Thanks to reader “Citizen” who posted the following question on my “Labor Pains” post:

How do you distinguish depression from ordinary feelings, if it isn’t as obvious as what you have described?

Separating clinical depression from the sadness and normal anxiety caused by life’s unpleasant moments must be a bit like distinguishing cow manure from horse compost. Although I’m not a farmer, I suspect it’s not easy or fun. (I’ll stick to writing about both on Beyond Blue.)

The First Noble Truth according to the Buddha is that life is suffering. To live is to suffer. Suffering is unavoidable. And M. Scott Peck began in classic “The Road Less Traveled” with these words: “Life is difficult. This is a great truth, one of the greatest truths.” So then how can shrinks tease apart depression from normal responses to life’s difficulties and challenges?

Some would say not very well.

“Drawing the line between normal and abnormal suffering has long been controversial in psychiatry,” writes Shankar Vedantam in a “Washington Post” article about new guidelines for the diagnosis of depression, “because people who have no disorders often experience the same symptoms as those who do, but their reactions typically are less prolonged and intense. Where to draw the line involves a degree of subjective judgment: If the criteria are too strict, some people who are depressed may not receive help.”

And if the line is drawn too broad, lots of people walk away with prescriptions they don’t really need, and pharmaceutical share prices rise (thus, the $12 billion-a-year U.S. market for antidepressants).

“The cost of not looking at context is you think anyone who comes under this diagnosis has a biological disorder, so should more or less automatically get antidepressant medication, and everything else is superfluous,” says Jerome Wakefield, the lead author of a new study suggesting that up to 25 percent of people whom psychiatrists would presently diagnose as depressed may just be reacting to stressful events in their lives, such as divorce, the death of a loved one, or losing a job.

I can understand Wakefield’s concerns because, even to this pro-medication person, it does seems like an awful lot of people are taking SSRIs (Selective Serotonin Reuptake Inhibitors). On the other hand, I know a few who should be taking them and aren’t (in my humble opinion).

In my psychotherapy sessions and in group therapy at the hospital, we often talked about situational depression versus bio-chemical depression. Depression is situational if it was triggered by an event such as a breakup, job loss, or trauma of any kind. If it doesn’t lift on its own, it can worsen into clinical depression.

During several months of my depression–especially as I tried different medications and holistic remedies but didn’t get better–I thought that my depression was situational: that my REAL problem lay with being a stay-at-home mom–with little or no intellectual stimulation, ugly Teletubbies on TV, 500-piece dinosaur puzzles to assemble, and hours of arts and crafts I should do with the kids if I was a good mom (according to parenting magazines).

“Maybe my problem is that I’m forcing an immense square peg into a minuscule round hole. If I got the right job, and worked full time, maybe then I wouldn’t be depressed,” I told my therapist.

“To work full time, you have to be able to not cry,” she said. (It was a good observation, given that I spent most of hour together bawling.) “Yes, you can work at integrating more intellectually stimulating activities into your life, but I really believe you’ve got to get on top of your bio-chemical depression before you can start to do that.”

A friend of mine presently buried in the Black Hole told me that she was afraid that her marriage was causing her depression.

“I’m wondering if I would feel depressed if I were in a more supportive relationship,” she said.

“Did you have these concerns when you were feeling good?” I asked, a question my therapist told me to ask myself whenever I came across another “solution” (like get a full-time job) to my depression enigma (which was never an enigma to her).

“No. I’m relatively happy with our marriage when I’m not depressed.”

“Now isn’t the time to go there, then,” I said, playing therapist (a favorite hobby of mine).

I know many friends who have struggled through situational depressions–their symptoms mimicked many of clinical depression. But, in time (in less than a year usually), the darkness lifted, and they were able to move on. I, on the other hand, was stuck–incapable of moving anywhere without a lot of intervention. And then some more intervention.