Practical Signs of Depression

Depression is the focus of attention during the month of December across the United States. As a mental health counselor, I see many people with depression, and while I use the standard guidelines, I have discovered that there are a number of practical things I look for. So I’ll share some of my tricks that I use to try to figure out if someone is depressed and how depressed they are.

1. Where is your mood thermostat set? I believe that each person appears to have a mood thermostat that is set by many things outside of their control. Think of a scale from zero-100. At the zero end, your mood is so bad that you wish a dump truck would run over you and put you out of your misery. At the 100 end, life is so good and wonderful you can’t believe what fortunate luck you have. Thus a mood of 65 or 70 is pretty good, a mood of 50 is so-so, and a mood of 25 or 30 is fairly discouraged and blue. Think about where your mood tends to be during the last week or the last month. If it averages below 50, you are probably somewhat depressed.

2. Do you have a "slippery mood?" Do you work really hard to get your mood up, and it seems to slide down quickly? No matter how hard you try to get your mood up to a higher level, it just won’t "stick" there.

3. How well do things "roll off your back?" I like to picture a duck in a rain storm. When a duck is doing well, the water runs off, and the duck appears to be thinking, "No sweat, I’m a duck, and this is no big deal." When your mood is down, things don’t roll off your back. Rather everything that happens feels like stabs to the heart. When your mood is good, you shake off little and big things, and take them in stride. But that is impossible when your mood is low.

4. Do you go to sleep but seem to wake up about 2-4 hours later and just can’t get back to sleep? People who are depressed tend to have this pattern. Mornings seem especially difficult. When you wake up, you just don’t feel rested. Sometimes you just can’t feel good until later in the day if you are struggling with depression.

5. Are you "over-thinking" things, especially negative things in your life? Does your mind seem stuck on unpleasant hurts and feelings of worthlessness?

6. Do you have thoughts of suicide or wish that you would die? These are often unwanted thoughts that seem to intrude in your life for no apparent reason. Thoughts of suicide are like running a fever when you are sick.  It is a sign that something in the body is struggling, and you should not ignore it.

When your brain chemistry has changed because of a depressive state, these thoughts seem to happen automatically. It is a signal to you that you are depressed and need to take action. You should feel no more guilt over suicidal thoughts than running a fever.  But you should take immediate action, since it is dangerous to ignore these warning, since you may feel more and more hopeless.

If you or a loved one has depression, a number of questions seem to always be asked. I’ll try to answer what are the most frequently asked questions.

1. What causes depression? There are multiple causes of depression, but I believe the more serious forms appear to have a strong genetic component. Look in your family tree. If you have genetic relatives who are sad, grumpy, irritable, depressive, impulsive, emotional, or are alcoholic, or substance abusers that may be the clue to your own depression. If you have a family tree of people who don’t seem to cope as well as average, or who have other forms of mental and emotional problems, this may provide a good explanation for your own mood problems.

Stress over long periods of time can also induce stress, but again my hunch is that some people are more prone to stress causing depression than others. Some just get upset stomachs, some get back aches, and others just blow it off. The way stress affects you probably has a strong genetic component.

2. What is the best form of treatment? I believe that a combination of medication and talking therapy provides the quickest relief and longest lasting relief. Too often professional tend to use only what they have available. So physicians tend to prescribe medication and don’t have much time to talk with patients. Counselors tend to use talking therapy since they know how to do that and can’t prescribe medication. Depressed people don’t benefit much from therapy until their mood comes up some, and symptoms often return if medication alone is used.

3. I don’t want to be addicted to mood altering drugs or feel like a zombie. Antidepressant medications are not addicting, and when they are correctly chosen for you should only "make you feel more like you want to feel." They do not make you feel like a zombie, or give you a drugged feeling. Some special medications are needed if you have a more rare form of bi-polar or manic depressive illnesses.

4. Are there other things that can help? Good nutrition, reducing your stress, building good relationships, keeping your mind focused on pleasant things are all helpful. Meditation, yoga, and exercise can all be helpful.

St. John’s Wort has been helpful in cases where there is mild depression, although I don’t find many of my patients getting much relief from it. Light therapy is also helpful for those who have Seasonal Affective Disorder.

5. What are the side effects of the medications? The side effects of most of the medications for depression are more what I call "aggravating" than serious. Gastrointestinal discomfort is the leading problem, followed by changes in sleep patterns. Prescriptions medications list many possible side effects which frighten some people, but that is because they are so thoroughly tested. We don’t know the rate of side effects of non-prescription remedies, but we are learning that there are some. For instance St. John’s Wort appears to interact poorly with certain foods and may cause you to sunburn more easily, but that has not been listed on any of the bottles I have seen.

6. What if the medication doesn’t work for me or if it makes me sick? It is important to not give up on the first or second trial. There are many different formulas and it is tricky to match the person to the proper medication and proper dosage. I find it quite satisfying to help people work with their doctor to get the right drug that makes them feel better with few side effects. My experience is that many depressed people don’t take their antidepressant medications properly. I find that when they understand the way they work they can work more closely with their doctor, so that they get a high enough dosage. Also many people just quit taking the medication because of some unpleasant side-effects rather than switching to a different one.

6. How dangerous are they? There are many things we don’t know about antidepressant medications. We don’t know the impact of long-term use. Most that are used are relatively new drugs, many in use for 10 years or less. But we do know that they are much safer than older antidepressants. The older ones tended to have serious and unpleasant side effects. And with the older antidepressants, a two-week supply was also enough for a fatal overdose. That was always a concern, since it was a bit like giving a depressed person a loaded gun. Most of the newer antidepressant are almost impossible to commit suicide with. So the newer drugs are in the most important way, much safer.

7. How long do I have to take medication? Most of the time, six months seems to be a good trial. But stopping them just before the holidays is probably not a good idea. I think that springtime is a better time to go off of medication than right before winter, since dreary days and less daylight often depresses mood. Some people, especially if they have been chronically depressed, have a strong family history of depression, or are older, may need to stay on the medication the rest of their life.