Is it the Blues or Something More?

Sad teen girl leaning against tree with four teen girls in background talking

Everyone goes through the blues now and then. Whether it was a bad break-up, the death of a loved one, or being laid off from work, we have all been there. But how do we know if what we’re feeling – or what we see someone we care about going through – is just the blues or something more serious? This episode of Total Health Radio offers insights and tips on recognizing the symptoms of different types of depression and knowing when to get help.

About the Guest
Mason Turner, MD, is chief of psychiatry at Kaiser Permanente in San Francisco.

Episode Host
Joyce Gottesfeld, MD, is an OB/GYN with Kaiser Permanente Colorado, where she’s worked 17 years. She’s a wife, proud mother of three girls, runner and blogger. Read more about Dr. Gottesfeld.

Learn More
Seeking more information about depression and warning signs of something more serious? Check out these Web resources:


DR. GOTTESFELD: Welcome to Total Health Radio.  I’m Dr. Joyce Gottesfeld.  We all feel blue at times.  Sometimes there’s a reason for these feelings.  For example, a loved one passing away, a bad breakup, being turned down for our dream job.  But sometimes it seems like there’s no reason at all.  And so for today’s show, we’re talking with Dr. Mason Turner, a psychiatrist with Kaiser Permanente in San Francisco about how to tell when we just have the blues—or when it might be something more serious.  Dr. Turner, thanks for joining us today to talk about this topic.

DR. TURNER: Great, thank you for having me.

DR. GOTTESFELD: So people use the term depression a lot.  Can you sort of define this?  What does depression itself really mean?

DR. TURNER: Depression is a very common term and it means different things depending on who you’re speaking with.  So when you speak to a psychiatrist, depression means one thing, and when you’re speaking to a friend, it may very well mean another.  So this is a very important question to answer.  Depression tends to be a mood state, where you feel sad or where you feel blue.  It can be related to situations, it can be related to biochemical issues of various sorts.  But it’s basically a mood state where you feel sad or down.

DR. GOTTESFELD: So when people feel depressed sometimes, it doesn’t mean they actually have depression.  Is that right?

DR. TURNER: That’s correct and actually depression is a very common and a very normal situation to feel from time to time.  There are times where we may feel depressed because we lose a loved one, or there are times we may feel depressed because things aren’t going very well in our jobs or our relationships.  Those are, as we would term, “normal” types of depression.  But sometimes depression can become very functioning limiting for people and incapacitating.  And that’s when we really want to think about treatment for depression.

DR. GOTTESFELD: How can you tell the difference—being sort of situationally depressed, how long might that last before you consider it something that needs evaluation and possibly treatment?

DR. TURNER: So there are three very common ways that we distinguish so-called “normal depression” or “reactive depression” for more serious forms of depression that we would once actually have people be treated for.  One of them has to do with the frequency of the depression.  Are you feeling depressed just for an hour or two per day? Or is it a struggle to wake up every morning because you’re so depressed and it lasts all day, every day for weeks on end?  We also look for the duration of the depression.  Has the depression gone on for a couple of days, a couple of weeks or for months at a time?  So the frequency and the duration are very important, but equally important are other symptoms of depression that we would look for.  Are you having trouble sleeping?  Are you having appetite changes or weight loss?  Are you feeling suicidal? Or feeling like you just really can’t go on and have no motivation to even get up and go through your day? And also, it’s important that we all develop skills to deal with the so-called “normal depression” that we experience in our daily lives.  But really what we’re talking about when we talk about treating clinical depression, is really this more serious form of depression that really is very functionally incapacitating for people.

DR. GOTTESFELD: Is that what the phrase “functionally depressed” means?

DR. TURNER: That’s correct.  So functionally depressed is a term that we use quite a bit in psychiatry and it means that you’re having some kind of functional limitations from your depression.  Maybe you can’t work.  Maybe you can’t fulfill your home or your other personal relationship responsibilities.  Or perhaps you just feel so badly that you can’t get up and do anything during the day, and these are functional things that we look for in terms of how a person is responding to their depression.

DR. GOTTESFELD: Can you tell me, are there different types of depression?

DR. TURNER: Yeah, so there are actually a variety of types of depression and that’s partly where a mental health professional can help to sort out for you really what type of depression that you have.  So people have so-called major depressive disorder, which is the classical, most common type of depression that we see.  And that’s what we use to treat medications, cognitive behavioral therapy, other therapeutic interventions can be very useful for that type of depression.  However, depression also can occur as part of a bipolar disorder.  It can occur as part of substance abuse and dependence.  It can occur in the postpartum period, when women are adjusting to a new baby. Depression really comes in a variety of forms, and one of the first pieces of information I really want to understand about my patient is what type of depression they’re suffering from.

DR. GOTTESFELD: That’s really interesting.  Again with my patients, I feel like I sometimes have trouble telling the difference between a situational and a clinical depression and sometimes they have a situational depression and they think it’s more clinical.  But sometimes they have a clinical depression and they think it’s situational, and they keep telling themselves to snap out of it.  But it’s not really that, I mean they’re not going to be able to because they really have this condition, this clinical depression that is going to need treatment.

DR. TURNER: There are times when people will come in with a situational depression—let’s take bereavement for example.  Someone has died in your life and you feel very sad about that.  That’s very normal, if you will.  However grief and that depression can actually turn into something that’s more of a clinical depression that requires treatment.

DR. GOTTESFELD: So you can get a professional to help you sort of sort through that.  In other words, if you are not sure—or even your partner, the people you live with, your family—are not sure if it’s just a situational depression versus a clinical depression, to get some help to start talking with somebody. Either their primary care doctor and then on to a behavioral health specialist, such as yourself.

DR. TURNER: That’s correct and one of the things I always tell patients is that we would much rather see you, do an evaluation, and determine that what you have is reactive depression based on a situation, then you’re waiting two, three, four weeks, two months to come in and then you’ve been suffering all that time and we could have started treatment much earlier.  So I always encourage people, whenever there’s a question, come in and talk to a professional about what you’re feeling.

DR. GOTTESFELD: And dangerous things can happen during that time.  I mean, you might damage a relationship; you might damage your position or your job—or worse, really.

DR. TURNER: That’s right, and I think this is an important place to emphasize that depression is one of the most common causes of symptoms in disability worldwide.  It’s actually the number two most common cause.  And so the functional limitations that occur as part of depression result in tremendous disability and tremendous issues for people.  And so when we can actually treat people early, and get the recommended therapy and medication started very soon, we really limit the functional impact of their depression down the line.

DR. GOTTESFELD: I understand from my medical training that depression can run in families.  In other words, people who have a family history are more at risk for experiencing depression.  Is that true?

DR. TURNER: Absolutely, and we know that depression not only is passed genetically, so the major depressive disorders are passed genetically, as are bipolar disorders as well.  But then ways of dealing with life’s stresses are also passed environmentally from parents to children and grandparents to grandchildren.  So it’s very important to think about how your family dealt with stresses and problems.  Did they become depressed and really incapacitated in being able to deal with those stresses, or were there factors that allowed them to really move forward.  Find solutions, and go to the next stage of their lives.  So I think these are both things we learn and were taught and there are things that we inherit from our parents.

DR. GOTTESFELD: But if you have a family history of depression, that’s not, sort of, a guarantee or a sentencing to a future of depression. As you were just saying, there are ways that you can identify that, address it in your family, and do things to help yourself going forward.

DR. TURNER: That’s correct and in fact, most people who have even both parents who are depressed will not become depressed themselves and the way that we would treat them.  However it’s an important piece of information for us to have and we’re trying to determine if it’s situationally related, or is this a biochemical depression that we need to treat in other ways?  That piece of information can be really crucial.

DR. GOTTESFELD: So if someone is starting to feel some depression and maybe it is situational, what are some of the things that they can do to help pick themselves up a little bit?

DR. TURNER: So the other piece that I would add about depression at this particular point is to say that also anxiety goes along with depression, the so-called nervousness that you feel.  And most of the time when someone is experiencing a situational depression, oftentimes this can be traced back to just being overstressed.  So one of the first pieces of information that I will teach patients is about how to manage their stress more effectively.  Because that will ultimately help them to manage any kind of negative feeling state that they’re experiencing.

DR. GOTTESFELD: This sounds really good.  So how do we manage stress, how do we reduce our stress?

DR. TURNER: What I always tell people, the best way of managing stress is to get rid of stress and reduce it to the degree that you can.  We all live very, very busy lives, and reducing stress is oftentimes, either very difficult, impossible or something that we just simply can’t do because of our multiple responsibilities in our lives.  So if we actually think about the fact that we look at our lives, reduce stress where we can, the next thing we have to do is learn how to build in relaxation meditation techniques into our daily lives.  Taking that five, ten, twenty-minute period in the middle of the day to relax, meditate, think about something that’s pleasurable to you is important.  And then of course good self-care is also really essential.  Eating well, getting enough sleep and really paying attention to your body.  When you’re ill, take time off from work to allow yourself to heal and those kinds of things.

DR. GOTTESFELD: When I talk to patients about this, I tell them you know, it’s not flashy, it’s not easy, it’s not a sexy solution.  There’s no pill necessarily, at least not initially, but these kind of boring things, getting enough sleep, eating healthy, getting regular exercise, they really do help.

DR. MASON: Absolutely, and I also emphasize to people that none of us, not one person in this world, can get by on four hours of sleep per night every night for years on end.  And so the fact that you actually feel okay for a day or two after you’ve gotten too little sleep doesn’t mean your body likes it.  It just means that it’s adjusting.  And over time, we have to pay attention to our body’s needs and that really is around the basics of food, water, sleep.  Those kinds of things.

DR. GOTTESFELD: Interesting. Any other things you want to add about depression before we wrap it up?

DR. TURNER: Well I would just add that for anyone who’s listening to this program and they feel depressed, they feel anxious, they feel like they’ve lost hope in being able to find help for themselves.  There is a lot of hope, there are a lot of great treatments out there for you.  And it’s really important to talk to your doctor, talk to your primary care doctor, talk to your psychiatrist, talk to a therapist.  But really reach out and try to get some help because we have really, really great treatments and really great ways of approaching depression.

DR. GOTTESFELD: Well thank you very much Dr. Turner, it’s been great to talk with you today.

DR. TURNER: Thank you.


This show is for educational purposes only. If you have specific health concerns, you are encouraged to address those with your personal doctor. And as always, if you’re having a health emergency, please call 9-1-1 or go to the nearest emergency department.