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DSM 5th Edition
Beck Depression Inventory (3 page PDF - self scoring)
Suicide Warning Signs
Depression is a serious medical illness; its not something that you make up in your head. More than a feeling of being down in the dumps or blue for a few days, the symptoms of Depression are severe and debilitating. Depression is characterized by feeling down, low and hopeless for weeks at a time. Factors that can contribute to the onset of Depression include stress, poor nutrition, physical illness, personal loss, relationship difficulties and the presence of other physical disorders.
Depression isnt always easy to detect, and people with depressive conditions can experience different symptoms. It may be expressed through lack of appetite or overeating; insomnia or an unnatural desire to sleep; the abuse of drugs and alcohol; sexual promiscuity; or hostile, aggressive, or risk-taking behavior.
Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a persons ability to function at work and at home.
Depression symptoms can vary from mild to severe and can include
Symptoms must last at least two weeks for a diagnosis of depression.
Also, medical conditions (e.g., thyroid problems, a brain tumor or vitamin deficiency) can mimic symptoms of depression so it is important to rule out general medical causes.
Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people (16.6%) will experience depression at some time in their life. Depression can strike at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime.
Depression Is Different From Sadness or Grief/Bereavement
The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such situations. Those experiencing loss often might describe themselves as being depressed.
But being sad is not the same as having depression. The grieving process is natural and unique to each individual and shares some of the same features of depression. Both grief and depression may involve intense sadness and withdrawal from usual activities. They are also different in important ways:
Risk Factors for Depression
Depression can affect anyoneeven a person who appears to live in relatively ideal circumstances.
Several factors can play a role in depression:
How Is Depression Treated?
Depression is among the most treatable of mental disorders. Between 80% and 90% of people with depression eventually respond well to treatment. Almost all patients gain some relief from their symptoms.
Before a diagnosis or treatment, a health professional should conduct a thorough diagnostic evaluation, including an interview and possibly a physical examination. In some cases, a blood test might be done to make sure the depression is not due to a medical condition like a thyroid problem. The evaluation is to identify specific symptoms, medical and family history, cultural factors and environmental factors to arrive at a diagnosis and plan a course of action.
Medication: Brain chemistry may contribute to an individuals depression and may factor into their treatment. For this reason, antidepressants might be prescribed to help modify ones brain chemistry. These medications are not sedatives, uppers or tranquilizers. They are not habit-forming. Generally antidepressant medications have no stimulating effect on people not experiencing depression.
Antidepressants may produce some improvement within the first week or two of use. Full benefits may not be seen for two to three months. If a patient feels little or no improvement after several weeks, his or her psychiatrist can alter the dose of the medication or add or substitute another antidepressant. In some situations other psychotropic medications may be helpful. It is important to let your doctor know if a medication does not work or if you experience side effects.
Psychiatrists usually recommend that patients continue to take medication for six or more months after symptoms have improved. Longer-term maintenance treatment may be suggested to decrease the risk of future episodes for certain people at high risk.
Psychotherapy: Psychotherapy, or talk therapy, is sometimes used alone for treatment of mild depression; for moderate to severe depression, psychotherapy is often used in along with antidepressant medications. Cognitive behavioral therapy (CBT) has been found to be effective in treating depression. CBT is a form of therapy focused on the present and problem solving. CBT helps a person to recognize distorted thinking and then change behaviors and thinking.
Psychotherapy may involve only the individual, but it can include others. For example, family or couples therapy can help address issues within these close relationships. Group therapy involves people with similar illnesses.
Depending on the severity of the depression, treatment can take a few weeks or much longer. In many cases, significant improvement can be made in 10 to 15 sessions.
Electroconvulsive Therapy (ECT) is a medical treatment most commonly used for patients with severe major depression or bipolar disorder who have not responded to other treatments. It involves a brief electrical stimulation of the brain while the patient is under anesthesia. A patient typically receives ECT two to three times a week for a total of six to 12 treatments. ECT has been used since the 1940s, and many years of research have led to major improvements. It is usually managed by a team of trained medical professionals including a psychiatrist, an anesthesiologist and a nurse or physician assistant.
Self-help and Coping
There are a number of things people can do to help reduce the symptoms of depression. For many people, regular exercise helps create positive feeling and improve mood. Getting enough quality sleep on a regular basis, eating a healthy diet and avoiding alcohol (a depressant) can also help reduce symptoms of depression.
Depression is a real illness and help is available. With proper diagnosis and treatment, the vast majority of people with depression will overcome it. If you are experiencing symptoms of depression, a first step is to see your family physician or psychiatrist. Talk about your concerns and request a thorough evaluation. This is a start to addressing mental health needs.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth edition. 2013.
National Institute of Mental Health. (Data from 2013 National Survey on Drug Use and Health.)
Kessler, RC, et al. Lifetime
Prevalence and Age-of-Onset Distributions of DSM-IV
Disorders in the National Comorbidity Survey Replication.
Arch Gen Psychiatry. 2005;62(6):593602.
According to the 5 th edition of the DSM, a person must exhibit at least five of the following characteristics to be diagnosed with a depressive disorder:
The above represent a "major
depressive episode". The other two criteria as stated by
DSM-5 is that "the occurrence of the major depressive
episode is not better explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder, delusional
disorder, or other specified and unspecified schizophrenia
spectrum and other psychotic disorders" and there has never
been "a manic episode or a hypomanic episode."
What are the
symptoms of Depression?
Loss of energy and
Feeling down from time to time is a normal part of life, but when emotions such as hopelessness and despair take hold and just won't go away, you may have depression. Depression makes it tough to function and enjoy life like you once did. Just getting through the day can be overwhelming. But no matter how hopeless you feel, you can get better. Learning about depressionand the many things you can do to help yourselfis the first step to overcoming the problem.
How do you experience depression?
While some people describe depression as living in a black hole or having a feeling of impending doom, others feel lifeless, empty, and apathetic. Men in particular may even feel angry and restless. No matter how you experience it, depression is different from normal sadness in that it engulfs your day-to-day life, interfering with your ability to work, study, eat, sleep, and have fun.
Some people feel like nothing will ever change. But its important to remember that feelings of helplessness and hopelessness are symptoms of depressionnot the reality of your situation. You can do things today to start feeling better.
What are the symptoms of depression?
Depression varies from person to person, but there are some common signs and symptoms. Its important to remember that these symptoms can be part of lifes normal lows. But the more symptoms you have, the stronger they are, and the longer theyve lastedthe more likely it is that youre dealing with depression.
Symptoms of depression include:
Is it depression or bipolar disorder?
Bipolar disorder, also known as manic depression, involves serious shifts in moods, energy, thinking, and behavior. Because it looks so similar to depression when in the low phase, it is often overlooked and misdiagnosed. This is a problem, because antidepressants for bipolar depression can make the condition worse. If youve ever gone through phases where you experienced excessive feelings of euphoria, a decreased need for sleep, racing thoughts, and impulsive behavior, consider getting evaluated for bipolar disorder. See: Bipolar Disorder Signs and Symptoms.
Depression and suicide risk
Depression is a major risk factor for suicide. The deep despair and hopelessness that goes along with depression can make suicide feel like the only way to escape the pain. If you have a loved one with depression, take any suicidal talk or behavior seriously and watch for the warning signs:
If you think a friend or family member is considering suicide, express your concern and seek help immediately. Talking openly about suicidal thoughts and feelings can save a life.
The symptoms of depression can vary with gender and age
Depression often varies according to age and gender, with symptoms differing between men and women, or young people and older adults.
Depression in men. Depressed men are less likely to acknowledge feelings of self-loathing and hopelessness. Instead, they tend to complain about fatigue, irritability, sleep problems, and loss of interest in work and hobbies. Theyre also more likely to experience symptoms such as anger, aggression, reckless behavior, and substance abuse.
Types of depression
Depression comes in many shapes and forms. Knowing what type of depression you have can help you manage your symptoms and get the most effective treatment.
Depression causes and risk factors
While some illnesses have a specific medical cause, making treatment straightforward, depression is more complicated. Depression is not just the result of a chemical imbalance in the brain that can be simply cured with medication. Its caused by a combination of biological, psychological, and social factors. In other words, your lifestyle choices, relationships, and coping skills matter just as muchif not more sothan genetics.
Risk factors that make you more vulnerable to depression include:
The cause of your depression helps determine the treatment
Understanding the underlying cause of your depression may help you overcome the problem. For example, if you are depressed because of a dead end job, the best treatment might be finding a more satisfying career, not taking an antidepressant. If you are new to an area and feeling lonely and sad, finding new friends will probably give you more of a mood boost than going to therapy. In such cases, the depression is remedied by changing the situation.
What you can do to feel better
When youre depressed, it can feel like theres no light at the end of the tunnel. But there are many things you can do to lift and stabilize your mood. The key is to start with a few small goals and slowly build from there, trying to do a little more each day. Feeling better takes time, but you can get there by making positive choices for yourself.
What you can do
Reach out to other people. Isolation fuels depression, so reach out to friends and loved ones, even if you feel like being alone or dont want to be a burden to others. The simple act of talking to someone face-to-face about how you feel can be an enormous help. The person you talk to doesnt have to be able to fix you. He or she just needs to be a good listenersomeone wholl listen attentively without being distracted or judging you.
Get moving. When youre depressed, just getting out of bed can seem daunting, let alone exercising. But regular exercise can be as effective as antidepressant medication in countering the symptoms of depression. Take a short walk or put some music on and dance around. Start with small activities and build up from there.
Eat a mood boosting diet. Reduce your intake of foods that can adversely affect your mood, such as caffeine, alcohol, trans fats, sugar, and refined carbs. And increase mood-enhancing nutrients such as Omega-3 fatty acids.
Find ways to engage again with the world. Spend some time in nature, care for a pet, volunteer, pick up a hobby you used to enjoy (or take up a new one). You wont feel like it at first, but as you participate in the world again, you will start to feel better.
10 tips for reaching out and staying connected
For more information, see: Coping with Depression
When to seek professional help
If support from family and friends and positive lifestyle changes arent enough, find a therapist who can help you heal.
Therapy can help you understand your depression and motivate you to take the action necessary to prevent it from coming back.
Medication may be imperative if youre feeling suicidal or violent. But while it can help relieve symptoms of depression in some people, it isnt a cure and is not usually a long-term solution. It also comes with side effects and other drawbacks so its important to learn all the facts to make an informed decision.
Related HelpGuide articles
Resources and references
Signs and symptoms of depression
Signs and Symptoms of Mood Disorders Lists the common signs and symptoms of depression and bipolar disorder. (Depression and Bipolar Support Alliance)
Types of depression
The Different Faces of Depression Discussion of the different subtypes of depression, including atypical depression, melancholic depression, and psychotic depression. (Psychology Today)
Depression causes and risk factors
What Causes Depression? Page 1 & Page 2 Learn about the many potential causes of depression, including genes, temperament, stressful life events, and medical issues. (Harvard Health Publications)
Well start out with my experiences
My first experience with treatment was at the mental health clinic at the local hospital. I was fairly indifferent toward the first psychiatrist I had there, but I was unpleasantly jarred to find out that he was leaving after six months. Apparently they were on some sort of rotation. When I walked into the new psychiatrists office, I immediately got a bad feeling. It looked like he felt this was a temporary situation, as the office was completely bare except for the desk and two chairs. The reason for my visit was to ask him to raise my medication, as I was feeling the familiar signs of depression after being fairly stable for a year. He never even looked at me, and only asked me one question to determine whether I was depressed again or not, Do you have thoughts of harming yourself or others? I said, Well, no, but I never have, so thats not really an indication for me. He ignored all the signs of depression I was recounting and refused to raise my medication. I absolutely hated him, and wouldnt go back until he was gone six months later. This time when I walked into the new psychiatrists office I was very wary, but the difference he had made in that cold office was amazing. Im a little fuzzy on the specifics, but I immediately noticed that the place smelled great. He had air fresheners in the office that made you want to inhale when you walked in. He had prints on the walls and (Im pretty sure) healthy plants. I may be just remembering the plants because he was such a nurturing person. He also had a photo of himself with a child on his bulletin board, which I took as a good sign. He was very accessible, listened to me, and ordered a blood test to find out the level of meds in my blood, which indeed was too low. He stayed longer than six months before moving on, and I was very sorry to see him go.
I had trouble with severe mood swings for years and my condition was getting worse. Upon finding out that several close relatives were bipolar, I did some research and found that without a doubt I had the symptoms. I took my information and family history to a local psychiatrist. He stated with sarcasm, If you went out and bought five Corvettes Id believe you were bipolar, but youre not. I believed him, left and did not seek any further treatment as I descended deeper into a horrible depression. Finally I went to a local clinic, and talked to a nurse practitioner who believed me enough to give me a trial of lithium. Literally within days I rounded a corner. The medication literally saved my life. The moral of the story for me is; if at first you dont get listened to, keep looking until you do. Also, Id rather talk to a nurse who listens than an MD who doesnt. Kate from Idaho
OK, finally I put off suicide until I could at least get in to see the psychiatrist. The Paxil that my GI put me on isnt working. Im slipping down a drain. I had 1 1/2 hours of sleep last night and in another 2 hours I have to go to work. But .I went to the shrink today like I promised. Told him of my plans to end it. Told him how close I came. Told him I was already dead inside. Told him I had 2 hours of sleep and had to work again. I told him I can hardly get through a day anymore. He said increase the paxil to 1 1/2 tabs and come back in a month. Oh well. I didnt deserve the help anyway. angelica
About six years ago I was suffering from incredible depression. (I have since been diagnosed w/Borderline Personality Disorder, and depression comprises only a part of this). At any rate, because I was cutting myself, wanting to die, and locking myself in my apartment for weeks at a time (where I would sleep for days on end), my employer (who happened to be my churchI was a church secretary) demanded that I see the licensed family therapist they had on staff. I went. He looked like a dish of spumonihe wore mixed pastels (polyester), and a horrifyingly bad toupee. On top of everything else, he told me (I am quoting here), that I was evil, that God was protecting other people from me, and that he felt sorry for anyone who knew me because I really was a bad person. This, said to a severely depressed person by a supposed professional, is BAD. I quit seeing him, obviously.
Heres the REALLY juicy part: he then attempted to blackmail me with my patient records, which he said (Im quoting again) that he would keep for his own protection, in case I said anything unflattering about him. He said he would make those records public if anything bad I said got back to him. I have since found out that in my state, ANYBODY can be a licensed family therapist, just by paying a fee for the license. Scary, huh? (NOTE: this loser has since been taken off the church staff, and I have long since gotten some QUALIFIED help. And I had a Government agency confiscate my records from his officewith my permission, because I work for a defense contractor and had to obtain a security clearance. I have no idea how many other people this pig damaged, though.) Anita from Alabama
After reading your story, I started to think about my psych, hes from India, he thinks Im really off my rocker. He tells me to do other things from what my therapist tells me, and I think he uses me for his guinea pig. Hes been trying to start me on some of the strangest meds, and all I want to do was to get my Effexor refilled. Then he gave me a 2-week supply, but this medicine takes effect in about 30 days. When I go back and see him, what does he do, he prescribes me something else. Im going to find another psych and keep my therapist. Shes more understanding of my problem. Tom
Even though I had had depression for years and mild mania, I started off with a psychologist who did not refer me to a psychiatrist until it got so bad I had to be hospitalized. Thankfully, the psychiatrist knew what he was doing (actually at that point it had become quite obvious). So he became my doctor for the last 6 years and was great. Except in October he was too close to a tree that got hit by lightning and he had to stop practicing while they evaluated him. The doctor he left as a back-up was too busy for any sessions. I had to go out and interview doctors. That was fun. Finally, my doctors office called me and told me to call this other doctor, that he would see me. Well, he started off the conversation stating he was a mood expert and started diagnosing me over the phone. He tells me I have to increase my medications and I have to be totally reevaluated and maybe hospitalized (a week before the holidays). I told him that I had no problem raising the medication and that he would find that I took my medications as I was told. He actually said Thats an oxymoron. After that experience, I did the incredible. I actually called the insurance company and asked them to find me a doctor. They did, he was nice and he took care of me until my old doctor came back. No, I never did make my appointment with the mood expert. You should always interview a doctor before actually going into their office. In this state, a doctor has the power to hospitalize you if they think you are in danger or a danger to others. Lourdes from Miami
I knew I had a bad shrink when he called me at home on Saturday morning to ask me my advice for how he should deal with his problems with his girlfriend. Eee-gads! Meg
It was my first experience with a psychiatrist, but I knew it was a mess when one of his assistants/office staff/next door neighbors/whatever kept walking into the office. On the second visit, the doctor spent most of his time on the phone with apparently his stock broker as they were talking all about money, selling this, buying that, etc. Needless to say, I did not go back, and shortly after that he was arrested for DWI and essentially run out of town on a rail. (Turns out I was not the only person that hed ignored in favor of his stock broker.) Current primary care doctor wants me to see a psychiatrist again, and after one bad experience, Im not sure this is a good idea. I called the insurance company just to clarify what the benefits were. Turns out that they really dont want you to use their mental health services. I cant use any doctor in the plan, nope, it has to be one who is also in their merit services program (which probably means money in one way or another). My other doctors (primary care doctor, orthopod, etc.) are located at the biggest hospital in the area but none of their merit services people are, and they could only give me two names of anyone in town that I could *maybe* see! Needless to say, I wont be seeing a psychiatrist, and Im not terribly upset about that! Laurie
When I first met Dr. X I had an almost unwelcome feeling. I felt like I should be paying for his services and only then he would treat me like I worthy of his therapy. Anyway, I told him that I wanted some sort of psychotherapy rather than drugs because of sideffects, etc. Although he listened to me he decided that drugs would be most useful in this case. Well I didnt take them, but I did continue to see him. Being a psychology student I am sure my beliefs about drugs were emanating from my psyche. With time, however, I gained respect for this person with a British accent and snotty attitude. When he started sharing some of his personal history and I found that we had a bit of history in common I began to trust him. I guess trust was a real issue for me. I began taking the meds and gradually became healthier. We developed a bit of a friendship which was in the end briskly cut off by him. I guess because he didnt want me to become too dependent on this one and only friendship. Anyway I still hear his voice once in while and find comfort in knowing that he knew me enough to get me to help myself. Anonymous
I have been having a hell of a time, lately, with psychiatrists (i.e., finding one and keeping one) during this last bout of depression. My heart sinks when I walk into a practitioners office and it barely looks as if they write scripts there. We probably just cant help it, but women are probably more sensitive to this. The past two pdocs Ive seen (and didnt go back to when I couldnt take it anymore) hardly looked at me, either, except to say these are the rules type statements and ask me if was suicidal. Funny thing it made no difference in their reaction if I said I was suicidal or swore I wasnt. Not really very humorous. The psychiatrist I saw previously was (is!) a real human being, who listened, empathized, and did his damnedest to help me feel that I too, am a human being, defects and all. He had an office with real furniture, old worn oriental carpets, real works of art, including that of friends of mine. Offices of both my current individual therapist and someone my husband and I see occasionally are warm, inviting, not fancy, but with pictures of both their kids and artwork done by the same. In other words, if they see themselves as human beings, perhaps they can give us the same courtesy. I resolve to walk right out of the robot practitioners offices as soon as I walk in from now on! Our instincts may be all we have left . Robin
I have been to untold numbers of these people over the last 5 years that I have been suffering from depression. One told me that I could blame it all on my parents and that I should let them know. (Thank God that I did not do so). The next one would give me a depression test every week that I saw him. He placed me on different drugs over the years, all with the same results, but at least the data was of use.
I then found a good man who showed me how to use my brain to help control the pain in my left arm. Two years of little depression. Then he had a stroke. Depression back. Back to other psychiatrist, still more drugs.
Then last year a breakdown in public; result pending police charges (a man with one good arm with two assault police charges), depression deeper, placed in a psych hospital; depression even deeper.
Then my good man came to my rescue, got me out of the hospital and he now treats me (at no charge), ring or visit him at any time. Anonymous
I refer to the first 3 psychiatrists I saw as quacks #1, #2, and #3. I suffer from severe, chronic clinical depression and have tried nearly every psychiatric medicine known with no permanent success. I was referred to the psychiatrists I saw by an EAP. It turns out that the only requirement to get on the EAPs list was that these providers apply and send in copies of their licenses.
Quack #1 was relatively innocuous. She prescribed a combination of two tricyclics which gave me severe anxiety attacks. Every other doctor I have seen wonders why she combined those two drugs as no one seems to have ever heard of using them together. She left the area before doing any more damage.
Quack #2 apparently did not believe in taking blood levels. I wound up in the hospital (not once, but twice) with toxic blood levels at therapeutic dosages of the antidepressant I was taking. I later found out that that was not unheard of for those particular drugs.
Quack #3 used to fall asleep in therapy sessions and would tell me it was because my monotone voice put him to sleep. When I finally got angry enough to fire him, he told me I was leaving because we were finally getting to the root of my problems and I was afraid to address my issues. When I asked him what those issues were, he said that I needed to discover them myself. Gal
I think I know shes a good therapist because, when friends/family ask how my session went or what my therapist thinks of me, I cant really give them a pat answer. In other words, she isnt authoritative or didactic. She listens, responds non-verbally, and then when Im finished with my latest spiel, she asks me questions about how what Ive just said relates to past sessions, relationships, my experiences growing up, etc. It feels as if she is quite solidly on my side, no matter what, and I trust her. Ive described our sessions as my weekly anchor to sanity (no advice from well-meaning friends, no belligerent orders to stop my behaviors, no fear or frenzy for one hour a week ).
I used to be very suspicious of therapy, I think, because of the bad press it gets in our culture. I assimilated this and thought of myself as a spoiled white female who couldnt solve her petty problems and who wanted to run to therapy (even though she wasnt bad enough to deserve treatment) so someone else could run her life. So I raged and screamed to get attention from my parents (alcoholic father, shy and enabling mother), fell into deep depressions at my lack of perfection, and cut my arm repeatedly to put my anger and pain into a place I could focus on.
Now I feel as if my life is my own and I dont want to spend another second feeling bitter or loathing myself. I just want new tools and perspectives so I can keep searching. I take 50 to 100mg of zoloft daily (I also take short breaks from it as I see fitmy therapist and psychiatrist both accept my need to control my medication and dont view my treatment as a power play). I still cut my arm occasionally, but we discuss it and dont treat it as some terrible backslide. I feel very lucky. I look at my chronic depression and realize that, given my lifes circumstances, much of it was a sane response to insane situations. I feel that Ive been easy to treat, but had I had a series of nightmare therapists, Id be so much worse off. Im very grateful to susan for her support. Laura
I think the thing that amazes me the most about some of the doctors Ive seen for my episodic depression is that theyve been so cruel. I wouldnt say some of the things theyve said to me to my dog. The first time I got depressed, I was terrified. Therapy was urgent, because of my strong anxiety and complete inability to cope. Naturally, I was referred (by my kind, gentle therapist) to a psychiatrist, which was scary. Was I really that sick? I was highly resistant to the idea of meds, but she didnt try to allay my fears. What makes you think you dont need medication? she barked, I think you do. She convinced me, and Im glad she did although Ill never forgive her for treating a suicidal but intelligent teenager like an imbecile. Other doctors I saw were nicer, but there was one last year who was pure evil. Ill always remember the disgust in her eyes when, in response to the question, Can you tell me something about this drug Im taking? she said, Dont you want to have children someday? You are going to harm your children, destroy their lives, if you dont fix your problems. Ugh. I think the reason antidepressants take so long to work is that it takes you a month to get over your appointments with your psychiatrist. Wendy from New Jersey
My first therapist was a social worker (MSW) whom my college roommate (also an MSW) recommended to me. I felt very comfortable with her, but after less than a year, I felt my therapy was at an impasse. (she had suggested meds, which petrified me) and I shut down after that.
I thought I could get along without a therapist but after a few months I realized it was not the case. The next therapist was a social worker too, with training in Freudian analysis, which I have since read is not very good for depression. She was not very empathetic. When I was worried about my parents finances because my mother has depression, she said dont worry about it, they have health insurance and then tried to change the subject, despite the fact that I was worried because their insurance wasnt paying for some very expensive x-rays. And she wanted to know why I was so upset to find out my mother has lung cancer. (Depressives tend to get overly upset at things, but really, shes my MOTHER!)
After being with her for almost a year, I realized I needed to do something or I would end up dead. I went to my primary care physician for a referral to a psychiatrist. He asked me a few questions, and a few minutes later he wrote a prescription for Paxil and told me to come back in 6 months.
Well, after that, I called my health insurance, got names of some psychologists. Our first session was an interview, I followed some suggestions from one of my books and asked her a lot of questions how often she treats depression, etc., etc. I began seeing her and saw a psychiatrist that she recommended. Its been a hard time finding meds for me (PAXIL was a bad choice for me and its taking a while to wean me off.) But all in all I am comfortable with both my psychologist and psychiatrist. Susan from NYC
I recently had a panic attack. I went to the local clinic and was given Paxil. I found a shrink in the yellow pages, its a small town and there was only a choice of two. The one just worked on state cases. I choose shrink number two.
I just got his bill for three sessions. Are you ready for this $890. My first session I asked his charges. He said $125 for a 50 minute hour, and the first session would go longer, getting background etc. My second session lasted over two hours until I finally said, hey doc, I gotta go. Im thinking, hey its a small town, hes not busy, maybe hes interested in my case.
Session number three was going into two hours and I just excused myself, never thinking he has got the clock running.
To sum up, Ive written the state
board of medicine and spoken to their ombudsman, whose first
comment was Jesus. Ive flushed the dope
down the toilet, and I feel much better thank you very much.
When a family member or friend suffers from depression, your support and encouragement can play an important role in his or her recovery. However, depression can also wear you down if you neglect your own needs. These guidelines can help you support a depressed person while maintaining your own emotional equilibrium.
Helping a depressed friend or family member
Depression is a serious but treatable disorder that affects millions of people, from young to old and from all walks of life. It gets in the way of everyday life, causing tremendous pain, hurting not just those suffering from it, but also impacting everyone around them.
If someone you love is depressed, you may be experiencing any number of difficult emotions, including helplessness, frustration, anger, fear, guilt, and sadness. These feelings are all normal. Its not easy dealing with a friend or family members depression. And if you dont take care of yourself, it can become overwhelming.
That said, there are steps you can take to help your loved one. Start by learning about depression and how to talk about it with your friend or family member. But as you reach out, dont forget to look after your own emotional health. Thinking about your own needs is not an act of selfishnessits a necessity. Your emotional strength will allow you to provide the ongoing support your depressed friend or family member needs.
Understanding depression in a friend or family member
Depression is a serious condition. Dont underestimate the seriousness of depression. Depression drains a persons energy, optimism, and motivation. Your depressed loved one cant just snap out of it by sheer force of will.
Is my friend or loved one depressed?
Family and friends are often the first line of defense in the fight against depression. Thats why its important to understand the signs and symptoms of depression. You may notice the problem in a depressed loved one before he or she does, and your influence and concern can motivate that person to seek help.
Be concerned if your loved one...
Doesnt seem to care about anything anymore. Has lost interest in work, sex, hobbies, and other pleasurable activities. Has withdrawn from friends, family, and other social activities.
How to talk to a loved one about depression
Sometimes it is hard to know what to say when speaking to a loved one about depression. You might fear that if you bring up your worries he or she will get angry, feel insulted, or ignore your concerns. You may be unsure what questions to ask or how to be supportive.
If you dont know where to start, the following suggestions may help. But remember that being a compassionate listener is much more important than giving advice. You dont have to try to fix the person; you just have to be a good listener. Often, the simple act of talking to someone face to face can be an enormous help to someone suffering from depression. Encourage the depressed person to talk about his or her feelings, and be willing to listen without judgment.
Dont expect a single conversation to be the end of it. Depressed people tend to withdraw from others and isolate themselves. You may need to express your concern and willingness to listen over and over again. Be gentle, yet persistent.
Ways to start the conversation:
"I have been feeling concerned about you lately."
Questions you can ask:
"When did you begin feeling like this?"
Remember, being supportive involves offering encouragement and hope. Very often, this is a matter of talking to the person in language that he or she will understand and respond to while in a depressed mind frame.
What you CAN say that helps:
Source: The Depression and Bipolar Support Alliance
Taking care of yourself
Theres a natural impulse to want to fix the problems of people we love, but you cant control a loved ones depression. You can, however, control how well you take care of yourself. Its just as important for you to stay healthy as it is for the depressed person to get treatment, so make your own well-being a priority.
Remember the advice of airline flight attendants: put on your own oxygen mask before you assist anyone else. In other words, make sure your own health and happiness are solid before you try to help someone who is depressed. You wont do your friend or family member any good if you collapse under the pressure of trying to help. When your own needs are taken care of, youll have the energy you need to lend a helping hand.
Tips for taking care of yourself
Think of this challenging time like a marathon; you need extra sustenance to keep yourself going. The following ideas will help you keep your strength up as you support your loved one through depression treatment and recovery.
Speak up for yourself. You may be hesitant to speak out when the depressed person in your life upsets you or lets you down. However, honest communication will actually help the relationship in the long run. If youre suffering in silence and letting resentment build, your loved one will pick up on these negative emotions and feel even worse. Gently talk about how youre feeling before pent-up emotions make it too hard to communicate with sensitivity.
Set boundaries. Of course you want to help, but you can only do so much. Your own health will suffer if you let your life be controlled by your loved ones depression. You cant be a caretaker round the clock without paying a psychological price. To avoid burnout and resentment, set clear limits on what you are willing and able to do. You are not your loved ones therapist, so dont take on that responsibility.
Stay on track with your own life. While some changes in your daily routine may be unavoidable while caring for your friend or relative, do your best to keep appointments and plans with friends. If your depressed loved one is unable to go on an outing or trip you had planned, ask a friend to join you instead.
Seek support. You are NOT betraying your depressed relative or friend by turning to others for support. Joining a support group, talking to a counselor or clergyman, or confiding in a trusted friend will help you get through this tough time. You dont need to go into detail about your loved ones depression or betray confidences; instead focus on your emotions and what you are feeling. Make sure you can be totally honest with the person you turn tono judging your emotions!
Encouraging your loved one to get help
While you can't control someone elses recovery from depression, you can start by encouraging the depressed person to seek help. Getting a depressed person into treatment can be difficult. Depression saps energy and motivation, so even the act of making an appointment or finding a doctor can seem daunting. Depression also involves negative ways of thinking. The depressed person may believe that the situation is hopeless and treatment pointless.
Because of these obstacles, getting your loved one to admit to the problemand helping him or her see that it can be solvedis an essential step in depression recovery.
If your loved one resists getting help:
Suggest a general check-up with a physician. Your loved one may be less anxious about seeing a family doctor than a mental health professional. A regular doctors visit is actually a great option, since the doctor can rule out medical causes of depression. If the doctor diagnoses depression, he or she can refer your loved one to a psychiatrist or psychologist. Sometimes, this professional opinion makes all the difference.
Supporting your loved one's treatment
One of the most important things you can do to help a friend or relative with depression is to give your unconditional love and support throughout the treatment process. This involves being compassionate and patient, which is not always easy when dealing with the negativity, hostility, and moodiness that go hand in hand with depression.
Provide whatever assistance the person needs (and is willing to accept). Help your loved one make and keep appointments, research treatment options, and stay on schedule with any treatment prescribed.
The risk of suicide is real
It may be hard to believe that the person you know and love would ever consider something as drastic as suicide, but a depressed person may not see any other way out. Depression clouds judgment and distorts thinking, causing a normally rational person to believe that death is the only way to end the pain he or she is feeling.
When someone is depressed, suicide is a very real danger. Its important to know the warning signs:
If you think a friend or family member might be considering suicide, talk to him or her about your concerns as soon as possible. Many people feel uncomfortable bringing up the topic but it is one of the best things you can do for someone who is thinking about suicide. Talking openly about suicidal thoughts and feelings can save a persons life, so speak up if you're concerned and seek professional help immediately!
Related HelpGuide articles
Resources and references
Helping a depressed person
Helping Someone with a Mood Disorder Covers how to support a loved one through depression treatment and recovery. (Depression and Bipolar Support Alliance)
Helping Someone Receive Treatment What to do (and not to do) when trying to help a loved one get help for depression. (Families for Depression Awareness)
Helping a Friend or Family Member with Depression or Bipolar Disorder How to help your loved one while also taking care of yourself. (Depression and Bipolar Support Alliance)
What is the role of the family caregiver? Tips on how families can work together to manage depression treatment. (Families for Depression Awareness)
Helping a suicidal person
How to Help Someone in Crisis Advice on how to deal with a depression crisis, including situations where hospitalization is necessary. (Depression and Bipolar Support Alliance)
National Suicide Prevention Lifeline Suicide prevention telephone hotline funded by the U.S. government. Provides free, 24-hour assistance. 1-800-273-TALK (8255).
Crisis Text Line - US 24/7 confidential line for any crisis. 741741 text SOS
Samaritans UK 24-hour suicide support for people in the UK and Ireland call 116 123. (Samaritans)
Lifeline Australia 24-hour suicide crisis support service at 13 11 14. (Lifeline Australia)
Crisis Centers Across Canada Locate suicide crisis centers in Canada by province. (Canadian Association for Suicide Prevention)
IASP Find crisis centers and helplines around the world. (International Association for Suicide Prevention).
International Suicide Hotlines Find a helpline in different countries around the world.
What to do if
you are depressed?
For more information: National
Institute of Mental Health www.nimh.nih.gov/publicat/depression.cfm#ptdep5
Where can I get
more information about Depression?
National Alliance for the Mentally Ill (NAMI), Colonial Place Three , 2107 Wilson Blvd., Suite 300 , Arlington, VA 22201, 800.950NAMI (6264) or 703.524.7600 or www.nami.org
A support and advocacy organization of consumers, families, and friends of people with severe mental illness-over 1,200 state and local affiliates. Local affiliates often give guidance to finding treatment.
Depression & Bipolar Support Alliance (DBSA), 730 N. Franklin St., Suite #501, Chicago, IL 60610-7204, 312.988.1150, Fax: .312.642.7243 or www.DBSAlliance.org
Purpose is to educate patients, families, and the public concerning the nature of depressive illnesses. Maintains an extensive catalog of helpful books.
National Foundation for Depressive Illness, P.O. Box 2257, New York, NY 10116, 212.268.4260; 800.239.1265 or www.depression.org
A foundation that informs the public about depressive illness and its treatability and promotes programs of research, education, and treatment.
National Mental Health Association (NMHA), 2001 N. Beauregard Street, 12th Floor, Alexandria, VA 22311, 800.969.6942 or 703.684.7722, TTY 800.443.5959, www.nmha.org
An association that works with 340 affiliates to promote mental health through advocacy, education, research, and services.
Many people who have depression turn to drugs and alcohol to make them feel better or to numb themselves from their feelingsestimates state that approximately 10.2 million adults live with a co-occurring mental health and addiction disorder.3 This relationship between mental health and addiction is dangerous, particularly because substance abuse can worsen depressive symptoms.
But there are many ways to find help, including calling a depression hotline for information about treatment centers and 12-step programs.
The connection between depression and substance abuse can place you at a higher risk for self-harm, injury, and suicide, so having a 24-hour depression hotline crucial for many people who are in crisis. You can be assured that all calls are private and confidential and that you will speak to a person with experience in helping people with similar issues.
Depression is a significantly debilitating mental health condition that can prevent you from living life to your fullest potential because you feel hopeless, sad, and tired. Additionally:1
There are effective ways to manage depression; calling a hotline can help you or a loved one begin your search for treatment.
What Questions Should I Ask?
When you call a 24-hour depression hotline, it is important that you share as much information as possible with the person on the other end of the line so they can better gauge your situation and provide relevant treatment information.
Before you call a depression helpline, you may want to write down questions you have, which might include:
If you are concerned about a family member, significant other, friend, classmate, or colleague, it can take an emotional toll on you. When calling a depression helpline, you can ask:
When you call, you may be asked your first name as well as your age, which helps the counselors figure out what types of programs you are eligible for. You may also be asked any of the following questions when you call:
Should I Call a Hotline?
Most people experience periods of sadness in their lives after major events, such as a job loss, a divorce, or the death of a loved one. However, clinical depression is different than regular sadness or a period of grief. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), depression is diagnosed when you have 5 or more of the following symptoms in a 2-week period:4
Mental Health Information
If you have depression and a substance abuse disorder, it can be very difficult to pick up the phone and ask for help. If you feel nervous and arent sure you can talk to someone on the phone, you can always try another time. Because all calls are confidential, you can feel safe about being open and honestthe person you speak to has experience and training and understands what you need.
If you want information about mental health in general, these resources can help:
Other Depression Hotlines
For many people, depression is an extremely lonely experience. Calling a hotline gives you the opportunity to talk to a caring person who can help you work through whatever negative thoughts or feelings you have.
If this is an emergency and you need immediate assistance, please call 911.
1. World Health
Organization. (2017). Depression.