Dr. Angela Hanford
Depression is wide reaching.Most people know someone who has struggled with depression.According to the National Institute of Mental Health (NIMH) (2017), major depression is the most common mental health diagnosis in the United States. It affects all age groups and genders.
The researchers for the National Survey on Drug Use and Health (NSDUH) (NIMH, 2017) estimatedthat in the United States approximately 16.2 million adults experienced an episode of major depression in 2016.Those ages 18 to 25 had the highest prevalence (10.9%), as did females (8.5%) versus males (4.8%).For teenagers in this same study, the estimated rate of depression was at 3.1 million for ages 12 to 17.This is a lot of people affected by depression.Furthermore, depression can significantly impact all areas of an individual’s life … emotional, relational, functional, financial, and spiritual.The good news is that effective treatment for depression is available!
What is Depression?
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) (American Psychiatric Association, 2013) categorizes several diagnoses as Depressive Disorders, such as disruptive mood dysregulation disorder, major depressive disorder, persistent depressive disorder (dysthymia), and premenstrual dysphoric disorder.
When most people think of the term “depression,” they are most often thinking of major depressive disorder or persistent depressive disorder.The difference between these two diagnoses is that persistent depressive disorder has fewer required symptoms and lasts for at least two years.Despite the differences, both are distressing and can cause significant impairment in functioning.Women may also experience symptoms of depression while pregnant or after delivery (i.e., postpartum depression).
Common Symptoms of Depression
For a diagnosis of depression to be made, certain symptoms must be present.These symptoms must also occur for most days and for at least two weeks.The following are a list of common symptoms of depression:
- Depressed mood (e.g., sad, empty, hopeless, tearful; irritability in children or teens)
- Loss of interest in activities that one used to enjoy
- Difficulty with concentration or decision making
- Feelings of worthlessness or of significant or inappropriate guilt
- Suicidal thoughts or recurrent thinking about death
- Change in appetite: Either loss of appetite or increased appetite.This may include weight loss or weight gain.
- Change in sleep: Either sleeping too little (“insomnia”) or too much.
- Decreased psychomotor activity or more agitated psychomotor activity.
- Decreased energy or fatigue.
Gender and Age Differences in Depression
The manifestation of depression may look different depending on gender and/or age.For example, the NIMH (2016) noted that men may be more apt to show anger and irritability while women display the more classical mood symptoms (e.g., sadness).In contrast, children may be more prone to displays of physical symptoms (e.g., complaining of feelings sick) or experiencing difficulty separating from his or her caregiver.
As previously mentioned, teenagers may appear more irritable than sad when depressed.Older adults who experience depression are more prone to cognitive impairments (e.g., confusion) and may seem tired or irritable (NIMH, 2017).In fact, the term pseudodementia was coined in order to differentiate between cognitive impairments that are the result of depression rather than traditional, irreversible dementia.As you can see, depression does not look the same in everyone.
What Causes Depression?
The cause of depression is not fully known and likely varies from person to person.However there are some factors that are linked to depression, such as genetic, biological, psychological, and environmental factors (NIMH, 2016).For example, the DSM-5 authors (APA, 2013) reported that having a first degree relative with major depressive disorder increases one’s chance of developing major depressive disorder by two to four times.
Depression may also have physiological causes, such as low thyroid or diabetes.This is one reason for why a medical evaluation is important for depression treatment.Alcohol or other substances may also contribute to depression, as can certain medications.Therefore, is important for your doctor to know all medications that you have been taking, including any supplements.
Life circumstances may also trigger a depressive episode.For example, losing a job, a major move, or a loss in relationship may precipitate a depressive episode.Trauma may also result in depression.According to the DSM-5, adverse childhood experiences are a risk factor for developing major depressive disorder (American Psychiatric Association, 2013).
Ultimately, it is likely a combination of factors that contribute to someone developing a depressive disorder.A counselor will explore a variety of factors when assessing for depression and determining treatment recommendations.
Suicide and Depression
Suicidal thinking is often a part of depression.If you or someone you know is experiencing thoughts of suicide, it is important to seek professional help immediately.
If an individual is actively suicidal, you should immediately call 9-1-1 or go to a local emergency room.Suicidal thinking can be scary, but help is available.
Although depression and suicidal thinking may not always be obvious, there are warning signs that may accompany suicidal thinking.For example, the Substance Abuse and Mental Health Services Administration (SAMHSA) (2017) lists the following suicide warning signs:
- Talking about wanting to die/kill self
- Stating that there is no reason to live
- Researching ways to commit suicide
- Reporting “feeling trapped” or in “unbearable pain”
- An increase in alcohol or other substance use
- Talk about how he or she is a burden
- Too much or too little sleep
- Agitation/acting as though anxious;recklessness
- Isolating from others or feeling isolated
- Rage; stating that they want to seek revenge
- Mood swings that are extreme
The American Foundation for Suicide Prevention (2018) adds:
- Saying goodbye to people
- Giving away possessions
- Losing interesting in things
This list is not exhaustive and, therefore, other signs may be present.Due to the safety concerns, this is an area where it is important not to keep secrets and to seek immediate help.
Healing From and Coping With Severe Depression Symptoms
If you are experiencing severe depression symptoms, especially if you have thoughts of death or suicide, the first step is to seek out professional help.Healing is possible!A counselor who is trained in treating depression will make an assessment of what type of treatment will be most helpful.He or she will also likely refer you to a medical doctor in order to rule out physical contributors to your depression (e.g., low thyroid).You may also be referred to a psychiatrist for a medication evaluation in order to determine if medication may be a helpful adjunct to psychotherapy.
There are many different types of counseling that may be helpful for your depression, depending on your symptoms and some of the root causes.For example, cognitive behavioral therapy can be very helpful in learning how to effectively combat the negative thinking styles that are a hallmark of depression.A therapist may also help you to determine activities that will boost your mood or help you to learn skills to more effectively navigate relationships.If trauma is a contributor, your counselor can determine the best treatment strategies to heal from trauma.
Strategies for Coping With Severe Depression SymptomsAlong with psychotherapy, there are some strategies that may help you cope with severe depression symptoms:
- Set daily (and attainable!) goals for activity, planning your whole day and include activities that have been enjoyable in the past.When depressed, people often lose interest in activities.However, this can lead to a cycle of shame and isolation.
- Avoid comparing yourself to others or to how you used to feel or behave.Remember, you can only be where you are and comparisons can lead to shame and further depression.
- If you become overwhelmed with an activity, break it down into smaller steps.Remember … one step at a time, one moment at a time.
- Prayer: God wants us to go to Him with everything.Check out Philippians 4:6 “… in EVERY situation … present your requests to God” (New International Version).One of my favorite books of the Bible is Habakkuk because the author is very real with his thoughts and feelings about what God had done with the nation of Israel.God did not answer by striking Habakkuk down for telling God what was on his mind!Check out the dialogue between Habakkuk and God.
- Scripture: Search the Bible for passages that are comforting in times of hardships.For example, many of the Psalms involve the psalmist pouring out his emotional pain and finding hope in God and His faithfulness.There are many verses that give hope, such as Romans 8:38-39 and 2 Corinthians 1:3-4.It may be helpful for you to write these verses down and to memorize them.
- Don’t isolate!Although depression is often accompanied by a desire to move away from people, the exact opposite is what is needed.Loneliness breeds depression.Also, we were created as relational beingsand we heal emotionally through relationships (see Daniel Siegel’s work on relational neurobiology).If you cannot bring yourself to call a friend, find a church service or engage in volunteer work.It is important to not remain in isolation.
- Let others who are trustworthy into your pain.Again, we are not created to do life alone.Even Jesus had His disciples!When life is toughest, we need trusting and caring friends to come alongside of us in our pain.
- Check negative thoughts to see if the thoughts are depression-driven or logic-driven. Try testing the thought as if it were on trial … What does the EVIDENCE demonstrate?Depression-driven thoughts are often extreme (e.g., generalizing or catastrophizing) or “all-or-nothing.”
- Journal:Journaling can be helpful for expressing thoughts and feelings.
- Relaxation exercises: Deep and mindful breathing, progressive muscle relaxation, yoga.
- Mindfulness: Mindfulness will help you to learn to gain control over your thoughts rather than your thoughts controlling you.There are many websites and apps that can help lead you in mindfulness exercises.I also recommend mindfulness for children and teenagers.
- Exercise: The health benefits of exercise have been well documented.Check with your doctor to see what type of exercise would be best for you.
- Distraction: Although it is important to process emotional pain, sometimes it is too much and the best thing that you can do in the moment is distract.Find something that you enjoy doing.It is helpful to make a list of activities that you tend to enjoy so that when you are feeling overwhelmed, you do not have to try to think of activity.
Yes, depression is hard and it hurts.However, you do not have to be in the pain alone!We have counselors who are here to help you walk through the hurts and fears so that you can become whole and set free!You can heal! Contact us today to begin your journey toward healing and hope.
Crisis Clinic of King County: 1-866-427-4747 or 206-461-3222) – 24 hour, confidential, free
National Suicide Prevention Lifeline – 1-800-273-8255 – 24 hour, confidential, free
Veterans Crisis Line – 1-800-273-8255 (press 1) – Confidential, for veterans and family members
Conquer Negative Thinking for Teens: A Workbook to Break the Nine Thought Habits That Are Holding You Back (2017) – Mary Karapetain Alford and Anne McGrath
Depression: A Teen’s Guide to Survive and Thrive (2016) – Jacqueline B. Toner and Claire A.B. Freeland
Mind Over Mood: A Cognitive Therapy Treatment Manual for Clients (2015) – Dennis Greenberger and Christine A. Padesky
American Foundation for Suicide Prevention (2018). Risk Factors and Warning Signs. www.afsp.org/about-suicide/risk-factors-and-warning-signs/. Retrieved on 6/18/18.
National Institute of Health (NIH) (2017). Depression and older adults. https://www.nia.nih.gov/health/depression-and-older-adults. Retrieved on 6/25/18.
National Institute of Mental Health (NIMH) (2016). Depression Basics. https://www.nimh.nih.gov/health/publications/depression/index.shtml. Retrieved on 6/25/18.
National Survey on Drug Use and Health (NSDUH) (NIMH, 2017). Major Depression. www.nimh.nih.gov/health/statistics/major-depression.shtml. Retrieved on 6/25/18.
National Institute of Mental Health (2017).Major Depression. https://www.nimh.nih.gov/health/statistics/major-depression.shtml. Retrieved on 6/19/18.
Substance Abuse and Mental health Services Administration (2017). Suicide Prevention.https://www.samhsa.gov/suicide-prevention. Retrieved on 6/25/18.
“Adult Alone””, Courtesy of Pixabay, Pexels.com, CC0 License; “Alone by the Lake”, Courtesy of Lukas Rychvalsky, Pexels.com, CC0 License; “Red Dahlia”, Courtesy of Pixabay, Pexels.com, CC0 License; “Blue Calm”, Courtesy of Pixabay, Pexels.com, CC0 License