By Dr. Stephen F. Grinstead, PHD, AD, LMFT, CAMFT Clinical Member
April 16, 2016

Our body reacts to stress by secreting two types of chemical messengers: hormones in the blood and neurotransmitters in the brain. Sometimes these biochemical changes can be mistaken for mood disorders such as depression, bipolar, anxiety and post-traumatic stress disorder.

So how can we differentiate between stress and depression? Although chronic stress and depression can affect our bodies in similar ways, there are key differences.

In order to determine whether you’re dealing with stress or depression, it’s important to understand the signs and symptoms of both.

Let’s Start with Stress

A key aspect of stress management is accurately describing our level of stress at any given time. I use the Gorski-CENAPS® Stress Thermometer concept to help my patients articulate their level of stress.

The stress thermometer starts with the premise that there are 10 levels of stress. When we reach the upper-moderate to severe levels of stress (levels 6 to 10) our thinking, emotions and behaviors are affected. The goal is to keep our level of stress at level 6 or below as much as possible.

Here’s a description of the stress thermometer to help you determine your stress level:

Relaxation Zone
Level 1: Relaxed, nearly asleep
Sleepy state, daydreaming

Level 2: Relaxed but not focused
You are functioning, but you are on autopilot (e.g. fixing coffee, brushing your teeth, combing your hair, etc.). You aren’t really focused yet and at low level of functioning.

Level 3: Relaxed and starting to focus
I call this vacation level. Yes, I’m focused, but my focus is on relaxing.

Functional Stress Zone
Level 4: Focused and active
At this level, I have energy and am starting to get things done.

Level 5: Focused with no effort
You are focused and in the flow. This is where you want to be at most of the time

Level 6: Focused with effort
This is the beginning of what I call the danger area.

Stress Reaction Zone
Level 7: Unable to stay focused
You go in and out of being present or get spacey.

Level 8: Irritated, agitated
Emotions can drive you to become very defensive.

Level 9: Overreaction
You may say or do things you later regret.

Loss of Control Zone
Level 10: Loss of control
Shut down, loss of function

When you are operating in the Stress Reaction Zone (levels 7 to 9), this is where you start to lose some of your frontal lobe functioning and are transitioning into survival mode: fight, flight or freeze the amygdala limbic system of the brain. This isn’t necessarily a bad thing.

Sometimes in emergency or crisis situations an active amygdala becomes a healthy survival tool.

The final zone, Loss of Control (level 10) is where people will completely shut down. They may go to bed and pull the covers up or use inappropriate levels of alcohol in order to escape.

If you are experiencing stress at these higher levels, you may confuse your stress reactions as symptoms of depression or other mood disorders. I’d like to walk you through what depression looks like.

Exploring Symptoms of Depression

There are several types of clinical depression that involve disturbances in mood, concentration, self-confidence, sleep, appetite, activity and behavior as well as disruptions in friendships, family, work and/or school. A clinical depression is different than the experiences of sadness, disappointment and grief familiar to everyone, which makes it difficult to determine when professional help is necessary. The following information is intended to provide you with an understanding of the symptoms of clinical depression and allow you to identify any symptoms that you may be experiencing to determine whether you should consider getting professional help.

A period of depressed mood (feeling blue or down) that lasts for several days or a few weeks is often just a normal part of life and is not necessarily a cause for concern. Although these feelings are often referred to as depression, they typically do not constitute a clinical depression because the symptoms are relatively mild and only last for a short period of time. Moreover, milder periods of depression are often related to specific stressful life events, and improvement frequently coincides with the reduction or elimination of the stressor.

There are also some types of depression, including bipolar disorder, in which depressive episodes alternate with manic or hypomanic episodes, which may include feelings of agitation and euphoria. A severe or long-term depressive episode can substantially wear down self-esteem and may result in thoughts of death and even attempts of suicide.

Below is a checklist that includes the symptoms typical for clinical depression. It’s important to note, however, that only some of these symptoms are necessary for a diagnosis of depression; if you experience four or more of these symptoms for at least a month or so please see a health care professional qualified to diagnose and treat depression.

• A significantly depressed mood or general absence of mood
• Inability to experience pleasure or feel interest in daily life
• Inexplicable crying spells, sadness and/or irritability
• Insomnia (difficulty sleeping) or hypersomnia (oversleeping) nearly every day
• A substantial change in appetite, eating patterns or weight
• Fatigue or energy loss
• Diminished ability to concentrate:
• Difficulty making decisions
• Feelings of hopelessness or worthlessness
• Inappropriate feelings of guilt or self-criticism
• A lack of sexual desire
• Suicidal thoughts, feelings or behaviors

Stress Management Toolkit

Once you rule out having depression, your very next step is to incorporate some effective stress management tools into your daily life. People who have depression will also benefit from many of the interventions listed below. Review this list for healthy options to manage your stress. Pick four or five that you are willing to practice consistently on a daily basis.

• Eliminate the use of alcohol and other drugs (other than appropriate prescriptions).
• Reduce or eliminate the use of nicotine, caffeine and sugar.
• Exercise or engage in some form of physical activity, such as walking, every day.
• Eat a proper, well-balanced diet. Also, use a good multivitamin daily.
• Obtain an adequate amount of sleep. If sleep is a problem discuss this with your doctor/therapist.
• Focus on positive aspects of your life, and start making a daily gratitude list.
• Pace yourself, modify your schedule and set realistic goals.
• Eliminate or reduce unnecessary tasks so that your schedule is more manageable.
• Consult with a physician if you are experiencing any medical problems.
• Reduce negative self-talk by developing and practicing positive affirmations.
• Practice deep diaphragm breathing for five to seven minutes two to three times per day.
• Practice progressive muscle relaxation for five to seven minutes two to three times per day.
• There are hundreds of styles of meditation. Learn and practice one daily.

Now that you have new tools, find an accountability partner who will help you implement an authentic plan of action. Remember, if you manage your stress, you will better manage your life.

Dr. Stephen F. Grinstead, PHD, AD, LMFT, is a member of the California Association of Marriage and Family Therapists, an independent professional organization dedicated to representing the interests of marriage and family therapists. Grinstead has been working with chronic pain management addictive disorders, relapse prevention therapy and Addiction-Free Pain Management for more than 28 years. He is the author of the book Freedom from Suffering: A Journey of Hope and someone who has lived with his own chronic pain for almost 30 years. He is currently the clinical director of training and consultation for the Gorski-CENAPS Corp. and owner of Grinstead Consultation, Training & Coaching Services. Grinstead specializes in training and consultation for addiction and co-existing personality and mental health problems. For more information visit the California Association of Marriage and Family Therapists website. First of all, stress isn’t all bad. Human beings need some level of stress to motivate us and deal with life on life’s terms. Stress provides energy and fuels the fight, flight or freeze phenomenon to help us adapt to our environment.

For more information visit the California Association of Marriage and Family Therapists website.