In our complex, fast-paced lives, it can be easy to confuse the two. Are you depressed – or experiencing the highs, lows and repetition of everyday life? Are you depressed – or stressed at work with financial constraints or another factor like a family problem? As we become more aware of the word ‘depressed’ with vital increased media coverage, are some of us in danger of thinking we’re depressed when actually, it’s stress? And vice versa, are some of us mistaking depression that needs medication for stress? With stories of students committing suicide before exams in the press, you have to ask where the tipping point lies.
While "stress" is not a psychiatric diagnosis, and depression is, there are, as Linda goes on to explain, a lot of symptoms common to both which make them difficult to differentiate, even for mental health professionals. The symptoms common to both include sleep disturbance, change in appetite, feeling sluggish, feeling jittery – symptoms a lot of people will be able to relate to, but there are nuances such as the type of appetite change that might help clarify. Below, we asked Linda everything we wanted to know about how stress relates to and differs from depression and what to do about both.
What’s the difference between being very stressed, feeling overwhelmed and finding it hard to cope – and depression?
There’s not a hard line. Diagnosing depression is difficult anyway because you look at a whole set of symptoms which are common to lots of psychiatric disorders, and then you see which circle best fits. So it’s hard enough to diagnose depression but when you talk about stress, which contains almost all of the same symptoms as depression, it’s a very slippery slope and I have to say, it is somewhat subjective.
Stress is not a psychiatric diagnosis, it’s a condition that we experience. In depression there’s a sense of helplessness and hopelessness, because as far as we understand, brain chemistry has been altered, so two particular neurotransmitters called dopamine (pleasure) and serotonin (happiness) are suppressed, and so anti-depressants target serotonin mainly, and that targets dopamine by default. But in stress, the major chemical is cortisol, which is the neurotransmitter, and it makes us constantly alert and searching for danger. Add to that rushes of adrenaline every time something is asked of you in that condition, and you get a hyper-alertness and a jitteriness which isn’t the same as depression.
What are the physical symptoms common to both?
Sleep: In both, there is almost certainly a sleep disturbance, which can go either way; you might be unable to get out of bed, or you might just not be able to sleep or you might wake a lot in the night. Sleep is absolutely critical because you cannot think rationally if you’re sleep deprived. So number one, before you look at anything, start getting some rest.
Appetite change: There’s often an appetite change although in depression, it can go either way; you can either not be hungry, or you can overeat. Whereas in stress, usually it’s that you’re pushed to overeat because your body is craving carbohydrates to fuel that anxiety thought which is: "Let me get out of here!"
Energy:In depression you can be very sluggish or very highly anxious and jittery. When you’re stressed, usually you’re pretty jittery – ‘wired’ is what people say and you can get so exhausted that you crash, but it’s a more common state to be wired up and jittery when stressed.
Choice:In stress, which is manifested by anxiety, the key is not the stress, it’s what you think about the stress. So that is a very critical point to make because people can be under tremendous stress and thrive, if they choose it. You look at what the person’s situation is, and how much of their stress is chosen, or could be eliminated, and how much is imposed upon them. If it is imposed upon them, and has been for some time, it’s more likely that they’re heading for depression, than if they chose it.
What do you mean 'if they chose it' ?
Take an athlete training for the Olympics. They are highly stressed, but they have chosen to put themselves in that position, so they’re not likely to become depressed. Someone who’s been promoted beyond their abilities and their salary is what the family depends on, is more likely to have their stress become depression.
I read that stress can become depression in “susceptible people” – what makes some people more susceptible to depression than others?
People who are susceptible to depression have usually experienced depression in the past, and depression arises from a sense of low self-efficacy, in other words, ‘I can’t make a difference to my life’, and hopelessness where the future – and the present – look so dark, there’s just a tunnel and it goes on forever. The feeling that your world, your self, and your future, are loaded against you, making you hopeless, makes you more susceptible to getting depressed under stress. ‘I’m stressed because this is impossible’ versus ‘I’m stressed because I’m facing a challenge that is new to me.’ One of the things we teach in therapy is to re-word, but stay accurate to what is happening to you.
What about chronic stress? For example a highly stressful job that will always be highly stressful? Should we just quit and find an easier one?
No, no, no, that’s a last resort. Usually, the job you’re in, you’re in for a reason, and you’re stressed because you’re good at it, so you’re being asked to do a lot. So I would almost never advocate quitting your job as a first step.
What you have to do is first of all sort your sleep. Here are my tips:
- Get to bed as soon as you possibly can and try to wake at the same time every day, even on weekends, because it really does regulate your circadian rhythm so that you’re more alert at the times you need to be. How do we get babies to sleep? We give them a routine!
- Turn your screen off at least 20 minutes before you go to bed so that melatonin can rise – if you don’t, even if you sleep, it will not be restful sleep.
- Use power naps, they take 10 minutes out of your day and they’re worth an hour to two hours sleep at night, which is magic! As far as I am aware, every head of state – everybody who’s head of anything – takes power naps.
- Then when you get into bed, use what’s called Paced Breathing, which is to breathe in through your nose, hold it until you’re slightly uncomfortable, then breathe out through your mouth as slow as you can, and that’s so boring, but so good for your physiology that you will probably go to sleep.
- If you don’t, or if you wake startled in the night, then, horrible as this sounds, get out of bed, go into another room where you have prepared a ‘worry notebook’ and a pen, and a kettle with some herb tea or something, and write down in that notebook everything that’s keeping you awake. By about the third night, you’ll notice the list looks the same! The point is to take your worries and put them outside your bed and your bedroom. Maybe pick up a boring book, and then when you start to feel sleepy go back to bed and start your breathing. In my 35 years of experience, by the third night, everyone feels more rested.
Is it true that no one ever died of insomnia?
As far as we know, that’s right.
If we could all live in a society where everyone worked the perfect amount, so just enough for a healthy dose of stress, for fulfilment, for example the three day a week job of our dreams – would we be a mentally happier society?
If you look at places like Denmark and Sweden, where there’s very good maternity and paternity leave, strict working hours – where instead of being praised, you’re considered bad if you stay late! – not only are they more productive than we British, but they’re also happier. Places where… there’s a chance for balance.
Is my generation (20s, 30s) actually more stressed than previous generations?
Yes, they really are. This is not pretend. If you look at statistics on the Office of National Statistics you will find the thirties up to forty are the most stressed, most depressed, and the loneliest. There’s no easy career path, there’s no chance of ownership of house, there’s no guarantee that good friends will hang around and we think we’re reaching out to people through social media but we’re not – we’re getting information, but we’re not curing the loneliness. You get happier the older you get, which is something to look forward to!
How does social media exacerbate stress?
The main stressor is not social media itself, it’s a perfectly good way to communicate and get information, the problem is what you’re not doing when you’re on social media. If you’re on social media instead of having real contact, and instead of having real time to breathe and calm your body, then you’re in trouble. Anyone who comes to my clinic has to put messages on all their electronic devices that say ‘Hi sorry I can’t respond to your text/ email now, I will respond between the hours of x and y.’ You put yourself in charge rather than waiting for the ping that hits your cortisol like nothing else.
What else can people do to alleviate stress – and depression?
Not texts and emails but actual contact. Our amygdala – the part of the brain that controls our emotions, also called the fear centre – what that responds to is the scent of another person! Babies first recognise their mothers through scent, not through eyesight which is very poor at birth. Scent is our most important sense for feeling safe and you’ve got to be near people to smell them! That’s what makes you feel calm – loving touch, which is why pets are so good, because you get loving touch and a release of oxytoxin and the amygdala say ‘Aha! I’m around good company, it’s going to be ok.’ It doesn’t have to be a partner, it can be a genuinely kind compliment to the person who serves you your cup of coffee, it can be opening a door to someone who’s having trouble coping – those things make the difference to you feeling safe, it’s as small as that.
Lots of my generation, when people ask how they are, reply something like “I’m so stressed”, “I’m so stressed I think I might be depressed”, should we stop saying 'stressed' when people ask how we are?
Absolutely. If, actually, you feel good despite feeling stressed, say ‘I feel great today, the weather is wonderful!’ You could have a joke, and that would make the person laugh, and if you laugh together, you release more tension than if you sat down and cried together.
Samaritans is available around the clock, every single day of the year, providing a safe place for anyone who is struggling to cope. Please call free on 116 123, email email@example.com, or visit samaritans.org to find details of the nearest branch.