I'm Blue, Soooo Blue (Depression, part 3)

Remember, everyone gets depressed at some time, but not everyone gets depression. Depression comes in many forms. Yesterday we talked about degrees of reactions to change. The same occurs in all symptoms of depression. The sympoms tend to run on a continuum: eating too much to not eating at all, or somewhere inbetween.

The Diagnositic and Statiscitcal Manual (DSM-IV-TR), which is the "bible" of diagnostic symptoms for mental health professionals, lists the symptoms of depression. According to the different levels, intensities, and symptoms, there are over 200 different combinations for depression.

The symptoms of major depression can be divided into three categories:

1. 
   Disturbances of emotion and mood.
2. 
   Changes in the "housekeeping" functions of the brain - those that regulate sleep, appetite, energy and sexual function.
3. 
   Disturbances of thinking and concentration.

Some of the most common symptoms of clinical depression include:

• loss of interest or pleasure in ordinary pleasurable activities, including sex.
• chronically sad or empty mood.
• irritability or excessive crying.
• social withdrawal or isolation.
• changes in energy levels, fatigue, feeling slowed down, slowed movements.
• agitated actions (pacing, hand-wringing, etc.)
• sleep disturbances (insomnia, early morning waking, or sleeping too much).
• changes in eating habits (loss of appetite, significant weight loss or weight gain).
• difficulty with focus or concentration, impaired memory, difficulty in making decisions.
• feelings of guilt, worthlessness or helplessness.
• feelings of hopelessness and despair.
• increase in addictive behavior.
• thoughts and/or talk of death and suicide.
• suicide attempts.
• chronic aches and pains that don't respond to treatment.

If some of these seem to apply to you, then think about them in terms of these three words - number, duration and intensity.

1) Number. The symptoms of depression are "additive" - that is, the greater the number of symptoms you have, the more likely you are to be clinically depressed. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), five or more of these symptoms should be present for a person or someone close to that person to consider him or herself "clinically depressed."

2) Duration. The longer you have been down in the dumps, the more likely it is that you are clinically depressed. According to the DSM IV, the five or more symptoms must exist for at least two weeks for a diagnosis of major depression to be made.

3) Intensity. Many of us can feel emotional pain and still cope with our daily existence. Some experiences of depression are within the normal course of living. The pain of major depression can be so great, however, that its intensity (along with the number and duration of symptoms) can significantly impair one's ability to cope.

If you feel like you are clinically depressed, GREAT! You know what you can do, talk to your primary physician or make an appointment with a mental health professional (psychiatrist, counselor, psychologist) to get started on a treatment plan. You can also go to one of these sites to assess your level of depression and share this information with your physician or MHP:
Zung Self Rated Depression Scale
Mayo Clinic Depression Screening
Psych Central Depression Quiz

Keep in mind these are SCREENING tools only and NOT a substitution for a thorough examination by your physician and/or MHP.


Remember, there is HELP and there is HOPE!


Next up: Treatment options.

Encouraging Hope

What is hope? It is not just positive thinking, a good mindset, or optimism.



Webster's Online dictionary defines hope as "to desire with expectation of obtainment" and "to expect with confidence". It is the feeling that what is desired can be obtained. We can get what we want and that events will turn out for the best.



Other examples or descriptions of hope:

• An adventure, a going forward, a confident search


• A multidimensional dynamic force, characterized by a confident yet uncertain expectation of achieving a future goal. Which, to the hoping person, is realistically possible and personally significant.


• The elevating feeling we experience when we see, in our thoughts and dreams, a path to a better life, a brighter future...with the understanding that significant barriers may exist along the way.


• A non-linear path with many twists and turn of doubt and fear that can negatively affect the view of it


• The feeling of knowing how to get what you want out of life and the desire to make it happen.


• A faith in the unseen


• A spiritual certainty

Without hope there is despair. Studies show that when there is no hope then there often people contemplating death and suicide. When people choose to stop living in their current realm of pain, fear and negative circumstances and seek help (counseling, a friend, a pastor) they are seeking a more hopeful life. We have two paths when dealing with people in despair. We can focus on their mistakes (those twists and turns along the non-linear path), what is wrong with them or we can focus on strengths, their potential for right, so that they may regain hope. Research shows that depressive symptoms decrease as hope is increased.



It is important that we all maintain an attitude of hope. Our attitude and behavior is what helps elicit hope and positive behavior in others. It is important that we express our faith in others and their ability to succeed. We must encourage and empower those we come in contact with to see beyond the discouraging circumstances. We must give them another picture to view, one of possibilities and potential. Hope is contagious, forward-thinking and goal oriented.



Still more essential is that we help others restore their faith in themselves. Once they believe in their own ability to change, then they can see that the circumstances are only temporary and they can get back on the road to hope.



When we encourage exploration of alternatives to the discouraging situation, we are instilling hope. We can do this by validating their feelings of despair, but not giving credence to the lie of despair. We can give them power over the situation by exploring options and alternatives and providing a sounding board for problem-solving. When they learn to develop hope from the inside out, even in one small aspect of their life, they can take that seed of hope and water it into a whole garden of hope. They can take that sliver and generalize it to a whole host of other life situations. They will begin to see possibilities that were once invisible to them.



When people restore hope they can explore where they were and derive meaning from it. They can learn from the past and move forward. They have the ability to set and achieve realistic goals. When the feeling of hope is restored people often feel more capable; they can do what is needed, see beyond today, and visualize their future.





Additional resources:



http://en.wikipedia.org/wiki/Hope

http://researchnews.osu.edu/archive/apahope.htm

http://www.suicideinfo.ca/csp/assets/alert63.pdf

http://www.attcnetwork.org/userfiles/file/11%20Pages%20from%20AM_v7_Series_4[1].pdf

http://division39.org/pub_reviews_detail.php?book_id=22

http://psy.psych.colostate.edu/courseweb/SUM2008/PY729YalomsTherapeuticFactors.pdf

http://www.merriam-webster.com/dictionary/hope

~~