The Difference Between Depression and Clinical Depression

My brother once told me that everyone gets depressed sometimes and I need to just get over my depression instead of wallowing in it. Yes, everyone gets depressed but I suffer from clinical depression as a part of my bipolar disorder and trust me, there is a huge difference between the “regular” depression that everybody feels and “clinical depression.” Clinical depression is more extreme in every respect.

Sleep and appetite are such significant bellwethers of depression that my psychiatrist begins each and every session asking about them and has done so for years. (They are known as neurovegetative symptoms although my psychiatrist refers to them as my neuro-vegetables.) Typically, people who are depressed either have problems with sleeping or sleep all the time. I become so enervated that I find it difficult to get out of bed let alone shower and get on with my day. More than once I was sent home from work for lack of showering. That is if I even showed up at work. For a long time, I had trouble being med compliant not because I was rebelling against taking my medicine but rather because I could not muster the strength to get out of bed and pick up prescriptions from the pharmacy. The same extreme also applies to appetite/eating. I overeat typically by going on a fast food or junk food frenzy. There are others who have zero interest in food and stop eating.

And then there are the feelings of worthlessness, hopelessness and of being an abject failure at everything. That frequently goes along with feelings of overwhelming sadness. I used to believe with all my heart that I just wasn’t made for this world. I was too damaged to survive. I used to call my psychiatrist literally from under the blanket because anything else was too much.  At my worst I would create “cocktails” of my various meds because I just could not stand to be awake anymore. I didn’t necessarily actively want to kill myself, it was just too painful to remain awake and if by chance I killed myself then — oh well. And even now when my mood is stable, I still can’t go to sleep without talk radio or tv on as my thoughts just consume me. I need to have someone else’s words to focus on as I’m falling asleep.

 And, of course, there is suicide which includes suicidal ideation, suicide attempts and actual suicide. I’ve been stable for a couple of years thanks to therapy, meds and ECT. That, however, does not mean that I’m immune from depression either the garden variety or clinical depression. You are bipolar forever. Even with my newfound stability when I head into a bout of depression within a day or so I’m right back at suicidal ideation. I’ve been there so many times that by now it’s almost a default position. My guess is the normies don’t think about suicide when they are depressed.

To me one of the biggest differences between regular depression is that clinical depression absolutely has a physical aspect to it. It’s discernable enough that when I feel down I try to determine what kind of depression I’m feeling (The necessity of doing that is a whole ‘nother story.) I feel depression as a weight on my back; a burden that I have to carry. When I’m seated or lying down I feel the many hands of depression pulling my body down making it exceptionally difficult to move. It feels as though the hands are reaching up from the earth and not allowing me to be released from its grasp. It’s not just lack of energy that keeps me abed, it’s an additional weight that pulls me down. I now know that this feeling is not unique to me. A lot of people who suffer from depression feel the literal physical aspect of it. On my twitter feed I see comments about this phenomenon on a daily basis.

I looked at a list of various symptoms of clinical depression and only commented on the ones that I feel most deeply. Below is the list set forth in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. The DSM is essentially the bible of mental illness.

Signs and symptoms of clinical depression may include:

  • Feelings of sadness, tearfulness, emptiness or hopelessness
  • Angry outbursts, irritability or frustration, even over small matters
  • Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
  • Sleep disturbances, including insomnia or sleeping too much
  • Tiredness and lack of energy, so even small tasks take extra effort
  • Reduced appetite and weight loss or increased cravings for food and weight gain
  • Anxiety, agitation or restlessness
  • Slowed thinking, speaking or body movements
  • Feelings of worthlessness or guilt, fixating on past failures or self-blame
  • Trouble thinking, concentrating, making decisions and remembering things
  • Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
  • Unexplained physical problems, such as back pain or headaches

So, dear brother, as you can see clinical depression is not something you just get over. It’s something completely different than everyday depression. Diminishing what people are feeling is never a good thing to do but when someone is clinically depressed, it can be especially harmful. When people say they are clinically depressed believe them, support them and assist them in getting any help they may need.

Yes, I really do undergo ECT

One of my purposes here is to destigmatize ECT.  I understand and support people who make an informed decision not to have the treatment. That said, in my experience a lot of people reject the treatment solely based on its stigma. I know I did. My doctor recommended ECT for 10 years and I rejected the idea until I was hospitalized and spoke with other patients getting the treatment.

Most people’s idea of what ECT is like comes from the 1975 film “One Flew Over the Cuckoo’s Nest.”  Given that the film is more than 45 years old (i.e., science and technology have advanced since then) and contains a ton of artistic license, current ECT treatments are nothing like that depicted in the film.  And the thing is not only do prospective patients not have a clear idea of what ECT does and does not entail, many physicians don’t have the full picture either. Last year in a 10 day period I was asked by 5 different physicians (PCP, gastroenterologist, etc.) about my ECT  experience. The typical questions were “Does it hurt?” and “Does it work?” I bitched about that to my psychiatrist who simply stated that ECT is something they learned about in medical school but that I was probably the first person they’d ever encountered who had undergone the treatment.

As “Does it hurt?” is the most common question that I’m asked I may as well address that right off the bat. No. It does not hurt. At all. In any many whatsoever. The treatment is done under anesthesia. People like my brother who don’t like needles may not enjoy getting an IV but yeah, no pain. Sometimes my muscles feel a bit sore afterward but no more so than after a good workout.

As for “Does it work?” Yes. It does. ECT saved my life. I have a very severe case of bipolar disorder with treatment resistant depression. I’ve tried 20+ different meds alone and in combinations. And that didn’t entail swallowing a pill and seeing if I felt better the next morning. It meant taking a small dose of a particular medicine to determine whether I would have a negative reaction to it. Then I would (more accurately my psychiatrist would have me) slowly increase the dose until I got to a therapeutic level. Then we’d wait to see if it worked. And when it inevitably didn’t work we’d increase the dose to the max recommended and wait to see if that worked. And when it did not we’d slowly titrate down. And this was repeated over and over and over. Only ECT has worked. I began with treatments three times per week and slowly decreased from there.  At this juncture I’m on maintenance and get treatments every 10 weeks.

Many people ask about the side effects as well. The most common side effect is loss of short term memory. I absolutely had some when I was on the 3x week schedule but once my treatments became more spread out the memory loss dissipated.  My attorney father was afraid that I’d forget everything I’d learned in law school so after my first few treatments he gave me a mini Bar Exam until he was convinced otherwise. Furthermore, I CAN put 2 sentences together so ECT obviously doesn’t fry your brain to the 9th degree.

I intend to go into more detail about the rewards and the side effects (they do exist) as my blog journey unfolds but for now please know that for me the positives far outweigh the negatives. 


Welcome to my blog. I’ve been around this planet long enough that I can be labelled as many things amongst them daughter/sister/aunt/attorney/artist/sports lover both as viewer and participant/writer/voracious reader and the list goes on and on. I am passionate about many things relating to those different parts of me. And… I’m mentally ill—more specifically, I’m bipolar.  The illness and the stigma surrounding it have in the past and continue to affect every part of my life in both a positive and negative manner. I intend to write about a plethora of topics reflecting my varied interests. Of particular interest to me is mental illness and the stigma associated therewith, ECT and its own stigma and bipolar disorder in general.

My bipolar credentials are as follows:  I have bipolar 2 and have had it since my teens although I wasn’t diagnosed until my early thirties. And, my depression is treatment resistant. I had a UCLA psychologist tell me that mine was the most debilitating case of depression she’d ever seen. Hell, I had another one fire me because my issues were beyond her skill set. Over the years I’ve tried 20+ meds alone and in combination and nothing helped. Things got worse and worse and eventually I was hospitalized. It was there that I finally agreed to try ECT and that has been a literal lifesaver