How Much Sadness is Normal?

The unexpected loss of a job, the collapse of a marriage, or the diagnosis of a life-threatening illness all sound like very good reasons to be sad. Although feeling sad is never pleasant, researchers have shown that many instances of normal sadness--the kind that descends after you lose a job or get dumped--are being misdiagnosed as depression.

"Since 1980, an enormous 'medicalization' of unhappiness has occurred. Life's ills--whether a failure to attain an expected promotion, ongoing conflict with a spouse, or overwhelming distress from coping with competing family and work demands--are too often treated as mental disorders based on the report of a few symptoms of sadness," said Allan Horwitz, PhD and Jerome Wakefield, PhD in the November 2008 issue of Psychiatric Times.

In their book, The Loss of Sadness: How Psychiatry Transformed Normal Misery Into Depressive Disorder, Horwitz, a professor of Sociology and Dean of Social and Behavioral Sciences at Rutgers University, and Jerome Wakefield, a professor of Social Work at New York University, make the case that psychiatry no longer clearly differentiates between normal sadness and depressive disorder. They believe that contemporary psychiatry confuses the two because it ignores the relationship between the patient's symptoms and the context from which they emerge.

Horwitz and Wakefield argue that major depressive disorder (MDD) has become psychiatry's signature diagnosis. Depression, they say, is diagnosed in about 40 percent of patients who see a psychiatrist today. This percentage is double that of just 20 years ago.

Add to this that the consumption of antidepressants has soared since 1990. According to health data collected by the Centers for Disease Control and Prevention, roughly 10 percent of women and 4 percent of men in the United States now take antidepressant medication.

"The consequences of over-medication is particularly worrisome for children and adolescents who are being socialized into a belief system that equates personal suffering with mental disorder to be overcome by taking a pill," Horowitz and Wakefield say.

So how do we know how much sadness is normal?

According to Horwitz and Wakefield, a diagnosis of major depressive disorder (MDD) is warranted when a patient has experienced at least 5 of 9 depression symptoms for at least 2 weeks, and the 5 symptoms include either depressed mood or an inability to derive pleasure from life.

Even if you have legitimate reasons to feel sad, when that sadness seems overwhelming and is interfering with your ability to continue your normal life, a good therapist or support group can help. Furthermore, when you have few reasons to really feel sad, and yet you do, this may not be "normal." If you are constantly sad and depressed for little reason, this deserves medical attention.

While some minor depressive feelings may be a normal part of life, major depression is a more serious condition. If suicidal thoughts and feelings are present, contact your doctor immediately.


Andrews et al. (2007). Issues for DSM-V: Simplifying DSM-IV to Enhance Utility: The Case of Major Depressive Disorder. Am J Psychiatry, 164, 1784-1785.

Cloud, J. When Sadness is a Good Thing. Time. August 16, 2007.,9171,1653643,00.html

Horwitz, A.V and Wakefield, J.C. The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder. New York: Oxford University Press, 2007.

Horwitz, A.V and Wakefield, J.C. An Epidemic of Depression. Psychiatric Times. Vol. 25 No. 13. November 1, 2008.

NIH Publication No. 07-3561, 2007

Wakefield J.C., Schmitz M.F., First M.B., Horwitz A.V. Should the bereavement exclusion for major depression be extended to other losses? Evidence from the National Comorbidity Survey. Arch Gen Psychiatry. 2007;64:433-440.