Clinical depression is about early, repetitive loss. The earlier in life the loss occurs, and the more often it happens, the more severe depression can become. Early loss doesn't necessarily have to involve the loss of an actual person, and rarely does. It generally involves the unavailability (loss) of a caregiver and/or the giving of affection and approval that is conditional. Unlike the loss of a physical person, these kinds of losses are often hidden from view.
Early loss also makes a person more vulnerable to depressive reactions later in life when any new loss occurs. The breakup of a love relationship or a divorce are the two most common examples of adolescent and adult losses that recall earlier childhood deprivations that can then intensify the current loss. Those earlier losses become evident if the adolescent or adult cannot recover from those breakups in a reasonable length of time. It's one thing to temporarily feel hopeless, lost, bereft, etc., after a breakup. It's quite another to spend years pining and/or refusing to re-engage life. No one considers threatening or actively planning suicide to be a reasonable response to a breakup.
If a child has experienced either or both of these conditions and eventually becomes a parent himself, he might become depressed when his child becomes old enough to leave and attend school. The same parent may become depressed anytime his child "moves on." This parent experiences the growth and independence of his child as a loss, not as something to necessarily be happy about.
There is a difference between clinical depression and a depressive reaction or episode. That difference is in the degree of severity, the repetitiveness of early deprivations, and how debilitating each is to daily living; how each affects work, play, relationships, and one’s outlook on life. A depressive reaction can result from the loss of a period of time in a person's life, which can be triggered by "developmental milestones," or transitions, (onset of adolescence, mid-life, empty nest, retirement, death of a parent, etc.) in people who are prone to depression. All of these transitions involve a kind of loss. For example, adolescence is a loss of childhood, a mid-life crisis is a loss of youthful vitality, an empty nest is a loss of a family as it once was, etc. As noted such transitions can precipitate depressive reactions that last well beyond what would be considered reasonable.
Signs of Depression: There are definite signs that indicate the onset of a depression that require attention from others. There is greater awareness about these indicators as a result of media attention, (movies, TV) schools, public tragedies, and the internet. There is new understanding that depressed people communicate their depression along a continuum in a number of ways. These messages are often communicated indirectly or non-verbally, making them more difficult to recognize. Sometimes we overlook them due to the demands of our own lives and have regrets later on if someone we know becomes seriously depressed or suicidal. Children, adolescents, and adults who are depressed do have things in common that parents, other adults, and friends can observe and recognize.
Most people know that any significant change in behavior or lifestyle can be a possible sign that a person is in conflict of some kind. With depression, withdrawal from one's routine or previously preferred activities, friends, social life, etc. Depressive speech often accompanies such a withdrawal. "What's the point anyway?" "Life sucks, then you die." "I wish I were somewhere (or someone) else." "Same crap, different day." Why bother, it's never going to get better." These are glass half-empty, frequent pessimisms that many of us use from time to time. When overused by someone who doesn't normally use them however, or when used in combination with other indicators, they should be paid attention to.
When confronted with depressive speech, there is a natural tendency to "cheerlead," to attempt to cheer the the person up, buoy his/her spirits, show him or her that's it's not so bad. In a depressed person, such a response can worsen the depression because the person feels more like a loser or a failure or a disappointment, or however it is he/she is experiencing themselves. They can feel more guilty than they felt before. Verbal expressions of excessive guilt or remorse can also be indicators, as is a feeling that the depressed person is responsible for someone else's misery or misfortune. A slow deterioration of grades in children or poor job performance in children and adults who were once high achievers is another obvious sign. Similarly, a deterioration in physical appearance should be noticed. Weight gain or loss (not all weight loss is good), poor grooming, wearing the same clothes, etc., should arouse curiosity in those close to such an individual. Often the individual will dismiss these changes claiming that he or she doesn't care what other people think, etc. Not caring is yet another sign. Of course, overt expressions of self hatred and loathing when accompanied by any or all of the other symptoms should always be attended to and taken seriously.
The sudden deaths of public figures, a role model any authority figure, or a contemporary, can become triggers. Even political turmoil; when our institutions and leaders fail us; can precipitate depressive episodes since it arouses all the feelings of insecurity, helplessness, and rage one had at an earlier time in life. It should be noted that both situations; that of the original depriving caregiver(s) and failing political institutions; are real, existential threats. They are not imagined losses.
Some people can experience an extended period of mourning when their home becomes an empty nest, when their identity as a parent changes. The loss of a job and/or income is another common trigger, particularly for men because, rightly or wrongly, they are socialized to be primary providers. Even the loss of youthful vitality can trigger depressive reactions. (The explosion of "Low T" palliatives was not an accident).
As with a lot of reactions and feelings, the level of intensity can provide a clue that there is more in play than meets the eye. If a reaction doesn't fit the situation, if it's over the top, if the person cannot get beyond it, it often means that the past is "glued" to the present and earlier losses haven't been properly resolved. There is a "piling on" effect. An experienced therapist can help identify and separate these old losses from current ones. Once that loss can be determined and discussed, a depressive episode can be resolved.
There are people who function quite effectively, particularly at work, yet can still be quite depressed. They are "agitated" depressives and are primarily men but are by no means limited to them. These people are always on the move, working, very busy, "running" from their losses, but can be very productive and achieve great success. Activity is one way of coping with loss. In children and adolescents, agitated depression can take the form of "class clown." The child gets laughs at his (again, they're generally boys) own expense. While his peers laugh, the class clown is often anxious and sad, may be underachieving, and is often dealing with depressing family conflict. Very few of them go on to become professional comedians and the ones who do are usually not shy about acknowledging the depressing sources of their humor. Robin Williams was one notable and recent example. Agitated depressives can respond well to relational, psychodynamic therapy because they are already engaged with life and seek relief through collaborative relationships.
There are other, more clinically depressed people who cope with loss by withdrawing from life. Their losses were so early and so often that life itself has become terrifying and overwhelming. They can literally hide under the covers, and become unable to muster enough energy or motivation to do much of anything. They will avoid others and neglect themselves. They look depressed. Thought processes can become severely distorted. Anger really is turned back on the self and/or blocked from expression. Suicidal ideas, gestures, or attempts can become a concern. Clinically depressed people are often unable to recover from losses at all without help, and some of them actively refuse help. Treatment can sometimes require additional interventions like medication, ECT, (electroconvulsive therapy) CBT, (Cognitive Behavior therapy) in addition to relational, psychodynamic therapy. A holistic, integrative approach is necessary to restore a sense of self. Just being motivated enough to seek out and participate in therapy can be a sign of progress and hopefulness.
There are also people who look and act depressed but aren't. Their depression, rather their depressive demeanor, is a "disguise" for something else, quite often intense anxiety about something, or possibly severe dependency. By disguise, I don't mean to imply that the person is aware or conscious of what is going on, that it's an act. He or she can actually feel depressed. They have sometimes been told they are depressed and/or been treated for depression. In these situations, a differential diagnosis is important for treatment to be successful, but often cannot be made in an initial interview. Debilitating social anxiety or agoraphobic episodes can produce behavior that looks like depression because the person withdraws from people and activities.
A person may act or look depressed as a result of a codependent relationship with a parent, spouse, or child. They withdraw from social activities, if they had them to begin with, become preoccupied with the other person, and are suspicious of outsiders who are experienced as a threat to the codependent relationship. In such a relationship, neither member can tolerate loss at all. When they involve children, frequent absences from school can occur, as can avoidance of school related social situations when they do attend. They can be susceptible to victimization (being bullied). These children are unconsciously sacrificing their own independence and age appropriate childhood experiences to remain close to a depressed parent. It is very difficult to leave someone who isn't happy.
There are some people who cannot tolerate loss at all and defend themselves against the pain of it by denying its importance. They tend to be in a rush to get over losses and can become impatient with those who require more time. Again, this kind of response can become problematic in a love relationship or within a family involving children. The deaths of pets, the loss of a favorite babysitter or nanny, of a grandparent, etc., are treated as inconveniences, the impact of which is stoically minimized and expected to be gotten over quickly. These parents cannot tolerate their children's grief because their own suppressed grief is overwhelming. The Mary Tyler Moore award winning portrayal of the grieving mother in the Oscar winning film, "Ordinary People" is a good example.