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Sad and Nervous or Depressed and Anxious: Is There a Difference?

CBA Wellness
Author: Cheryl Canning, QC, Burchells LLP

I am one of a growing number of Canadians who find winters difficult. I don’t enjoy outdoor activities in the snow, I don’t like being cold, and the lessened daylight leaves me wanting to wrap up in a blanket and wait for Spring to arrive. Throughout January, February and March I grit my teeth, turn on my light therapy lamp, pop my Vitamin D, and remind myself it will all be better when Spring arrives.

Well, it’s Spring now (or at least that’s what the calendar says… mother nature seems to be hitting the snooze button). We are still waiting for the warm weather to arrive, but the snow is gone and the days are longer. So why don’t I magically feel better?

It’s not lost on me that a better attitude towards winter would help with all of this, and I’m working on that, but in the meantime, that doesn’t answer the question as to why I don’t feel better now that Spring has sprung. Could it be that there is more to my melancholy? Could it be that *gasp* life circumstances are contributing to my mood?

Let’s be honest, that’s very likely the case. My dad passed away just 7 months ago and my mother has advanced dementia, which means I wake up every morning and immediately check my phone for information from my sister. My sister is struggling immensely trying to care for our mother and I’m not sure which of them I am more worried about. I don’t live anywhere nearby and cannot easily help. On top of that, my older son is graduating from high school in a couple of months and the anticipation of him leaving home already weighs on me. My younger son is just entering the teenage years and has left me scratching my head constantly, wondering what he is thinking and what is going on in his life.

Could all of this be contributing to my lowered mood? Of course it is! Am I “depressed”? Maybe. But maybe not. Maybe I’m just experiencing life’s normal ups and downs.

A relatively significant portion of my practice involves defending personal injury claims, which means that I spend a great deal of time poring over medical records. The most challenging cases are often those in which there is no identifiable “condition” but there are symptoms that are affecting the plaintiff’s ability to function. Whether the symptoms are real or imagined, in my experience, more often than not, the plaintiff truly believes they exist and their function is genuinely limited by them. Doctors appear to struggle with this. Patients want an answer. They want to know what is wrong and what the fix is and they expect doctors to be able to provide that information. That leaves doctors in the position of having to label things that are not really capable of being labelled.

When I first started practicing 20 years ago “chronic pain” was a generic label applied to every plaintiff who had ongoing symptoms of pain with no identifiable explanation for the pain. Then fibromyalgia took its place, being applied far outside situations involving its actual diagnostic criteria. Fibromyalgia fell out of favour to be replaced by myofascial pain syndrome. Since then we’ve seen fleeting trends of complex regional pain syndrome and somatic symptom disorder. These are all real medical conditions, but they were not appropriate for all of the situations in which they were being used. They were catch all labels applied to give patients the peace of mind to be able to say “I have this medical condition. That’s why I feel the way I do and why I can’t do all the things I used to do.” It’s human nature to want to be able to label the problem and to be able to blame it when you feel you are not behaving in a way that is expected of you.

I feel like depression and anxiety are beginning to fall victim to this sort of usage as well. We’ve made some progress towards de-stigmatizing these conditions and it is now more socially acceptable to admit to having them, so maybe that is one of the reasons why we see the diagnoses more often. But are we overusing the labels?

We all have ups and downs in life. The downs can be caused by an entire spectrum of issues, from having a bad day to having a significant life-changing event. We all have innate anxiety to some degree and some situations we find ourselves in leave us less capable of controlling that anxiety. That’s normal. That’s life. Feeling sadness and feeling anxious are not necessarily disordered feelings.

Much like people who feel chronic pain and want to be able to label the things that makes them feel bad, when we feel emotional pain, we also want to be able to label it. We don’t want to think “My life is a little crappy at the moment” because that leaves us feeling as if we should be able to control life and if it isn’t perfect, it must surely be our own fault. We want to think “I have a disease and it’s not my fault.”

I don’t mean to diminish the importance of identifying depression and anxiety or to suggest that people should not seek treatment for them. Identifying and treating these disorders is as important, and should be no more stigmatized, than identifying and treating diabetes. But not every spike or dip in blood sugar is diabetes, and not every spike or dip in mood is depression. We need to accept that we are not going to be happy and calm all the time. We need to allow ourselves the ability to have a good cry and wallow in self-pity now and then. We need to know that it’s okay to experience the anxiety that comes hand in hand with new experiences. Once we label these fleeting experiences as disorders, they are no longer fleeting. We accept them as being part of our overall makeup that is permanent and not as something that will come and go.

How do you tell the difference? That’s the subject of a much longer article that I am not qualified to write. What I can suggest is that you begin by acknowledging the difference and touching base with yourself frequently. If you’re feeling down right now, think back. How long have you felt that way? Is there something going on in your life that could be causing it? Are you actually sad, or are you feeling flat and neither happy nor sad? Learn how to identify mental health disorders (CBA Wellness’ Online Course: Mental Health and Wellness in the Legal Profession is a great way to learn!). Seek help if you think you need it.

I’m going back to watching for green sprouts in my garden and looking forward to the days when the sun brings warmth on my face. I’m feeling better already.

— Cheryl Canning, QC

Comments

  1. I’m sure you only mean well with this post, but people suffering from clinically diagnosed anxiety and depression have heard variations on this theme ad nauseum. It’s not exactly a revolutionary thought that perhaps overdiagnosis of these conditions occurs, or that people would prefer to “blame a disease” (in your words) instead of what people often call “taking responsibility for your feelings”, by which they mean, “suck it up, princess.”

    We have a real problem with mental health stigma, and the people who misunderstand how mental illness works. I have no doubt that in your line of work, you see cases of individuals who’d like to take advantage diagnoses like fibromyalgia or depression, but these individuals’ existence says nothing about the prevalence of these conditions more widely, or the prevalence of fakers, or the prevalence of people you insinuate are weak-willed for not accepting that “we all have bad days”.

    Yes, life circumstances do have an effect on our emotional state, and none of us can or should expect to be happy, calm, or content all of the time. But an article that suggests that mental health diagnosis is overblown, even if it’s followed up by a suggestion to “seek help if you think you need it”, is socially irresponsible. People with depression are told all the time that their emotional state is overblown sadness, that they’re wallowing, that they just need to realize they can’t be happy all the time. This article is really just more of the same.

    Finally, to your title, “Sad and Nervous or Depressed and Anxious: Is There a Difference?” I can answer that unequivocally. Yes, there’s a difference. I’d suggest you familiarize yourself with diagnostic criteria for anxiety and depression, respectively, because “sad” and “nervous” are not the primary or sole symptoms of these conditions.

    Information on depression:
    https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/conditions-and-disorders/depression

    Information on anxiety:
    https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/conditions-and-disorders/anxiety-disorders

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