Why Am I So Sad? Understanding Persistent Sadness and How to Cope

Feeling sad all the time is a terrible feeling. You lose interest in doing anything other than lying in bed. It feels like you’re always covered by a dark cloud, and you don’t think it’s ever gonna get better. You ask yourself, “Why am I so sad?” and “Why do I feel so bad all the time?” 

Sound familiar? Sometimes, persistent sadness is a completely valid reaction to difficult life circumstances. But other times, it might feel like it comes out of nowhere, without a clear reason. It’s important to understand the difference between typical sadness and something more serious.

“The main difference between ‘normal’ sadness and ‘NOT normal’ sadness comes down to how that feeling of sadness is impacting your overall functioning, the severity of the symptoms, and how persistent it is,” says licensed clinical social worker Elyce Mandich.

“Sadness is a very common and expected emotion for you to feel at times, especially in response to something upsetting, like a fight with a friend or the end of a relationship. However, if that sadness is ongoing, impacting relationships, school or work, or overall functioning, there may be something more going on,” Mandich adds.

So, if you're wondering whether your sadness could be something more than just sadness, read on to learn about different mental health conditions and scenarios that are associated with low mood. However, it’s important to avoid self-diagnosis. Consult with a mental health care professional for an accurate diagnosis and treatment plan. 

Major depressive disorder

One of the most common conditions linked to chronic sadness is major depressive disorder (MDD), also referred to as clinical depression or simply depression.

This is a mood disorder characterized by ongoing low mood, with symptoms persisting for most of the day, for most days across at least two weeks. On top of sadness, other MDD symptoms include loss of pleasure and interest in things you used to enjoy, lack of motivation, a desire to withdraw, worthlessness, and hopelessness.

These symptoms make it incredibly hard to go about your day-to-day life. You might struggle to brush your teeth, shower, or feed yourself, let alone function at school or work. 

Dysthymia

Dysthymia, also called persistent depressive disorder, involves similar symptoms of MDD listed above (like low mood, low energy, and loss of interest and pleasure in things you used to love), but they’re generally less severe and more chronic. The diagnostic criteria for this lesser-known mood disorder say symptoms must have lasted for two years or more. 

Bipolar disorder 

Also referred to as bipolar depression, this disorder results in mood swings including:

• Depressive episodes. Periods of persistent depressive symptoms, including low mood and hopelessness.

• Manic episodes (AKA mania). Episodes of elevated mood and other symptoms like irritability, reckless behavior, and racing thoughts.

• Hypomanic episodes. Less intense manic episodes that don’t impact daily functioning as much.

Depressive episodes tend to last longer than manic episodes do. Additionally, people with bipolar II disorder are more likely to spend more prolonged periods in a state of low-grade chronic sadness. 

Seasonal affective disorder

Seasonal affective disorder, aptly abbreviated as SAD, refers to depression that comes on with seasonal changes. The depressive symptoms (including persistent sadness, hopelessness, low energy, and loss of interest) last for around four or five months. For most people, SAD begins in the late fall or early winter when there’s less daylight. However, some people experience summer-onset SAD, which is less common. The two differ in presentation.

Winter-onset SAD symptoms include withdrawing, sleeping too much, and eating more than usual, while summer-onset SAD is linked to insomnia, agitation, restlessness, and loss of appetite.

Post-traumatic stress disorder (PTSD)

Some trauma survivors develop a chronic mental health condition called post-traumatic stress disorder. Although PTSD is more commonly linked with symptoms like flashbacks, nightmares, and hypervigilance, this trauma-related disorder also results in persistent sadness and low mood. More PTSD symptoms include recurring traumatic memories, feelings of guilt, negative views of yourself and the world, and an inability to feel positive emotions.

Grief and loss

Grief, unfortunately, is a part of life. Coping with loss can be extremely difficult, and everyone processes and moves through the stages of grief differently. Whether you are grieving the death of a family member, friend, or pet, loss hits hard. You may even grieve the loss of a relationship in the sense of a breakup or divorce, even if there wasn’t an actual death. 

One of the stages of grief is depression, and there’s no set period of time for how long it “should” last. Grief can be lifelong where symptoms come and go over time. However, according to the American Psychiatric Association, up to 10% of adults who’ve experienced grief develop prolonged grief disorder, which can be marked by either extreme emotional pain, or, on the other end of the spectrum, emotional numbness. You might also feel like a part of yourself has died, avoid all reminders of grief, and feel like life is meaningless. 

Certain health conditions or hormonal changes 

Some medical conditions or hormonal imbalances can cause symptoms of depression as a symptom, including:

• Cushing’s syndrome

• Adult-onset growth hormone deficiency

• Hypothyroidism

• Perimenopause and menopause

• Prenatal or postpartum hormonal changes 

If you’re experiencing any other health-related symptoms, make sure to visit your primary care provider to rule out any medical condition or conditions that may be contributing to your sadness. 

When to seek treatment for persistent sadness

The good news? You don’t have to feel sad all the time. Even when things feel completely and utterly hopeless, there is a light at the end of the tunnel. Plus, there are many others in the same shoes as you. About 1 in 7 people will experience depression, at some point in their life, to put things into perspective. These conditions are treatable, and many people find great relief from their symptoms.

“Generally speaking, it may be time to seek support if your symptoms are lasting beyond a couple of weeks, worsening, or there is significant interference with your daily life,” says Mandich. 

She suggests asking yourself the following questions (much like our depression quiz) to determine how much your sadness is interfering with your life and whether you should seek therapy. 

• How long have I been feeling this way?

• Are these feelings getting worse, staying the same, or improving?

• How are these feelings affecting me at work, school, or in my relationships?

• Am I losing interest or pleasure in activities I once enjoyed?

• Am I experiencing changes in sleep, appetite, or energy levels?

• Am I feeling hopeless or seeing no prospect for the future?

• Are my symptoms preventing me from completing daily tasks?

• Do I have thoughts of death, self‑harm, or suicide?

These are some signs that you could benefit from treatment. If you’re experiencing suicidal thoughts or thinking about self-harm, don’t hesitate to call or text the 988 Lifeline for support 24/7, 365 days a year.

Therapy for persistent sadness 

Many different therapy modalities can help you cope with ongoing sadness and related symptoms.

“There are ‘top down’ approaches and ‘bottom up’ approaches,” Mandich says. “Top-down therapy approaches start with the thinking, higher functioning part of the brain, whereas bottom-up therapy begins with sensations in the body.”

Top-down approaches can help you with emotional processing and changing unhelpful thought patterns and beliefs, Mandich says. Examples of these modalities are:

• Cognitive behavioral therapy (CBT). A talk therapy focused on exploring how your thoughts, feelings, and behaviors connect. You’ll learn how to identify unhealthy thought patterns and change them. 

• Dialectical behavioral therapy (DBT). A skills-based therapy rooted in mindfulness, distress tolerance, emotional regulation, and interpersonal relationships. You’ll build healthy coping skills to deal with difficult emotions.

• Acceptance and commitment therapy (ACT).  An acceptance and mindfulness-based therapy that helps you face difficult emotions rather than avoid them, while committing to living life in line with your values.

• Interpersonal therapy (IPT): An approach that emphasizes your relationships with others and how they impact your mood. It’s based on the principle that if you improve your relationships, you can improve your depressive symptoms.

Bottom-up approaches take a different approach. If you find that talk therapy isn’t fully relieving your symptoms, your therapist might suggest exploring more alternative options. “They can help to access the lower, more reptilian brain regions, which can be especially effective for people who have experienced trauma,” says Mandich. Examples include:

• Eye movement desensitization and reprocessing (EMDR). A therapy developed specifically for PTSD treatment. It uses bilateral (side-to-side) movements to help you reprocess traumatic memories, changing how they’re stored in the brain. 

• Somatic experiencing. A body-based therapy potentially helpful for PTSD.  It allows you to release stored tension and trauma through awareness of different bodily sensations and where you feel emotions in your body.

• Brainspotting. This unique approach uses eye positioning to identify “brainspots” linked to emotional pain or trauma. It’s believed to go beyond conscious thinking to help you heal from trauma. However, it’s worth noting that this therapy is relatively new, with less research backing it; however, current research is promising.

When you consult with a therapist, you can ask them what therapy modalities they use in their approach and which ones they think would be most helpful for you. 

Ready to find support?

If you’re ready to seek professional help but don’t know where to start, we have you covered.  We can help you discover therapy services to get you through this difficult chapter of life and come out on the other side. A professional can determine whether you’re dealing with a mental health condition and devise an effective, evidence-based treatment plan. 

With the right support, you can start feeling better. Use our directory to get started.