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42-1 How do major depressive disorder and bipolar disorder differ?

Most of us will have some direct or indirect experience with depression. Major depressive disorder is a prolonged state of hopeless depression. Bipolar disorder (formerly called manic-depressive disorder) alternates between depression and overexcited hyperactivity.

Anxiety is a response to the threat of future loss. Depression is often a response to past and current loss. To feel bad in reaction to profoundly sad events (such as the death of a loved one) is to be in touch with reality. In such times, depression is like a car’s low-fuel light—a signal that warns us to stop and take appropriate measures.

In the past year, have you, like one in three American collegians, at some time “felt so depressed that it was difficult to function” (ACHA, 2009)? Perhaps you’re weary from juggling school, work, and family responsibilities. Perhaps social stresses, such as loneliness, feeling you are the target of prejudice, or experiencing a romantic breakup, have plunged you into despair. And perhaps low self-esteem increases your brooding, worsening your self-torment (Sowislo & Orth, 2012; Steiger et al., 2014). Dwelling on these thoughts may leave you feeling deeply discouraged about your life or your future. You may lack the energy to get things done or even to force yourself out of bed. You may be unable to concentrate, eat, or sleep normally. Occasionally you may even wonder if you would be better off dead.

For some people suffering major depressive disorder or bipolar disorder, symptoms may have a seasonal pattern. Depression may regularly return each fall or winter, and a reprieve from depression—or possibly, mania—may dependably arrive with spring. For many others, winter darkness simply means more blue moods. When asked “Have you cried today?” Americans answer Yes doubly often in the winter (TABLE 42.1).

Data from: Time/CNN survey, 1994.

Biologically speaking, life’s purpose is survival and reproduction, not happiness. Coughing, vomiting, and various sorts of pain protect our body from dangerous toxins and stimuli. Depression similarly protects us, sending us into a sort of psychic hibernation. It slows us down, defuses aggression, helps us let go of unattainable goals, and restrains risk taking (Andrews & Thomson, 2009a, b; Wrosch & Miller, 2009). When we grind temporarily to a halt and reassess our life, as depressed people do, we can redirect our energy in more promising ways (Watkins, 2008). Even mild sadness can improve people’s recall, make them more discerning, and help them make complex decisions (Forgas, 2009, 2013). It can also help them process and recall faces more accurately (Hills et al., 2011). There is sense to suffering. But sometimes depression becomes seriously maladaptive. How do we recognize the fine line between a blue mood and disabling depression?