Everyone feels down at times. The breakup of a relationship or a bad grade in class can lead to sadness or low spirits. Sometimes sadness comes on for no apparent reason.
Is there any difference between these shifting moods and what is called depression? For someone who has experienced an episode of depression, the answer is most probably yes. Many times we can tell the difference between depression and 'ordinary' sadness or unhappiness by the duration and the depth of the despondent feelings, as well as by the presence of some characteristic signs and symptoms, listed below.
Why is the distinction between sadness and depression important?For lots of reasons. In severe cases, depression can be life threatening. Difficult as it may be to talk about, suicide, or attempted suicide, is a possible outcome. More typically, people who are depressed may fail to live up to their potential, doing poorly in school, finding little enjoyment in life, and staying on the social fringes. Depression is often ignored or untreated, sometimes for lack of information, sometimes because of the social stigma that is attached to it; in fact, because depression 'saps' a person's energy and motivation, it can even prevent people from taking steps to help themselves. This is regrettable, because effective help is available for the person suffering from depression.
Anyone who feels 'down' nearly every day for weeks or months may be clinically depressed. A person with depression may experience:
The above is not meant to replace formal assessment by a competent professional, but can give you an idea of some of the signs and symptoms that may point to an underlying depression.
There is growing evidence that depression is in part an illness with a biological basis. It is known to be more common in individuals with close relatives who have been affected. Research on the physiology of the nervous system suggests that the level of activity of "neurotransmitters" such as norepinephrine and serotonin changes in long standing depressions [antidepressant medicines work by correcting a "chemical imbalance" of this kind]. One type of imbalance is associated with bipolar or manic-depressive illness, characterized by dramatic mood swings from depression to irritability or euphoria. A number of physical illnesses also lead to depression. An examination by a physician may be in order to look into these possibilities.
Whatever we may eventually discover regarding the biology of depression, it is certain that psychological and social factors also play a vital role. The loss of a loved one, or a disappointment at school or at work, may trigger a depression; past losses, perhaps not fully acknowledged, often set the stage. Some people find themselves enmeshed in negative ways of thinking that have a detrimental impact on their mood. Lack of social supports, separation from loved ones and one's familiar environment, the absence of avenues for fulfillment, and few opportunities to take initiative or pursue one's own interests also predispose some people to depression. Some of these experiences can be very 'real' for many college students, in particular.
Friends and family may provide all the support that is needed in mild cases of depression. Someone who is willing to listen and ask concerned questions can make all the difference. However, even the most caring and patient companions can find themselves frustrated when depression is more severe. It is important to seek professional help before one's relationships with significant others become jeopardized.
Mental health professionals who may be consulted include psychiatrists, clinical and counseling psychologists, professional counselors, and other psychotherapists. Some turn first to general physicians or religious advisors. While each specialty has its own perspective and expertise, it should be remembered that practitioners of all kinds have experience in dealing with depression, and can refer to other professionals when necessary.
Some moderate and most severe depressions respond to antidepressant medications. These are prescribed by a physician, generally a psychiatrist, or by a licensed nurse practitioner, after a thorough evaluation. There is usually a positive effect in a few weeks. Some types of depression require special medication: for instance, individuals with manic-depressive illness (a particular form of depression) often do well on lithium. Taking medicine does not preclude other forms of treatment. Individual psychotherapy, alone or in combination with medicine, is often beneficial. Insight-oriented psychotherapy aims to bring underlying conflicts, drives, and identifications into awareness, in the hope that increased understanding will lead to more options and a better sense of self. Other therapies have the goals of changing negative ways of thinking, or overcoming isolation by developing interpersonal skills. Group therapy has been shown to be effective in helping those who have difficulty forming relationships.
Therapists may help individuals make changes in difficult life situations. With the individual's permission, they sometimes set up meetings with friends or parents to explore ways of resolving a crisis. Depressed individuals who are at high risk of killing themselves may need to be in a hospital temporarily. While this is often seen as a drastic measure, it can be life-saving, and it may allow effective treatment to begin.
Suicide is the second leading cause of death in young people. Each year in the U.S., approximately five thousand individuals between the ages of 15 and 24 take their own life. A major cause of suicide is mental illness, very commonly depression. Others who are not suffering from depression are overwhelmed by painful emotions and see death as the only way out. Most of those who die could have been helped. An individual considering suicide frequently confides in a friend, who may be able to convince the person to seek treatment. When the risk is high, concerned friends and relatives should seek professional guidance.
Although suicide is very hard to predict, there are some reliable indicators of risk.
"People who talk about it rarely do it."
"People who really want to kill themselves are beyond help."
"Suicide is a purely personal decision."
"Asking about suicide can put the idea in someone's mind."
It is useful to listen in a manner that shows appreciation of the person's difficulties. This does not mean entering into the despair; an attitude of careful optimism is appropriate. Depressed individuals are very often wrapped up in their own concerns; advice should be simple and practical, and may have to be repeated. When there is a threat or real possibility of suicide, it is important to stay close to the individual until professional help is obtained.
Change can be slow. Putting out energy and getting no response can be frustrating. People in a helping role should try to make sure their own needs are being met. Too high a level of frustration can lead to anger and a sudden decision to withdraw. It is a good idea to seek assistance well before this point is reached.
Suicidal individuals often try to convince others that the "worst" thing would be to let anyone know of their plight. Friends put in this position should consider the possible consequences of failing to obtain professional help. It is a sign of caring to bring a person to treatment that may alleviate suffering and save a life.
If you are interested in learning more about depression or suicide, you may wish to check out the following links:
Survivors of Suicide
Grief and Loss
American Foundation for Suicide Prevention
National Institute of Mental Health
Adapted from information compiled by Peter Holland, MD, from the University of California - Santa Cruz.
Compiled by Martin Lynch, M.A., M.Div. for the University Counseling Center.