Dr. Khimji hosted Calgary’s 19th Walk With A Doc this past weekend, you can watch the full health talk on Decoding Depression here:

How is your mood? How often do you ask yourself that? How often do we ask each other that? Although mental health gets more attention than ever before, it is still important to keep shedding light on related topics. This article is about a specific mood disorder which is very common and very sinister: depression. Depression is silent, insidious, and may be easily hidden behind common pleasantries or even a smile. Just because someone is outgoing or socially engaged or functioning day to day, does not mean they are not struggling with depression. Equally, you do not need to wait until you are drowning and suffering to recognize that depression may be impacting you. Let’s get decoding!

(Short on time? Click here for The Bottom Line)

No matter your age, gender, ethnicity, profession, hobbies, or circumstances, depression can affect you. It is a distinct mental health condition that causes a lasting, persistent feeling of sadness and a loss of interest in previously enjoyed activities. The clinical terms are Major Depressive Disorder (MDD) and Clinical Depression, and they are not the same as normal feelings of sadness.

It is normal to feel “down” or sad from time to time. You may have even felt discouraged or gloomy before. That is a part of the human experience. It is especially normal after life events such as losing a job, going through a breakup, or a change in your life circumstances. Depression, however, lasts longer, lingers, and comes specifically with more feelings of hopelessness, especially about the future, and even pushes people to consider taking their own life.

So, how do you tell the difference between this and “normal” sad feelings?

When I work with someone for the first time, I screen for MDD using criteria to help me understand where their mood is at. The presence of the following signs may indicate when Depression is more likely:

  • Little interest or pleasure in doing things
  • Feeling down, depressed, or hopeless
  • Trouble falling asleep, staying asleep, or sleeping too much
  • Feeling tired or having little energy
  • Poor appetite or overeating
  • Feeling bad about yourself, feeling like a failure, or that you let yourself or your family down
  • Trouble concentrating on things, such as reading or watching media
  • Moving or speaking noticeably slower and/or feeling more fidgety or restless than usual
  • Thoughts that you would be better off dead, or thoughts of harming yourself in some way

When some or all of the above feelings persist for at least 2 weeks, especially the first two points in combination, we are definitely looking more at depression rather than ordinary sadness. We assess severity based on how frequently someone is impacted by the above signs.

An essential part of navigating depression is to understand that experiencing any of the above signs can make it much more difficult to function day to day. For instance, going to work, self-care, chores, and getting along with others, tend to become much more challenging.

You may wonder, what causes depression? There is no single cause for depression. It usually develops from a combination of risk factors. For example:

  • Neurotransmitters (aka your “feel-good hormones”) – changes in amounts of these in your brain influence susceptibility to depression.
  • Genetics – you are at a higher risk for depression if a family member has it.
  • Environment – stressful events, life circumstances, conflicts, lack of support, isolation, etc.
  • Health – specific conditions such as chronic pain, cancer, multiple sclerosis, and diabetes are associated with a higher risk of developing depression.

Depression can feel like a weight that does not easily lift. Interestingly, it may not even involve sadness. Some people instead feel numb or lack emotion. Others may feel very easily irritated or more frustrated than usual. Small day to day tasks such as brushing your teeth, getting dressed, and starting your day feel like an exhaustive burden requiring more energy than usual.

One of the most sinister features of depression is the negative self-talk. Thoughts become increasingly negative, leading to feelings of guilt, shame, or worthlessness. And this creates a vicious cycle of negative thoughts leading to negative words, which in turn lead to negative feelings (about yourself and others), which then leaves you with one last step of the cycle: negative habits and unhealthy behaviours to cope with the stress of all of it. And that of course fuels more negative thoughts and feelings. And so the cycle continues.

The key is to break the cycle. As always, here are some actions you can take to enhance your mental health and better navigate depression:

  • Talk Therapy (Psychotherapy)
    • Helpful for understanding how your thoughts, feelings, and behaviours interact with each other and affect you.
    • You will learn healthy coping strategies, develop better stress management, and cultivate techniques to navigate tough situations and relationship complexities.
  • Medication (Pharmacotherapy)
    • Anti-depressant medications can greatly help with symptoms of depression.
    • These directly impact the neurotransmitters in the brain that regulate your mood such as serotonin, dopamine, and norepinephrine.
  • Mindful Practices
    • A combination of skills and tools you can employ and practice to enhance your mental and emotional wellbeing.
    • Examples include mindfulness, meditation, journaling, practicing gratitude, understanding your emotions, learning how to self-regulate, and practicing self-care.
  • Lifestyle Medicine
    • You can apply each pillar to enhance your mental well-being:
      • Nutrition: what you put into your mouth impacts your gut, which impacts your brain, which in turn impacts what you put into your mouth.
      • Movement: the more you move your body, the more the weight/burden of depression tends to lift.
      • Sleep: prioritize enough high-quality, restorative rest.
      • Connection: staying connected and in community helps greatly, while social isolation and lower social engagement keeps you deeper in depression.
      • Stress: healthy coping mechanisms and mindful practices as above are useful.
      • Substances: eliminating or at least reducing smoking, alcohol, and drug use will reduce your risk of getting depression and the intensity of the low mood.

Remember, depression is a silent, easily-hidden mental health condition that is far too common. Rather than shy away from this and sweep it under the rug, it is important to shine light directly onto it. And if it is not something you struggle with, the above actions are ways you can prevent it.

Depression thrives in the shadows. Let’s change that.

The next time you see someone, anyone, that you pass by, that you may know or not know, that you see often or only once… remember they may be struggling with things you have no idea about. Be kind. To yourself and to others.

Now that we have decoded depression, I hope you feel hopeful, positive, and more aware of what you can do to help yourself and others when it comes to this mental health condition.

As always, chase progress, not perfection.

I believe in you,


Dr. Khimji


PS. If you are struggling with your mental health, are experiencing thoughts of taking your life or harming yourself or others, or you are feeling like this article speaks to you, please seek care from your healthcare professional or emergency medical care as appropriate.


This Week’s Challenge

Any moment this week that you have a feeling (of any kind) come up for you, try to bring your awareness towards that feeling. Label the emotion(s) you are experiencing and describe them as descriptively as you can. 


The Bottom Line

Depression is an extremely common affliction that often hides in plain sight. You may not know the person next to you is struggling even if they appear to be functioning just fine. Feeling down or sad is a normal part of being human and experiencing life. Depression persists for at least 2 weeks and involves feelings of hopelessness, loss of excitement in previously enjoyed activities, difficulties with sleep, energy, appetite, and concentration, feelings of guilt or failure or negativity about yourself or others, and thoughts of harming yourself or that you may be better off dead. Multiple factors influence your risk of developing depression as well as how it comes about, from biochemistry and genetics, to your environment and medical conditions. You may feel numb or emotionless, or irritable and frustrated more easily, depression is not limited to sadness. A horrible feature of depression is negative self-talk and negative thoughts, which lead to feeling poorly about yourself, which lead to unhealthy coping behaviours, which in turn create more guilt, shame, stress, and negative self-talk. Talk therapy, medications, mindful practices (journaling, gratitude, meditation, etc), and applying the pillars of Lifestyle Medicine, are all excellent tools to help you enhance your mental health and well-being. Be kind to others, you never know what they might be going through. Be kind to yourself, no matter what you may be going through.

PS. If you are struggling with your mental health, are experiencing thoughts of taking your life or harming yourself or others, or you are feeling like this article speaks to you, please seek care from your healthcare professional or emergency medical care as appropriate.