90. Depression & Eating Disorders: Why They Travel Together and How They’re Treated with Holly Willis, PMHNP

Um, and I'm curious, you know, for those that maybe don't know as much about it, what's the difference between maybe being sad or kind of down in the dumps versus a clinical depression presentation? Like, what are the differences? What are things that maybe folks need to look out for or be aware of?

Yeah, it's a great question.

So sadness, feeling down, that is all part of the normal spectrum of emotion, right? Emotions are neither good nor bad.

Sometimes they might feel better or worse depending on what they are.

But ultimately, they're trying to tell us something, um, about what we're experiencing, and it's important for us to experience a broad range of emotion, not just the ones that feel good.

Um, but what differentiates these normal emotional experiences from a diagnosable depression is that depressed mood or ir- irritability in something like major depressive disorder is present most of the day nearly every day during this episode, which has to first of all last for longer than two weeks, but typically major depressive episodes are considerably longer.

Um, and then in diagnosable depression, there's an accompanying constellation of symptoms that you see that are related to the low mood, that, um, together they cause this clinically significant distress or impairment in social, occupational, or other areas of functioning.

That is a direct quote from the DSM that you will see over and over again, um, because the DSM makes space for the diversity of the human experience-

Mm

...

the human expression, human behavior.

So we don't want to pathologize a normal part of the emotional experience, but when something starts causing clinically significant distress or impairment, that's when we can move into the area of a diagnosable depressive disorder.

The related symptoms that you might see in addition to just that low mood or sadness, um, along with a depressive diagnosis would be lack of joy or pleasure in things that you normally find pleasurable.

We call that anhedonia, or not feeling, not feeling joy or pleasure.

Um, changes in your sleep, changes in appetite.

That can be more hungry, less hungry, more sleeping, less sleeping.

Um, a sense of worthlessness or excessive guilt, low energy, fatigue.

Then you get in the brain fog things like trouble concentrating, trouble making decisions, and of course, you can have recurrent thoughts of death or suicide.

So it isn't just being sad or having a low mood.

It's having that sadness and low mood that's predominating your experience-

Mm-hmm

... um, lasting for at least two weeks, and accompanied by these other symptoms that together create a picture that you, it's impairing how you function.

Mm.

So this concept of impairment, what does that look like? What are some real-world examples when things are impaired across domains? People might be wondering, what does that actually mean?

Yes.