What is Depression? A Christian Counselor in Spokane, WA Explains

I have worked with many clients who suffer from depression too, and I found myself always needing more information about what exactly depression is. I have known family members who have struggled with it, as well as friends and colleagues over the years.

So, I determined to take a medium dive into the literature to see if I could feel at the end of that journey that I could put my arms around what depression is, what its causes are, and what some viable treatments are. This is the first of three parts that cover the subject.

As I began to read from several academically reviewed sources, the journey did not really land on solid ground. I still feel that depression is like this fog or mist from a Stephen King novel that covers everything and that we don’t know about it. It lurks out there as an invisible impending threat.

We have all been through times when we felt emotionally down without explanation or that things were so stressful that we felt destined to fail at whatever challenge was ahead. Or, as life can be, we have been dealt some serious losses.

Freud said that depression (he called it melancholia) “is an affective disorder characterized by a deeply painful mood, a loss of interest in the outside world, a loss of ability to love, the inhibition of every achievement and the lowering of self-esteem, which manifests itself in self-reproach and self-abuse” (Leuzinger-Bohleber et. al. p. 1). Sounds familiar, doesn’t it?

Essentially, depression is a persistent low mood that affects most areas of one’s life and shapes the way one interprets the world in which they live. Depression is a serious mental illness, and it is not a sign of a weakling state or some character flaw. In ancient civilizations, the common view of depression was that people who were depressed for extended periods had spiritual problems.

The Greeks thought that causeless depression was due to internal body fluids like bile. In the 18^th and 19^th centuries, these ideas persisted, and some other theories emerged, but the treatment of these folks was horrific. Such things as being locked into asylums, bloodletting, immersion into water for as long as one could stand, and spinning stools, to name a few.

In the 19^th and 20^th centuries, such ideas as electroshock and lobotomies were introduced. I mention this past to put into perspective where we are today. We have a greater understanding of the ramifications or symptoms of depression, as well as having made much progress in treatments.

Prevalence

If misery loves company, then there is a lot of company among the depressed in our modern world. As of September 2025, the percentage of adults who reported being depressed in their lifetime at least once was 28.5%. For adolescents and young adults, the prevalence was almost 20%, and 8.3% had had at least one major depressive episode. There is consistent research over the past several decades that females are more likely than males to have depression.

For the elderly, the numbers are difficult to assess and are likely undiagnosed because people tend to think their symptoms are normal for their age. One report found that almost 50% of older folks in nursing homes displayed depressive symptoms. I suspect this phenomenon with the elderly speaks to some of our societal flaws. About 36% of depressed elderly folks receive any treatment for their condition and are less likely to receive treatment as they get older.

From my days as a Marriage and Family Therapy graduate student, I focused on the elderly and discovered the suicide rate for that group is high and likely way underreported. This is likely due to not knowing if an overdose of meds was intentional or not. And shockingly, most completed suicides were with firearms.

Major Depressive Disorder and its qualifying symptoms serve as a marker for gathering data on the prevalence of depression among groups of people. Though many people can experience a single episode, there is consistent research that shows that most people who have one episode are 50-80% more likely to have another episode in their life.

Teens are vulnerable to depression. There are many reasons for this, but it seems obvious that social media immersion has contributed to the greater occurrence. About 18% of adolescents aged 12-17 have had a major depressive episode.

Adolescents are keenly aware of their standing in their world and are often hypersensitive – they always have been. What’s more important than being cool? It doesn’t take much to send a teen down the rabbit hole of insecurity of their self.

The sadness that comes from depression is most often rooted in a negative self-evaluation. No doubt, certain circumstances in life can get one down. Financial stress, unemployment, death of a loved one, or any misfortune outside of oneself can easily be turned inward. These troubles become difficult to process, and though they seem to come from outside yourself, you reason that an internal flaw can better explain the troubles.

“In depression, what feels lost or damaged is part of oneself” (McWilliam, p 234). Common statements by the depressed have been “I’m not good enough, I’m flawed, I’m self-indulgent, I’m evil” (p. 235).

The poor soul is driven to take an inward look and doesn’t like what he/she sees. “Depressive people are agonizingly aware of every sin they have committed, every kindness they have neglected to extend, every selfish inclination that has crossed their minds.” (p. 239).

The sources of these thoughts are legion. They are often a result of how they have perceived others’ responses to them, often from an early age. The seed of self-doubt and self-disappointment or loathing often comes from the adults in their lives who sent that message or valued peers who seem to hold a grip over their sense of self-worth.

Some inexplicable sources for depression could connect to biology/genetics or a combination of factors. We will delve into this in part two of this series.

Symptoms

Before I share the clinical diagnostic symptoms for depression, it’s important to know that several physical symptoms can be attributed to depression. Depression affects the body. Many folks experience unexplained aches and pains in the muscles or joints. If there is a chronic pain issue, it could get worse. Many have complained of back pain or headaches.

Perpetual fatigue is common even when getting enough sleep. Sleep is often disturbed by either insomnia or hypersomnia. While depressed, there is often the experience of eating binges and gaining weight, and conversely, loss of appetite and significant weight loss. Gastrointestinal issues are also common.

There are often changes in one’s physical movement, being either slowed down or agitated. In addition to these marked symptoms is a reduction in sexual drive. The point is that depression adversely affects the whole person, not just the mind.

The DSM 5 (Diagnostic and Statistical Manual of Mental Disorders) is the common tool to determine a given mental disorder. The keyword is “disorder.” To qualify, the disturbance needs to negatively impact one or more aspects of one’s life. The description of the disorder makes no statement of judgment, does not imply cause, nor does it offer treatment. The following is word for word from the of the DSM 5 regarding Major Depressive Disorder (MDD).

1. Five (or more) of the following symptoms have been present during the same week period and represent a change from previous functioning; at least one of the symptoms is (1) depressed mood or (2) loss of interest or pleasure.

2. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (note: in children and adolescents, can be irritable mood.

3. Markedly diminished interest in pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation)

4. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month) or decrease or increase in appetite nearly every day.

5. Insomnia or hypersomnia nearly every day.

6. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feeling or restlessness or being slowed down).

7. Fatigue or loss of energy nearly every day

8. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).

9. Diminished ability to concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).

10. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

11. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

12. The episode is not attributable to the physiological effects of a substance or other medical condition.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787 [1]

There is another diagnostic resource known as the International Classification System for Diseases (ICD) that mirrors most of the symptom criteria that is in the DSM 5. Specifically, the diagnostic code is ICD-10 for major depressive disorder.

Depression can be a persistent condition as well. In major depressive disorder, the condition can come and then leave for a time or never come back. But Persistent Depressive Disorder, sometimes referred to as dysthymia, is a condition that lasts two years or more. The criteria for PDD are much like MDD. One of the characteristics is that it is resistant to treatment and is considered a more severe condition.

The symptoms of these illnesses are serious and should not be ignored by the one experiencing them or those who might witness them. Depression is not a condition in which you can just exhort the person to snap out of it, pull themselves up, or tell them to think differently.

There are several theories about the causes of this illness, but it should not be treated any differently than if someone has diabetes or a heart condition or any other disease where we don’t judge the character of someone for having it.

The symptoms can be on a spectrum of mild to severe, so keep that in mind as you consider how you are feeling or as you consider someone else. If you or someone you care about is experiencing these symptoms as listed above. Please feel free to contact me at 509-569-7102 or email me at martyr@spokaneschristiancounseling.com.

If you feel your safety or the safety of someone you care about is in jeopardy, please call 988 or 911 immediately to get appropriate help.