Depression Versus Sadness: How to Tell the Difference–and How to Help

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May 23, 2025 - 10:01 Updated: May 22, 2025 - 17:09
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Depression Versus Sadness: How to Tell the Difference–and How to Help
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“Take it easy” is often said to those feeling down. Yet for people suffering from depression, this advice can seem frustratingly out of touch. Depression is far more serious than ordinary melancholy, but how can we tell the difference?

On NTDTV’s “She Health” program, Dr. Liu Zongxian, director of psychiatry at the Songde Branch of Taipei City Hospital, shared vital insights into diagnosing depression, supporting loved ones, and preventing relapse.

Depression: It’s More Than Just Feeling Sad

Everyone feels sad or down sometimes, and these feelings usually disappear with time. However, depression is a condition that does not disappear, and can be caused by genetic, biological, environmental, and psychological factors. For example, low levels of serotonin in the brain can cause depression.

Liu said the symptoms of depression can be identified through four key aspects, remembered by the acronym “ABCD”:

A: Affect (emotion)—Patients with depression are generally in an exceptionally low mood, feel a lack of energy, and show a decline in overall vitality.
B: Behavior—Depressed people may become withdrawn, avoid going out, and lose interest in activities they once enjoyed.
C: Cognition (thinking)—Depression can affect focus and mental clarity—those who were previously sharp may seem inattentive or mentally dull.
D: Drive (physiological motivation)—Depression may cause sleep problems, such as insomnia or sleeping excessively, reduced sexual desire, low appetite, and a general lack of motivation.
Liu noted that even if the above symptoms occur, their duration matters. If the symptoms stem from a temporary low mood without chemical imbalance, they may gradually improve after one to two weeks. However, if the symptoms last more than two weeks, it may be a sign of clinical depression, and consulting a psychiatrist is recommended.

The Right Way to Support Someone With Depression

Liu mentioned encountering relatives of depressed patients who scolded, criticized, or preached to them—actions that only worsened the situation and added pressure.

He emphasized that caregivers should focus on companionship and listening. For example, if the patient enjoys certain activities, join them. If they’re disinterested, talk about things they used to enjoy and recall positive experiences to help shift their mood gradually.

While listening, you can gently ask what the patient wants to say, what difficulties they’re facing, and how they feel now.  Always maintain an attitude of “we are always by your side” to provide reassurance and a sense of safety.

Liu reminded caregivers not to dominate conversations or completely withdraw, but to remain flexible. He stressed that caregivers’ empathy is extremely important. For example, say “You look sad,” then ask what’s troubling them. This approach can help the person feel seen and understood. However, if the patient isn’t ready to talk, you can still bring up past interests or happy memories to help them feel there are still positive parts of life to connect with.

Caregivers shouldn’t try to fix every emotional issue, as that is rarely possible. Instead, the goal is to encourage the patient to open up. Even if problems aren’t solved, simply expressing them can bring relief.

When a patient shares a story, they’re reexperiencing it. These may be moments when they once felt helpless, hopeless, or overwhelmed. However, by retelling the event with a caregiver who offers support, understanding, and patience, the patient may begin to slowly untie the knot in their heart and experience relief. Liu said this is also a common technique used in psychotherapy.

A Reminder for Caregivers: Take Care of Yourself Too

Liu advised caregivers to monitor their own well-being. Becoming too emotionally involved can lead to guilt or burnout, especially if the patient’s condition worsens. If helping someone begins to feel overwhelming, it’s important to seek support from others—friends, family, or professionals.
When a case becomes too difficult to manage, it’s a sign that professional help is needed. A doctor can assess the patient’s condition and discuss options with the caregiver for moving forward.

What If the Person Refuses to See a Doctor?

If someone resists treatment, Liu suggested framing care around treating specific symptoms—like insomnia or appetite loss—instead of depression itself. Alternatively, having someone who has recovered from depression speak to them may offer encouragement and show that improvement is possible.
Should the above strategies prove ineffective, some hospitals offer in-home visits by a physician, which may be a helpful last resort.

How to Boost Recovery and Prevent Depression

While professional treatment is essential, daily habits also play a key role in recovery and prevention.

1. Get Moving

Liu noted that exercise helps the brain release serotonin and dopamine. The more you move, the lower your risk of developing depression. Exercise and regular sunlight exposure are also key to preventing relapse.
A meta-analysis published in the American Journal of Psychiatry found that physically active people have lower rates of depression across all ages and regions.
However, people with severe depression may feel too depleted to exercise. Liu advised providing encouragement and building trust rather than forcing them to go out. In many cases, consistent support leads to a gradual willingness to try.

2. Nourish the Brain

Tryptophan, a precursor to serotonin, is vital for mental health. Insufficient tryptophan limits the synthesis of serotonin, affecting the normal functioning of the nervous system.
Liu recommended eating foods rich in tryptophan—such as oats, nuts, salmon, and fish oil—to support serotonin and improve mood. However, in some cases, the brain may be unable to synthesize serotonin properly, so even high tryptophan intake may not resolve depression on its own.

3. Medication: Proceed With Caution

Antidepressants can be life-changing for many, but they are not without risks. Liu emphasized that all medications have potential side effects and that any concerning symptoms should be reported to a doctor immediately.
Studies have found that long-term antidepressant use is associated with increased risk of coronary heart disease, cardiovascular mortality, and all-cause mortality.

Unlike sleep aids, most antidepressants are not addictive. Liu said that people with severe depression may feel significantly better after three to four weeks of treatment—but they should not stop taking the medication at that point. Discontinuing too early can lead to relapse, often more severe than the initial episode.

In general, people with severe depression should continue antidepressants for at least six months. If they show significant improvements, the dosage can then be gradually reduced or discontinued under medical supervision.

Empathy Is the Best Medicine

Helping someone through depression requires patience, empathy, and persistence. It’s not about offering quick fixes—it is about being present and steady. With the right support—and professional help when needed—healing becomes a real and achievable goal.
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