What is Depression?
“Oh, life is so unfair! Nothing ever works out for me.”
“Nobody cares about me or my pain.”
“I am just a stupid idiot that can’t do anything right.”
“Why did God let this happen to me?”
“Nothing is ever going to change.”
Such is the self talk of a depressed person.
Depression brings up a lot of questions:
How do you know if you are depressed?
How do you know if a loved one is depressed?
If you are depressed, what should you do about it?
Why can’t people just snap out of it?
What is the difference in depression in men versus depression in women? Why do men commit 80% of the suicides committed each year?
How do you help someone who is severely depressed?
Some statistics:
Mood Disorders (National Institute of Mental Health Statistics)
Mood disorders include major depressive disorder, dysthymic disorder, and bipolar disorder.
Approximately 20.9 million American adults, or about 9.5 percent of the U.S. population age 18 and older in a given year, have a mood disorder.
The median age of onset is age 30.
Depressive disorders often co-occur with anxiety disorders and substance abuse.
Major Depressive Disorder
Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44.
Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.
Major depressive disorder is more prevalent in women than in men. (although some say depressed women are in treatment and many depressed men are in jail).
Dysthymic Disorder
Symptoms of dysthymic disorder (chronic, mild depression) must persist for at least two years in adults (one year in children) to meet criteria for the diagnosis.
Dysthymic disorder affects approximately 1.5 percent of the U.S. population age 18 and older in a given year.
This figure translates to about 3.3 million American adults.
Bipolar Disorder
Bipolar disorder affects approximately 5.7 million American adults, or about 2.6 percent of the U.S. population age 18 and older in a given year.
Suicide
In 2006, 33,300 (approximately 11 per 100,000) people died by suicide in the U.S.
More than 90 percent of people who kill themselves have a diagnosable mental disorder, most commonly a depressive disorder or a substance abuse disorder.
The highest suicide rates in the U.S. are found in white men over age 85.9
Four times as many men as women die by suicide; however, women attempt suicide two to three times as often as men.
Where Does Depression Come From?
Depression can come along for a variety of reasons. When someone grew up in a controlling or abusive home a child will feel a sense of helplessness to change their circumstances. That child will grow up and be pre-disposed to depression due to an ingrained belief that their circumstances are hopeless and they are powerless to change it. Then, a series of unfortunate circumstances will affect their sense of well-being. The person may be convinced that they are always going to be a victim of life’s cruelty.
The hallmark characteristics of depression is a sense of hopelessness or helplessness. Events such as going through a divorce, losing a home to foreclosure, losing a child, learning a spouse has had an affair, getting laid off from work, are just a few of the circumstances that can lead to or increase feelings of hopelessness and despair.
Sometimes the feelings of despair are so strong a person can feel convinced that the pain will never end. Often, due to learned helplessness in childhood, due to abuse or neglect, a person will lack some of the skills needed to weather the storms.
In helping a person with depression, infusing hope into their lives and building a sense of resiliency will help them get to the other side. Helping someone recognize that their feelings are normal based on what they are experiencing is helpful. Many feel isolated and that they are an abnormality. Because they feel their pain is abnormal they won’t reach out for help.
Dysfunctional families operate with “family secrets” that no one talks about. The individual learns that talking about the pain is not acceptable and the isolation increases the depression. The smiling depressed is a phenomenon of someone who feels they need to maintain a certain public image. The false image of being okay on the outside keeps the person from attaining the help they need.
A depressed person left alone with their negative thoughts is a combination for deepening depression and suicide. Suicide is an attempt to end the suffering.
Clinical Depression Symptoms (From the The DSM IV):
5 of the symptoms over the course of two weeks or more
- Depressed mood (e.g. feels sad or empty)
- Diminished interest in activities once enjoyed
- Weight loss or weight gain
- Insomnia or hyper-somnia (sleep too much)
- Slowed body movements
- Feelings of worthlessness, hopelessness or helplessness and/or excessive guilt
- Diminished ability to concentrate, indecisiveness
- Fatigue or loss of energy (simple tasks become difficult)
- Thoughts of death or suicide (mild and fleeting to severe with a plan)
Chemical Imbalance in Depression:
- Reduced availability of neurotransmitters like Serotonin, Dopamine, Norepinephrine, GABA and Acetylcholine.
- Increased levels of toxic neurochemicals such as Homocysteine
- Lower levels of serum Magnesium, Zinc or Potassium
- Unhealthy, or deficient levels of essential vitamins like B6, B9, B12 and Vitamin-C
- Undersupply of key cofactors like amino acids that are used to help transport neurotransmitter precursors into the blood-brain barrier.
- Increased cortisol stress hormone levels
Specific Symptoms Men Experience:
- Irritability
- Anger
- Aggression or rages
- Substance Abuse
- Risk-taking (gambling, reckless driving, sexual liaisons)
- Withdrawal (“I don’t want to talk about it” or “I just want to get away”)
- Reduced libido
- loss of interest in previously enjoyed activities
- Thoughts of suicide (Men tend to follow through more quickly than women)
- Escapist behavior such as working too much, or watching lots of TV
- Body aches and pain
Suicide:
Around 32,000 suicides occur each year and men complete 80% of the suicides. The reason men commit most of the suicides is that men are more likely to use lethal means such as firearms or jumping out of buildings. Men are less likely to talk about it with anyone beforehand, and tend to decisively act on thoughts quicker than women do. A woman told me about the time her dad walked past her in the front yard and said “I’ll be right back.” and then shot himself at the park after getting laid off from his job.
Women make more attempts and will try overdoses and slitting wrists more often. Attempts are considered a “cry for help” and some will recover from their attempt and then get the help they need.
Specific Symptoms Women Experience:
- Difficulty caring for their children
- Thoughts of harming their baby or child
- Low Self-Esteem/ Worthlessness
- Agitation or getting upset easily
- Weepiness (Crying without knowing why).
- Worsening symptoms during menstrual cycles (PMDD or Pre-Menstrual Dysphoric Disorder)
- Body aches and pains
Social Pressures:
Men are much less likely to admit that they are depressed, most likely due to social pressures to be strong. Social pressures for men include being a provider, being strong, being a leader. A man is likely to become depressed when he struggles to provide for his family or loses his home to foreclosure, for example. Men identify with their career or employment and will be left reeling after a layoff. I heard one story of a family man who went to a park and shot himself after he was laid off from work.
Social pressures for women include the pressures of being a homemaker (a complex and multifaceted job), if women also have a career or job there is pressure to keep up with both and women often feel burdened by the two full time jobs (the second shift at home). Women tend to take primary responsibility for the demands of caring for children or elderly parents.
Both Women and men who have been sexually abused as a child are more susceptible to depression (girls are sexually abused 2-3x more often than boys). Women also suffer depression after a miscarriage, infertility, or a pregnancy they weren’t ready for. Post-part-um depression is very real and can be severe. With a first child, a women’s identity shifts and they go from being a career woman to a woman with a child who needs them around the clock. Hormones are out of balance after a pregnancy and mom’s are often sleep deprived. Power imbalances in the home can also lead to depression.
A lack of social support increases the risk of suicide and is a hallmark component of depression. Depressed people will tend to isolate themselves or lack the energy they need to get out around people. If you notice someone is beginning to isolate after a loss, reaching out to them and encouraging getting out can help.
A Manic Episode (Bi-polar Depression):
1. Decreased need for sleep (2-5 hours of sleep)
2. More talkative then usual with pressure to keep talking
3. Flight of ideas (thoughts racing) and/or grandiosity
4. Distractibility
5. Increase in goal directed activity
6. Excessive involvement in pleasurable activities that have a high risk potential (i.e.Spending sprees, foolish business investments).
Someone who has a bi-polar depression will swing back and forth between depression and a manic episode. The mood swings can vary in intensity and length.
How to help a depressed person:
1. Infuse Hope
A depressed person feels hopeless. Help them to see “the silver lining,” or the good in things around them, “It’s not all bad.” Help them to see and focus on what is going well. Rejoice in small accomplishments.
2. Break the Isolation
Encourage being around people or reaching out for support. Participation in activities, groups, church attendance, Celebrate Recovery, having coffee with a friend all apply.
3. Provide Empathy
Be empathetic and try not to minimize their pain. Just saying to them “look at the positive things” will increase a sense of isolation. Any effort to look at the positive must include empathy and concern or it will seem disingenuous. Statements that validate such as, “I know this is really difficult for you” will help. Just listening and showing empathy can go a long way.
4. Challenge Negative Self-Talk (Improve inner self worth)
Find out what they are thinking about themselves, such as “I’m stupid,” “I can’t do anything right,” “Nothing is ever going to change.” You might be surprised at how people abuse themselves in their thoughts. Ask them to catch their negative thinking at replace the thought with something more balanced. Some may even need to tell themselves opposing statements such as, “I’m not stupid.” to break the habit.
5. Understand Grief and Anger
Often depression is grief stuck in a mud pit. The person may have something to grieve but lack the understanding or time to process it. The stages of grief are; denial, anger, bargaining, sadness, and acceptance. Also, there may be anger or hurts that are unresolved as well. Help the person through the process of forgiveness.
6. Temporary State (many depressed people will recover eventually on their own).
Depressed people feel convinced it will never end. It feels terrible and seems unbearable. Suicidal thoughts are an effort to end the suffering. People often think it is selfish but the person is convinced other people don’t care and won’t miss them when they are gone. Sometimes they need to be shown the big picture and reminded that they do matter.
7. Encourage Physical Exercise
Exercise can be a more effective anti-depressant than anti-depressant medications. However, many depressed people can’t get themselves to go for a walk. To be effective, exercise must be frequent and vigorous several times a week. You have to start somewhere so encouraging a short walk is a starting point.
8. Anti-depressants
Many people shy away from anti-depressants but they are a useful tool in the process of recovery. Never ever tell a depressed person they shouldn’t be on their anti-depressants. That could trigger a manic episode or a deepening depression. Often there is a significant shortage of important neurotransmitters in the brain, such as serotonin that need a boost (similar to a person with diabetes or a thyroid condition). People are often afraid they will be on them forever, but I know of many cases where people improved their self care and worked through issues and were able to discontinue the medication successfully.
9. Psychotherapy
Talk therapy can really help a person identify and overcome entrenched negative thinking. Often it takes time to peel away the many layers and resolve old hurts. Finding a therapist you can trust to talk openly to can be instrumental in overcoming depression.
10. Hospitalization
If a person is severely depression and a risk to themselves or others then it is important to be in a hospital setting. This setting will provide safety and rest. A doctor will determine when the individual is safe to go home.
11. Natural Supplements (for Mild depression)
- Sam-E and St. John’s Wort have anti-depressant properties
- Kava Kava and Valerian Root have relaxing properties
- Melatonin is a natural sleep aide
- Vitamin B complex vitamin
- Vitamin C
- A multivitamin
- Probiotics can help with absorption of nutrients
12. Diet
Foods rich in magnesium, Tryptophan (increases serotonin), Vitamins C, B complex, and minerals are important for recovery. Omega 3 fatty acids (Fish oil or Flax seed oil) help the brain function at its best. Most westerners are not getting enough. Avoid simple sugars and simple carbohydrates (White breads, white rice etc...) Simple carbs will increase sluggishness and irritability. Foods that can help treat depression: Oranges, red bell peppers, sweet potatoes, dried apricots, nuts, turkey (L-Triptophan increases serotonin), spinach and leafy green vegetables, Salmon and other fish, avocados.
13. CBT Cognitive Behavioral Therapy
Help person identify extreme thought patterns and modify them to be more balanced. Challenge All or nothing thinking, Catastrophizing, Personalization.
14. Journaling
The $3.00 therapist. Often when hurts and negative emotions are held inside the person becomes a type of pressure cooker without a proper vent. Vents can be destructive behaviors such as alcohol abuse or spending too much. A healthy way to vent can be to write out all of your thoughts on paper. It is private and no one is grading you. Your handwriting can be sloppy and your thoughts random. It can be a big relief to put it somewhere else besides deep inside.
15. Music
Music can be a soothing way to relax if you select calming music.
16. Light Therapy
Studies show that using broad spectrum lighting or being outside in the sun can help alleviate depression. Reveal lights have a broader spectrum than traditional bulbs. Replace your old ones with Reveal lights. Stronger bulbs can be purchased online.
17. Massage
Massage can help to relax tension and get rid of toxins. Be sure to drink lots of water before and after.
18. Scripture
A person of faith can write out meaningful verses for memory and meditation on to assist in gaining perspective and a sense of hope. I tell clients to find some verses that encourage them and write them on notecards and place on their mirror, by the kitchen sink, in their car.
John 16:33
"I have told you these things, so that in me you may have peace. In this world you will have trouble. But take heart! I have overcome the world."
Deuteronomy 31:8
The LORD himself goes before you and will be with you; he will never leave you nor forsake you. Do not be afraid; do not be discouraged."
Psalm 46:1
God is our refuge and strength, an ever-present help in trouble.
2 Corinthians 12:10
That is why, for Christ's sake, I delight in weaknesses, in insults, in hardships, in persecutions, in difficulties. For when I am weak, then I am strong.
The National Suicide Hotline 1-800-SUICIDE (748-2433).
I hope some of this was helpful. I welcome any comments and always read them.
Blessings to you,
Gretchen