What Is Depression?

Everyone feels down at times. The breakup of a relationship or a bad grade can lead to low
mood. Sometimes sadness comes on for no apparent reason. Is there any difference between
these shifting moods and what is called depression? Anyone who has experienced an episode
of depression would probably answer yes. Depression, versus ordinary unhappiness, is
characterized by longer and deeper feelings of despondency and the presence of certain
characteristic symptoms (see below). This distinction is important, because in severe cases,
depression can be life threatening, with suicide as a possible outcome. Depressed people may
also fail to live up to their potential, doing poorly in school and staying on the social margins.
Depression is frequently ignored or untreated; the condition often prevents people from taking
steps to help themselves. This is unfortunate, as effective help is available.

Signs of Depression
Anyone who feels down most of the day nearly every day for weeks or months may be
clinically depressed. Depressed individuals may experience:
 Loss of pleasure in virtually all activities
 Feelings of fatigue or lack of energy
 Frequent tearfulness
 Difficulty with concentration or memory
 A change in sleep pattern, with either too much or too little sleep; the person may wake
up in the night or early morning and not feel rested the next day
 An increase or decrease in appetite, with a corresponding change in weight
 Markedly diminished interest in sex
 Feelings of worthlessness and self-blame or exaggerated feelings of guilt
 Unrealistic ideas and worries (e.g., believing no one like them or that they have a terminal
illness when there is no supporting proof)
 Hopelessness about the future
 Thoughts of suicide

What Causes Depression?

There is growing evidence that depression is in part an illness with a biological basis. It
is more common in individuals with close relatives who have been depressed. Research
on the physiology of the nervous system suggests that the level of activity of
neurotransmitters, such as norepinephrine and serotonin, changes in longstanding
depression: Antidepressant medicines probably work by correcting a "chemical
imbalance" of this kind. One type of imbalance is associated with bipolar disorder
(previously called manic depression), characterized by dramatic mood swings from
depression to irritability or euphoria and other symptoms. A number of physical illnesses
can also lead to depression: An examination by a medical clinician may be helpful to
rule out medical causes of depressive symptoms.
While depression does appear to have biological components, it is certain that
psychological and social factors also play a vital role. The loss of a loved one or a
disappointment may trigger a depression; past losses, perhaps not fully acknowledged,
often make someone more vulnerable to depression. For complex reasons, some
individuals find themselves enmeshed in negative ways of thinking, which can
contribute to depression. Other environmental components are a lack of social support
and the absence of avenues for fulfillment.

What Treatments Are Available?

Friends and family may provide all the support that is needed in mild cases of
depression. Having someone who is willing to listen and ask concerned questions can
make all the difference. However, even the most caring and involved friends or family
members may not be enough when depression is more severe. In such cases, it is
important to seek professional help.
Mental health professionals who may be consulted include psychiatrists, clinical
psychologists, and masters-level therapists. Some may first seek help from a general
physician or religious counselor. Each type of professional has their own perspective
and expertise, and practitioners of all kinds have experience dealing with depression.
The important thing is to seek professional help when symptoms are severe and/or
longstanding. In factl, it is wise to seek help even when symptoms are not severe to
help prevent depression from getting worse.
Some moderate and most severe depressions respond to antidepressant medications.
These are prescribed by a physician, generally a psychiatrist, after a thorough
evaluation. A positive effect is usually felt within a few weeks. Some types of mood
disorders require specific medications; for example, people with bipolar disorder 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 raise insight and awareness of unconscious
conflicts, drives, and problems in the hope that increased understanding will lead to
more freedom to deal with issues and a better sense of self. Other therapies take
a cognitive and/or behavioral approach and attempt to change unhelpful ways of
thinking or address isolation by helping the person develop interpersonal skills. Group
therapy has been shown to be effective in addressing depressive symptoms and raising
insights about the self and relationships to others.
Therapists may help individuals make changes in difficult life situations. With the
individual's permission, they can 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 may seem like a drastic measure, it
can be life-saving, and it may allow the person to get the treatment and support that
they need.
Suicide
Suicide is the second leading cause of death in young people. A major cause of suicide
is mental illness, very commonly depression. People feeling suicidal are overwhelmed
by painful emotions and see death as the only way out, losing sight of the fact that
suicide is a permanent "solution" to a temporary state—most people who try to kill
themselves but live later say they are glad they didn't die. Most people who die by
suicide could have been helped. An individual considering suicide frequently confides in
a friend, who may be able to convince them to seek treatment. When the risk is high,
concerned friends and relatives should seek professional guidance.
Suicidal thoughts may be fleeting or more frequent, passive (e.g., "What if I were
dead?") or active (e.g., thinking of ways to kill oneself, making a plan). Preparations for
death, such as giving away possessions or acquiring a gun, are cause for great
concern. A sudden lift in spirits in a depresed person can be a warning sign that they
are planning to kill themselves. Any level of suicidal thinking should be taken seriously.

How Can You Tell if Suicide Is a Possibility?

While suicide is often hard to predict, there are some warning signs:
 Being depressed or having other mental disorders
 Talking directly or indirectly about wanting to die or “not be around”
 Increased social isolation
 Significant changes in appearance and hygiene
 Giving away valued possessions; making other preparations for death
 A sudden change in mood

While anyone can become suicidal, there are certain risk factors that make suicide more
likely:
 Previous suicide attempt(s)
 Having a family member or friend who recently killed themselves; multiple suicides in the
community
 Other recent, significant losses, such as the loss of a relationship or job
 Cultural and religious beliefs supporting suicide (e.g., belief that suicide is a noble
resolution of a personal dilemma)
 Alcohol and drug abuse (as this can lower inhibitions and increase impulsiveness)
 Feelings of hopelessness
 Access to means of suicide (e.g., a gun, a quantity of pills)
 Unwillingness to seek help and/or barriers to accessing mental health treatment
Misconceptions About Suicide
"People who talk about it won't do it."
Suicide threats should always be taken seriously. The truth is that few individuals are
single-minded in their decision to kill themselves; many are asking for help even as they
contemplate suicide.
"People who really want to kill themselves are beyond help."
Fortunately, this is not the case. Suicidal impulses may be intense but short-lived. The
majority of individuals who are suicidal even for extended periods recover and can
benefit from treatment.
"Suicide is a purely personal decision."
This argument is sometimes used to justify a "hands-off" attitude. It is a misconception,
because suicide doesn't just affect the person who dies; it affects others also.
"Asking about suicide can put the idea in someone's mind."
Research proves that asking someone about suicide will not "put the idea in their head."
In fact, many people having suicidal thoughts often feel relieved when someone
asks. Suicidal individuals are engaged in a private struggle with thoughts of death.
Talking about the possibility of suicide can alleviate the loneliness of the struggle and
can be a first step in obtaining help.

How Can I Help a Depressed Person?

It helps to listen in a way that shows you care and empathize. This does not mean
entering into the person's despair; an attitude of careful optimism is appropriate.
However, avoid minimizing the person's pain or making comments like "Everything's
fine" or "Your life is good—you have no reason to feel suicidal!" Try saying something
like "I can see how hopeless you feel, but I believe things can get better" or "I hear you;
I want to help." Advice should be simple and practical; for example, "Let's go for a walk
and talk more" or "I am here for you, but you need more professional advice; let's look
up some numbers together."
Change can be slow. Trying to help someone who is depressed and is not responding
to your attempts can be frustrating and anxiety provoking. It's important to take care of
yourself and get support, too. If you don't take care of yourself, you may burn out, feel
angry, or give up on the person. It is a good idea to seek help and support well before
you reach this point.
If a person is expressing that they have suicidal thoughts or you see signs of possible
suicidality, it's important to take it seriously. Sometimes, a suicidal person may ask you
to keep their situation a secret. It can be tempting to promise to keep this secret and/or
to take on the burden of supporting them all on your own; however, these are not good
ideas. Consider the possible consequences of failing to get the person professional
help. It is a sign of caring to get help for someone who is at risk of killing themselves,
even if it makes them angry at you. If you are unsure of what to do, you can call CAPS
for advice at (831) 459-2628 or call a suicide hotline (see below).
If a person is threatening to kill themselves in the immediate future, is actively trying
to kill themselves, or has just made a suicide attempt, call 911.