What is the first thing that comes to your mind when you hear the word depression, and what do you think of when you hear that someone is depressed? You are aware that nowadays we often hear the word itself, as well as some ‘depressing stories‘. Sometimes it seems present to such an extent that we constantly hear someone saying ‘oh, everyone is depressed/feel blue nowadays’. Not only does it wrongly generalize, but such an attitude also implies a serious problem because if everyone is depressed, it may turn out that it is not a serious issue or an important topic at all. It can, of course, go in a completely different direction – panic and helplessness. ‘If we are all in a ‘gutter’ then we cannot get out of it and save ourselves’. Whichever of these two paths we take, we reach a point where we do not help and support as much as we should - neither ourselves nor others. This is why it is important to define what depression is (and what is not) and to be aware of our relationship with people struggling with it.

When experts hear and use the word depression they refer to the condition in which at least five out of the following nine symptoms are present for minimum two weeks: 1) intense feeling of sadness or emptiness for a long period of time (two weeks and longer), that is present for most of the day; 2) low interest or absence of interest in activities that used to be pleasant; 3) sleep problems, such as insomnia or oversleeping; 4) problems with nutrition, such as taking too little or too much food; 5) feeling restless or irritable; 6) increased fatigue; 7) feelings of guilt and worthlessness that have no real cause or are exaggerated in relation to the event; 8) difficulties in maintaining concentration and making decisions and 9) suicidal thoughts, ideas or suicide attempts. Our patients and clients add their own ‘definitions’ to this description, such as, for example, that depression is ‘something sad - the saddest and empty – the most empty’, ‘the feeling as if you've been living your whole life under some kind of scrum, under some kind of anesthesia like that at the dentist where you feel nothing and nothing feels good’, ‘a feeling that you are constantly dragging 100 tons of weight and darkness with you through a tunnel where everything is black, both what is around you and what is in front of you’.

A person who has not experienced this can easily slip into minimizing the problem and the feeling that it is all a matter of choice, and consequently give advice such as ‘don't worry, do something useful, be positive, don't think about it, etc.’. Unfortunately, it is not uncommon to go a step further - to blame and criticize by saying something like ‘it's all about being lazy and spoilt - if they had to get up at five a.m. to do some physical work, I am sure they wouldn’t be depressed’ or ‘they are all weaklings who can't handle life and challenges’ or ‘they are all failures, because if they were successful in business and had money, they certainly wouldn't have any time or reason to be depressed.’ This understanding of people with depression, often accompanied by a stereotypical image of a ‘depressed person’ as someone who is unkempt, who constantly wears black, constantly cries and has gloomy thoughts, does not get out of bed and does nothing. Believing in these and similar images and stories makes us ‘shock’ again and again (although obviously not enough to change our attitude) every time we hear that comedians like Jim Carrey, the ones who lived life to the fullest, struggled with depression, like Anthony Bourdain and numerous other people who were ‘beautiful, well-dressed and smart’, rich and super successful.

These prejudices further hurt and reinforce the stigma, deepening feelings of inferiority, shame, loneliness, various other unpleasant emotions and all the symptoms mentioned at the beginning. The consequences are further distancing, finding it a problem to seek professional and any other help, as well as the tendency to mask depression (with bodily symptoms, functionality, humor, anger...) or ‘bury’ it with various things and substances. Social rules and prohibitions on certain emotions are indirectly told by the fact that in women the diagnosis of a depressive disorder occurs more often with anxiety or fear-related disorders, appetite disorders and weight gain, while men with depressive disorder more often have a disorder related to the use of alcohol or psychoactive substances, poor impulse control and increased risk-taking behavior. In men, depression is often masked and ‘turned’ into another problem because society and culture send the message that ‘(real/strong) men don't cry.’

Bearing all this in mind, it is a great and nothing less than heroic thing that a man living in this region, a public figure, describes with a book, clearly, loudly ‘out of his skin, life with depression’. We can't all do what Aleksandar Stanković did, but we can work to normalize vulnerability, break prejudices and cultivate empathy, compassion and solidarity. We can reach out and help get out of the gutter, out of stigma and darkness. It’s time!