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Coping With Depression:

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What to do, how to help...

SYMPTOMS CHECKLIST Answer YES or NO to the following: Depression I am unable to do the things I used to do. I feel hopeless about the future. I can't make decisions. I feel sluggish or restless. I am gaining or losing weight. I get tired for no reason. I am sleeping too much, or too little. I feel unhappy. I become irritable or anxious. I think about dying or killing myself. Mania I have a decreased need for sleep. I have much more energy than usual. My thinking is speeded up. I feel unusually euphoric and "high." I can't seem to stop talking. I can't keep my mind on one thing - I jump from task to task. I have a heightened interest in sex. I am irritable and short-tempered. I have a close blood relative who has had a serious emotional illness or alcohol abuse. I think about dying or killing myself. If you answered YES to five or more statements and have felt this way for weeks, contact a physician or psychologist. If you answered YES to the last statement, regardless of how you answered on the others, please seek help immediately.

Causes
It isn't exactly clear what causes depression, but several key factors are at play.

Genetic predisposition. Major depressive disorder may run in families but can occur in people who have no family history of depression. People with bipolar disorder have a different genetic make-up, but not everyone with this make-up will get the illness. Basically, a family history of depression will yield a higher chance of a person also having depression.

Psychological factors. People with low self-esteem, pessimism, and who are easily overwhelmed by stress are prone to depression. It is unclear if these are psychological predispositions or symptoms from an early form of the illness. Negative experiences, such as abuse at home or witnessing violence, can also lead to depression.

Physiological factors. Changes in the body, such as a stroke, heart attack, or cancer, can cause depressive illness. Imbalances of neurotransmitters (chemical transmitters) in the brain (dopamine, norepinephrine, and seretonin) are responsible for this disorder.

Environmental factors. A serious loss, troubled relationship, financial problem, or stressful change (whether good or bad) can trigger depression. Sometimes later episodes can be precipitated by mild stressors, or not at all.

Depression in Women
Women experience higher prevalence, longer episodes, low chance of spontaneous remission, and are two to three times more likely to fall into a double depression than men. Women may also face additional stressors, such as responsibilities at home and work. Hormonal factors may also play a role - menstrual cycles, pregnancies, miscarriages, post-partum depression, and menopause can cause chemical imbalances in the brain. Note: Post-partum depression is marked by hormonal, emotional, and physical changes after giving birth. Depressive episodes are not normal and require active intervention.

Depression in Men
Statistical measures for men is harder to acquire, as men are less willing than women to seek help. Symptoms may include irritability, anger and discouragement. Men usually deal by abusing drugs or alcohol, and sometimes becoming workaholics as well. Depression is associated with an increased risk of coronary heart disease in both men and women, but men suffer a much higher death rate.

Depression in Children
One of the most difficult things to diagnose in children and teens, depression is often confused with a temporary phase of rebellion or growing pains. Young children may pretend to be sick, refuse to go to school, cling to a parent or excessively worry that a parent might die. Older children may sulk, get in trouble at school, act negative/grouchy, and feel misunderstood. Usually there are no physical symptoms, so it is best to look for mood changes and get a diagnosis from a child therapist. Teenagers may lose interest in hobbies and friends, go through bouts of crying and shouting, become reckless and self-medicate with drugs/alcohol, socially isolate themselves, engage in self-destructive behaviours, and become highly sensitive to rejection and failure.

Treatments/Medication
The most common and effective treatment comes in a concurrent two-process system: the patient takes antidepressant medications to alter brain chemistry and offer short-term relief, and attends psychotherapy sessions (also known as "talk therapies") to learn effective ways to deal with future bouts of depression. Group therapies have also shown to be helpful.

It is important to diagnose depression as soon as possible. A physical examination is the first step to ensure an accurate evaluation, as certain illnesses and medications can yield depression-like symptoms. If a physical cause for depression is ruled out, a psychological assessment is the second step. Information divulged should include a complete history of symptoms (i.e. when they started, how long they have lasted, how severe they are, if treatment was already administered, etc.), family history, current or past alcohol/drug use, and thoughts of suicide and death. A mental status evaluation is also needed to determine if speech, thought patterns, and memory have been affected. Treatment will depend on the outcome of the evaluations.

How to Help Yourself
If you suspect that you may be suffering from depression, there are several things you can do to alleviate this:

Set realistic goals.

Break large tasks into small ones, set priorities, and do what you can when you can.

Try to be with others and confide in someone.

Participate in activities that may make you feel better.

Try mild exercises and going to the movies, ballgames, and religious/social activities.

Remind yourself that this is a baby-step process - your mood will improve gradually, not immediately - so don't become discouraged if nothing changes right away.

Postpone important decisions until the depression has lifted, or get an objective view from someone else.

Take it day-by-day.

Think positive.

Let your loved ones help you.

Remember, no one can help you unless you're willing to be helped.

How to Help Others
If you suspect that someone you know may be suffering from depression, the best thing you can do to help is to be there to lend a hand. Encourage the person to get appropriate help and stick to treatment (or, if the treatment doesn't seem to be working, to seek other types of treatment). Emotional support is essential. Be understanding, encouraging, optimistic, affectionate, and patient. Don't expect the person to "snap out of it" or "get over it." Listen, don't disparage. Offer hope and encourage activities that the person once enjoyed. But don't suggest too much too soon, as the person may become overwhelmed or feel attacked. Most importantly, report any suicide or death remarks to a trained professional as soon as possible.

Unfortunately, many people will suffer from depression and never get diagnosed. The increase in the last five years suggests a surge in reported cases or a newfound awareness in the general public. Either way, the best prevention is education. I wished I could have helped Sarah when I had the chance, but I didn't know how, and I'm not sure she knew either. It's a terrible ordeal to suffer through depression or to watch a loved one go through it. Research is ongoing, and most patients who receive treatment are able to resume their lives, but for others, this is not the reality. For them, waking up in the morning is a painful task. They feel they can't go on, that they shouldn't go on. Researchers may one day find a permanent cure and offer millions what they don't have now - hope for a brighter day. ¤ C.Ho.

[ Types of depression, symptoms. Part I of the article. ]