It’s not “just in your head.” A depressive disorder is a genuine mind-body experience. It can wreak havoc on emotions, motivation, interest, concentration, memory, appetite, sleep and movement, as well as your thought process about yourself and the world. Depression can even cause or intensify medical symptoms.
A depression is much more than the “down week” all of us experience now and then. Nor should depression be confused with appropriate grief reactions to loss. It’s usually not simply a matter of pulling yourself up by your bootstraps and putting a smile on your face. If left untreated, depression can last for a long time and leave devastation in its wake.
Depressions vary among individuals in terms of symptoms, severity and recurrence. Some individuals experience depression only once. Others become depressed several times, some regularly at certain times of the year (especially autumn and winter). Some experience incapacitating mood swings from depression to elation or mania. Some people manage to get over depression by their own devices; many others need the right kind of help.
With appropriate treatment, over 80 percent of all depressed people can be helped.
If you believe you have symptoms of depression, contact a psychologist and/or psychiatrist for diagnosis and treatment. Also contact your medical doctor to help determine whether there are medical causes for your symptoms.
Part 2: Symptoms of Depressive Disorder
The following symptoms are persistent, bothersome and have been present nearly every day for at least two weeks If you answer yes to the first two symptoms and at least three other symptoms, you may be depressed. See a psychologist, psychiatrist or your physician to confirm the diagnosis.
◊ I feel depressed, sad or empty most of the day, most days. For children or adolescents, this can be irritability. ◊ I’ve lost interest and pleasure in activities that are usually enjoyable. ◊ My appetite is decreased or increased, or my weight has increased or decreased without intentionally dieting. ◊ My sleep pattern has changed. I’m having trouble getting to sleep or staying asleep and/or I’m sleeping less or more than usual. ◊ I’m moving slower or my movements are agitated and restless. ◊ I’m fatigued or my energy is lower than usual nearly every day. ◊ I feel worthless and excessively guilty. (Examples: I keep going over mistakes I made in the past. I’m feeling unusually sensitive to rejections or slights.) ◊ I’m having trouble concentrating and remembering. I keep misplacing things and getting confused easily. ◊ I can’t seem to make decisions. I feel aimless and overwhelmed. ◊ I’m often having thoughts of death or suicide.*
If you have just a few of the symptoms, or several symptoms of lesser severity, and they have lasted for at least two years, you may have dysthymic disorder.
Help is available. Don’t wait! Consult a psychologist, psychiatrist or physician.
You may also notice these signs of depression:
◊ I’m feeling hopeless, pessimistic and helpless. ◊ I have persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain. ◊ I am using alcohol or drugs (whether legal or illegal) to treat symptoms. ◊ I am feeling unmotivated, overwhelmed or aimless. ◊ I am feeling unusually angry or irritable. ◊ I’m worrying excessively. I am more fearful than usual.
*If you or someone you know is having suicidal thoughts, seek help immediately from your medical doctor, psychologist, psychiatrist, or the emergency room of your local hospital.
Part 3: Mania
Another, less common type of depressive disorder is manic depressive disorder, also known as bipolar disorder. In bipolar disorder, the individual experiences moods that cycle between depression and mania or, in other cases, hypomania (an abnormally elated state). The depressive phase is characterized by the symptoms of major depressive disorder. The manic cycle is characterized by the symptoms of mania, listed below. Mania impairs thinking, judgment and social behavior in ways that cause serious problems and embarrassment. For example, in a manic phase, a person may make business or social decisions that they would never make when feeling normal or depressed. Mania can be associated with great creativity in some individuals. This diagnosis should only be made by a mental health professional.
Symptoms of Mania
Markedly increased energy.
Severe insomnia, needing little or no sleep for one of several days.
Disconnected, racing thoughts.
Grandiose ideas. For example, a person with mania might unrealistically believe that others are unavoidable drawn to him, or that he has a great deal of money coming.
Inappropriate social behavior.
Increased sex drive.
Part 4: Causes of Depression
After decades of debate and research about whether depression is caused by “nature” or “nurture”, it seems the answer is “all of the above.” A combination of genetic, psychological, and environmental factors are very likely involved in the onset of depressive illness. A depression can be triggered by one or all of these factors.
Brain chemistry—too much or too little of a certain neurotransmitters in the brain (such as serotonin)--plays a prominent role in many mood disorders.
Environmental stressors and other psychosocial factors are important deciding factors that can help to prevent or manifest depression. When one or more of the “corners” of one’s life are up in the air in the same time, the conditions are right for depression. People who develop depression may have faced a recent loss, illness, relationship conflicts, financial difficulties, job change, a move, or any unwelcome or stressful change. Frequently, in one’s history are past losses that were never fully resolved.
Depression is often described as “anger turned inward.” Individuals who have not learned to appropriately experience and discharge emotion often end up “sucking it up,” and in the process, making themselves depressed.
Individual psychological makeup also plays an important role in vulnerability to depression. People who do not have good mechanisms for coping with stress tend to be more vulnerable to depression.
Those with a family history of depression may have an inherited biological predisposition to become depressed. This risk is somewhat higher for bipolar disorders. However, not all with a presumed inherited predisposition actually develop depression. And of course, depressive disorders are often seen in individuals with no known family history of depression.
Part 5: Treatments for Depression
Some people are able to come out of a depression on their own. Many others need treatment. Just as types and severity of depression vary by individual, so does treatment.
Many depressed individuals respond very well to psychotherapy alone. Others respond to medication. In general, more severe depressive illnesses, particularly recurrent ones, tend to respond best to medication along with psychotherapy. In those cases, medication may offer quick symptom relief, while psychotherapy helps foster positive change to more effectively deal with life issues.
A clinical psychologist can perform an assessment and make treatment recommendations. Your psychologist should discuss with you your treatment options, taking into account your preferences (for example, many people prefer not to take medication) and treatment goals, and together design a treatment plan. If a medication evaluation is called for, she will refer you to, and coordinate your care with, an appropriate medical doctor.
If you believe you have some of the symptoms of depression, consult your physician to be certain your symptoms aren’t related to a medical condition.
If you have a history of depression, it’s a good idea to check in with your physician and/or your psychologist at the first signs that depression is creeping up on you. That may give you your best shot at heading off serious problems, or at least being ready to deal with them should they occur.
Psychotherapists vary in their therapeutic approaches. Some therapists do a great deal of listening and not very much talking. Others—like me—are more interactive. People generally have the best outcome with a psychotherapist with whom they feel comfortable.
In our sessions, you can expect me to listen, make observations and help you find direction, so that you are not merely having insights but are using them to make positive changes in your behaviors, thought patterns and feelings.
My approach to depression is a multi-level one that:
(1) addresses reasons for the depression, exploring psychodynamic history, current life circumstances, thought styles and behaviors that contribute to depression.
(2) fosters solutions in terms of engendering positive thought patterns, new behaviors and better skills (for example, stress management, improved communication, better decision making skills).
Part 6: Self-Help for Depression
Depression puts you in a Catch 22. One weapon against depression is doing things that feel rewarding and meaningful. Easy, right? Well, not quite. Depression, by definition, means you feel exhausted, helpless, questioning your own worth, doubting your own abilities, unable to concentrate well enough to organize a way out of depression, feeling less pleasure, often feeling hopeless about the future, and unable to experience much pleasure.
Here are some things you can try—in addition to professional help— to help along the process of recovery from depression.
First: Get help. Consult a psychologist, along with your physician or psychiatrist.
Remind yourself—even if you don’t believe it at first—that your negative thoughts are part of your depression and probably do not accurately reflect reality.
Gently challenge the lack of motivation that accompanies your depression. Each day, set priorities and write a list of small, manageable goals . Break tasks down into small “chunks”. Make a good try at meeting your goals. allow yourself to feel good about each small accomplishment. Don’t beat yourself up if you just can’t, right now, accomplish all you'd like. For example: If housecleaning seems overwhelming, don’t try to clean the whole house. Instead, clean for ten minutes where the result will most show. Later, do ten more minutes. Remember, small steps add up to miles.
Exercise a little every day. Exercise helps stimulate brain chemicals that lift depression. If you can’t manage twenty minutes, do two minutes! Small steps count.
Eat nourishing meals.
Get out in the sun. Sunlight helps to elevate those important brain chemicals.
Do things that usually make you feel good, if only for a short while. Engage in hobbies, social or religious activities. Go to a movie, read or watch sports.
Re-connect to your spiritual ties.
Override the impulse to isolate yourself. Spend time with uplifting people. Consider limiting time with negative or difficult people.
Ask for help. Talk to others. Remember, people who have never been seriously depressed may not understand. In trying to help, they may unintentionally say things that feel unhelpful. You may want to share this information with them so they can respond in ways that are more helpful.
Don’t expect your depression to lift immediately. It will take time to feel like yourself again.
Try to remember that humans do their best growing out of pain or necessity. For many people, depression becomes a wake-up call to take inventory of and change situations, thought patterns and behaviors that contribute to depression. Consider talking to a psychologist who offers the expertise to help you do this productively
Part 7: Helping Someone Who is Depressed
If you care about a person who is depressed, you are probably feeling a range of emotions. It’s typical in your position to feel concerned, worried, frightened, frustrated, helpless, and even angry.
If you are like countless others who have tried to help a depressed person, you’ve found yourself saying things like: “Snap out of it.” “Just pull yourself up by your bootstraps.” “Your problem is a negative attitude. You need to see the glass as half full.” If you are dealing with a person who is suffering from a depressive disorder, this good advice probably won’t have the intended effect.
Here are some things you can do to help:
Important: Encourage or help the depressed person to get appropriate diagnosis and treatment.
Encourage the individual to stick with the treatment long enough to see improvement.
Listen. Don’t try to talk him or her out of feeling depressed. Empathize with the emotional distress. Offer reassurance that, with treatment, most depressions lift.
Be sparing with advice. Too much advice—or ill-chosen advice—might be counterproductive. Remember, what would work for you might not be right or be possible at present for the depressed person.
Don’t let the depressed person isolate. Persist in gently suggesting a walk, a movie, church, a cup of tea, or other mild activities that once were pleasurable. Don’t insist on too much too soon.
If you hear suicidal remarks, you must take them seriously! Immediately alert the depressed person’s doctor or mental health professional. If you believe there is imminent risk of self-harm or harm to another, utilize the emergency room of your local hospital. If necessary, phone the police for assistance.
If you find yourself feeling angry at the depressed person, consider that your anger may be more at the depression, than at the depressed person. Try not to take your frustration and anger out on her or him.
Take care of yourself. Take replenishing time away from the depressed individual. Find someone you trust with whom to ventilate your feelings. Consider seeing a psychologist yourself for support and counseling.