the placebo effect of it in that way. And I think there are so many things that if you took

to going home and Googling mental health medications. There's a lot of misinformation out there and it can get in your head. You could have heard from a friend. You could have seen it on TikTok. And so for me, it's really important to have those conversations up front and also make it known that I'm okay with them bringing that back to me if they go home and read something and they're now worried about taking it. I want to have those conversations and be the one you come to with

that, I don't want you to think about that on your own at home and just stop meds, right? Like that's not helpful. And then obviously we go over risks, benefits, side effects, that sort of thing in the conversation. You know, our meds take a little bit to work, which I think is also quite frustrating to folks. So, you know, four to six weeks on a good day, they'll all admit I've seen them work in two. But what that means is you're much more likely to have side effects before you see a benefit. And that's really frustrating to people.

even if side effects go away. And so, yes, I wish we had much faster solutions, but it's what we have and they do work and I've seen them work wonders. And I think that you just sometimes have to have a little bit of patience with it and acknowledge that we wish they were better and faster in that sense. But this is what we have right now and they do help. So can you talk a little bit about how you postulate

pull in and pull together a plan that might be very personalized for one person. And even in terms of pulling in some of the lifestyle pillars that might be different for somebody else. I mean, I listen a lot, right? So I want to hear what you want.

And what would make you committed to treating yourself in a holistic way, right? So I have a lot of patients who are interested in using lifestyle changes at the same time. And I think in those patients, you know, you talk about all of these things. It might be baby steps, right? We call it behavioral activation, right? If you're really sad and you don't want to get out of bed, maybe you

can't be out all day and do all of the things, but maybe you could be out for five, 10 minutes and you start there, right? It's a slow process, but there are ways to kind of work that into your schedule, start to be more scheduled, right? I think as we get more depressed, I think what we tend to do is stay in bed more and we tend to wear sweatpants more, especially if we work from home, right? And so even just putting on regular clothes can make a difference in some of that. And so there are little things you can talk

about in there about how to sort of start that process if it feels daunting. And we do talk about that a lot. I think looking for a therapist plus meds, I think will be part of the conversation. But what kind of therapist also depends on the person. So sometimes people want to have conversations that are more open ended. And sometimes people want to be taught

skills. Those are two different types of therapists. You might have a therapist who can do all of it, but there's a person who might do something like cognitive behavioral therapy or dialectical behavioral therapy, and that's going to be skills. So kind of what I was talking about with behavioral activation, if you want to go from sleeping to up, they're going to be like giving you homework and asking you to do stuff. And that might feel too structured for some people or just structured enough for some people.

right? And so having those conversations is also important. And like me understanding therapy, because I went through training to be able to do therapy and know all of the different kinds and have done all the different kinds can make it easier for me to explain to patients what they're looking for, how to make a plan, how to think about it. And, you know, like self-care is

always part of this. But again, you wouldn't just like self-care your way out of it. But I think it's important to recognize like socializing has an impact on your mental health. Exercise has an impact on your mental health. It's just when you feel able to do it and how you do it and how that kind of fits in with everything else. That's part of the conversation. And I think it's just so critical, the point that you made about

the various types of therapeutic options that are out there in terms of therapy itself. I think people think about it as just one umbrella term and don't necessarily recognize that there's different approaches

And then there's also the factor of cultural concordance. I know some studies have shown that really thinking about that piece can be helpful just because there's a little bit of a shorthand then in terms of how you're thinking about lived experiences and how they might be impacting your recovery, the types of things that might be stigmatizing for you that might not be for somebody else. So can you talk a little bit about that? We sometimes use the word fit

And those are like study after study will say therapy is effective if there's a good fit or a good therapeutic alliance. We are the tools. If you don't trust me as a therapist or a therapist as a therapist to be the tool and you don't feel like they're listening, it's safe that they understand you. You're not going to do what they tell you to do, do any of the homework, have an open and honest conversation because you don't feel safe. And so then it can't be helpful.

So if you go and meet somebody and you immediately know that they wouldn't be a good fit, I would try somebody else if you have that opportunity. I recognize that, again, time, waiting, availability, all of that stuff can be part of it. But I would give them a chance beyond the first session if possible, just because like my first session is, it's a lot more questions than listening. And later on, they'll be listening more so you can tell that. But again, with cultural fit, you know, people don't like to educate.

right? Like they don't want to tell you about their experience. They want you to understand it in some way. There are not a lot of black psychiatrists, but that doesn't mean you can't find them. But it does mean somebody like me needs to be a little more informed in these conversations. So I'm not scared to be a part of that conversation despite my skin color and my lived experience. And so

I'm aware of that. It's important to me. But if someone said, hey, I don't want to see someone that looks like you. I want to see somebody who looks like me. I would help them get there because I think as hard as it is to find, unfortunately, it can be an extra trust, an extra.

extra just safety to the conversation and knowledge base that can be helpful for people to feel more comfortable talking about it, especially because mental health, how you think about it is so culturally ingrained. And like you might be coming from a place of religion being something that people would tell you to do instead of getting a mental health treatment and having that conversation with someone that gets it might be safer than having that conversation with anyone. But I would also say that

A lot of us do try to keep up with everything to be helpful because of availability, awareness of that, and really trying to do the best that we can for as many people as we possibly can.

they can. Let's talk about social media. You mentioned if you're in a work from home environment or a hybrid environment, so you have less socialization during the day at work, the loneliness epidemic that we hear so much about. How are you sort of processing some of these shifts in the way that we interact with each other and

links or connections to either that first experience of depression or just as an input in sort of your lifelong experience?

When I think about this stuff, it's never one thing or the other. Like it's never all social media. And that's why there's more mental health stuff that you're hearing about now. You know, the data on social media is very mixed. Some data will say using it makes you depressed. Some will say people who are depressed use it and feel better. Right. And so you kind of get both ends because they found a community that someone they could talk to all of that. It's just a different kind of community. Right. Like loneliness is a feeling, not

a reality in the sense that you might have a lot of friends and still feel lonely. You might socialize and still feel lonely. You might be talking to people online and still feel lonely, right? It's how you feel about the thing, not necessarily that you're isolated completely. And so, you know, I think a lot about these things when I'm talking to patients. So I think, how often are you using social? How do you feel when you're using social? Have you ever even asked yourself

that? Because for the most part, the answer is no, because it's incredibly passive. But we see the news on social and the news has never been passive, especially as the world becomes more complicated or the things that are going on in the world might affect your identity in particular. And I think people just scroll and think it's fine. And that's not

true. And so I try to have conversations about what I would call like mindful scrolling and having conversations about recognizing how it can and might impact your mood. And that like not staying on it all the time is not like you don't care about the world. It's just sometimes you need a break and that's okay.

Something I hear a lot on campuses, especially because of the COVID pandemic, is that people are less comfortable making friends. And I think that that has a significant impact on our mental health holistically. So you could become more socially anxious. You could become more depressed. You could burn out. All of that stuff is protected in a lot of ways if you have one close friend. I don't mean a

thousand. I mean one. And so I think it's important that we talk to people about how to make friends, what are the barriers to making friends, where you could look for friends as a parent, as a doctor, wherever this comes up, because I do think people struggle with it a lot more than maybe is being talked about out loud. And we're just sort of saying like, they're lonely, but maybe they're lonely because they don't actually know how to have those conversations or how to start the process.

or where to look. And I think all of that is really important when I think about things, you know, like it might not be the first thing that I do, but, you know, when I'm talking about

what people think about depression, I'll be in my first visit, I might say, like, do you have any friends that you talk about this with and open and honestly, is there someone in your social support that you feel like you can tell this to? And if people say no, I'm more concerned about sort of outcomes and making sure that they're safe and all of that. And so I think it's important that we don't ignore all of those things. Like,

as clinicians or as humans, like they do impact us. Is it one thing and that's all it is? Absolutely not. But are they all compounding in a way that's making it harder for people to feel good day to day in their lives? I think so. And so I think, you know, being aware of that, like actually asking folks like what their days look like, what their work environment is like, how that's affecting them. All of that is something therapists are

prone to hone in on and should. And it can make a big difference in how you're processing things, I think, and how meds even work. Can you talk to us a little bit about action items for having this type of difficult conversation? If we're talking to a listener who might be navigating a difficult experience when it comes to depression and being able to communicate that with someone that they're close to in an open way as they start that treatment journey,

For sure. I think that this applies if you're the person struggling or you're the friend concerned or a family member concerned. So first off, do not do this in a public setting. Like you will not have success if this is like in the middle of a movie theater or a mall or something. Like you want to have this conversation somewhere private. You want to make sure that the person you're talking to is someone that you're pretty sure is a good person to talk to about this.

this. I wouldn't take your first shot with someone you've heard say negative things about depression or something like that, because even if you have to have that conversation eventually with a parent who might think that, it's probably not the first place you should go, because if you go there immediately and they say something that makes you feel bad, it might question your ability to get care in the right way. It might make you think differently about yourself and your self-esteem. So starting with someone you think is safe, I think matters. Having just like

an open conversation like as much as you can be vulnerable but you don't have to tell anybody everything you can say i've really been struggling with my mood lately i i think i'm depressed

Has that ever happened to you? And something like that could be true. If from a friend's perspective or the family member's perspective, don't start with blaming their behaviors like you haven't been doing this or whatever. Start more like sometimes I really struggle with getting out of bed. Is that ever a problem for you? Right. Like something that's just very open ended and not judgmental. And maybe they don't take the bait because they're not ready, but it at least is a place to start.

I think these conversations with friends and family, you should always know that like you shouldn't just do one, like it should be an ongoing conversation. So maybe the first time all you're comfortable saying is like one layer of an onion, but maybe because of how they reacted and how they listened and validated your experience. When you go to the doctor, you'll feel better coming to them and peeling the onion back like one more layer, right? And we don't ever owe our friends or family everything. That's just not a

thing. I'm a vulnerable human. I write about myself. I write about being on medication myself, but I don't actually tell everybody everything because it's still some stuff that I'd like to keep for me and maybe my therapist. Right. And so you're not somehow not

doing a good job talking about it if you don't disclose everything, right? Like I think social media can make people think that the answer is almost oversharing, like saying everything and that's how you share. How you share is really like where's your comfort level on it? Who are you talking to? Where do you want to start? And based on reactions and how you felt doing it and what it was like, you can then –

share more as you're comfortable or just stick with that, but at least someone knows you're struggling and you can turn to them when you need to talk to somebody. Thank you so much for joining us on this exploration into understanding and managing major depressive disorder.

We discovered that feeling down isn't always a clinical condition and true depression goes beyond a few bad days. It can involve persistent low mood, lack of interest, and other symptoms that last for at least two weeks. We learned how factors like family history, additional medical issues, and everyday stressors from social media pressures to living in a more isolated, work-from-home culture can shape someone's experience with depression. We

We also explore a variety of support options out there, whether it's starting with your primary care doctor, seeking specialized help from a psychiatrist, or adding therapy into the mix, sometimes alongside medication. And even though there's no one-size-fits-all solution, it's crucial to remember that you're not alone and that treatment can be tailored to meet you where you are.

Whether you're weighing if your symptoms are more than just a rough patch or looking for ways to help a friend, the core message is the same. Depression is treatable. Health is out there. And taking the first step to talk about how you feel is the bravest and most important move you can make.

To find out more information about Dr. Jesse Gold, make sure to check out our show notes. Thank you so much for listening. Please take a moment to follow, rate, and review this podcast on your favorite listening platform. If you'd like to send me an email about topics you're interested in or questions for future guests, please send me a note at webmdpodcast at webmd.net. This is Dr. Neha Bhattuk for the WebMD Health Discovered Podcast. ♪