Depression

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Depression

Nearly everyone understands what it is like to feel "down," "discouraged," "sad," or "unhappy. When a person feels sad most of the time, loses interest or pleasure in most activities, or has significant difficulty functioning because of chronic sadness or "emptiness," he or she may be experiencing depression. Fortunately there are several strategies for managing moods and several helpful forms of treatment for depression.

Symptoms of Depression
In addition to feelings of sadness or emptiness, some of the most common symptoms of depression are:
1. Loss of interest or pleasure in activities. Example: A student who used to love to hike and play the piano no longer feels fun anymore.

2.  Significant change in appetite, or change in body weight when not dieting. Example: A student rarely feels hungry, and loses 10 pounds. Another student eats or wants to eat all day.

3. Sleep Disturbance. Example:  A student reports lying in bed for two hours before falling asleep and then waking up several times during the night. Another student wants to sleep all the time.

4. Fatigue.  Example: A student reports feeling tired all of the time

5. Feelings of worthlessness or feeling excessively guilty. Example: A student feels no good at anything. Other students believe they are ruining others' lives, even though they cannot identify anything specific that they have done to hurt others.

6. Decreased ability to concentrate, or difficulty making decisions.  Example: A student has difficulty focusing on a textbook for more than a few minutes.

7. Recurrent thoughts about death or suicide. Example: A student thinks about what a relief it would be to be hit by a car and not have to deal with life anymore. Another student contemplates ways to commit suicide.
 
When several of these symptoms occur for a period of about two weeks or longer, and when these symptoms interfere with one's ability to function in school, on the job, in social relationships, etc., then it is likely that the person is experiencing what psychologists call a "major depressive episode." Another form of depression, referred to as "dysthymic disorder," involves depressive symptoms that may be fewer in number or less severe but occur over a period of two years or more. Some individuals show a seasonal pattern of depression: for example, episodes of depression may occur in the winter seasons but improve in spring.

Additional symptoms that are often associated with depression include crying spells, irritability, obsessive thoughts, anxiety, social withdrawal, and low "self-esteem."

Depression and Academic Functioning
Depression can interfere with academic functioning in a number of ways. As one of the main symptoms of depression is decreased ability to concentrate, a person who is depressed will often have difficulty focusing on class lectures or on reading a textbook. A student who was previously able to read a text chapter in an hour may now spend 20 minutes on one page and remember very little of what they read. Depression also interferes with the ability to make decisions.

For example, it may become very difficult to decide on a topic for a writing assignment, or more difficult than usual to decide where to begin when there are several tasks to do. In short, depression can significantly interfere with academic functioning.

Additionally, a depressed person tends to distort perceptions of self, the world, and the future in negative ways. Thus, a person is likely to feel hopeless about doing well in a class, is likely to see his or her skills as lower than they actually are, and is likely to judge his or her work as being worse than it actually is. This hopelessness and tendency to see skills and work as worthless decrease motivation and add to discouragement.

Finally, fatigue or low energy can interfere with a depressed person's ability to complete homework, attend class, and think clearly on exams.

Causes of Depression
Several theories about the causes of depression have been proposed and researched. Factors which have been studied include:
• Stress (e.g., financial pressures, the build-up of daily "hassles," etc.),
• Loss (e.g., death of someone close to us, loss of identity as a top student in a high school, break-up of a relationship, etc.),
• Low rewards (e.g., few pleasurable events to look forward to),
• Anger turned inward (e.g., stuffing away angry feelings and hoping they will go away)
• Rigid or distorted thinking patterns (e.g., the belief that one must be perfect right now or that it is essential that one be loved by everyone),
• Genetic predisposition,
• Physical illness,
• Lack of sunlight during the winter months
• Other physiological causes

Combinations of these factors can make it more likely that a person will become depressed. Some individuals can identify an event that seemed to trigger their depression; other individuals cannot point to a cause of their depression. It is often difficult to distinguish whether severe depression is either "chemical" or "emotional," since depression involves both aspects of functioning: a severely depressed person is likely to feel sad, to experience problems in living, and to exhibit changes in physiological functioning.

Things To Do
People can get depressed even when they are "doing all the right things". There are many events that are outside of our control. People do not get depressed because they are "weak" or lazy. There is no set of behaviors that is guaranteed to prevent depression. On the other hand, some strategies help us be more resilient to depression. These include:
1. Live a balanced lifestyle. In particular, regular (but not excessive!) AEROBIC EXERCISE, a BALANCED DIET, and ADEQUATE SLEEP are critical to emotional health. These factors will do more to help you manage moods than nearly anything else you could do. For example:
• Go for a 20-minute brisk walk four times a week.
• Add one fresh fruit or vegetable to your daily diet.
• Cut out caffeinated soft drinks. (They stimulate the body's "alarm response" arousal state, similar to the effect of adding stress to your life.)
• Go to bed a half hour earlier.

2. In managing time, be sure to include time for relaxation and time for pleasure. Develop your own repertoire of small, medium and large sources of joy. Identify activities that you enjoy which take little time and money, and do them often!

3. Avoid social isolation. Studies have shown that people with good social support systems are less vulnerable to stress and depression. When an individual gets depressed it is very tempting to withdraw from others, and this in turn can make the depression worse. When people are depressed their "body language" often changes and actually discourages others from making contact with them! To avoid downward spirals, stay connected with healthy people and/or seek new friendships. This may involve having the courage to make eye contact with and say hello to other students in class, inviting a neighbor to join you on a walk, or inviting an acquaintance to go to a movie.

4. Find appropriate ways to express intense emotions such as sadness and anger. For example:
• Identify persons in your life with whom you can talk about your feelings. Avoid overburdening any single person by discussing concerns with more than one friend or family member.
• Learn how to assert yourself appropriately when you are angry. Assertion skills involve respecting both your rights and the rights of others. Anger can be a tool to alert you when something is threatening a good relationship, and learning how to be honest without being hostile can enhance a relationship as well as help prevent your depression!
• Consider writing about your feelings. Keep a journal. Write letters to people about whom you feel angry or sad; once you have expressed your feelings you can decide whether or not to send the letters. Some people prefer the medium of art: draw a picture of your feelings if it is easier than writing with words.
• Seek professional help if symptoms of depression become moderate to severe and/or interfere significantly with your ability to function.

Things to avoid
1) Don’t make long-term commitments or important decisions unless necessary.
2) Reduce your involvement in activities which are stressful or overwhelming.
3) Don’t assume that things are hopeless.
4) Don’t engage in "emotional reasoning" (e.g., "because I feel awful, my life is terrible")
5) Don’t assume responsibility for events which are outside of your control.
6) Don’t avoid treatment as a way of coping.

Helping a Depressed Friend
If someone you care about is struggling with depression, you can be a valuable resource. A depressed individual can be emotionally withdrawn, isolated, lethargic, self-critical and, sometimes, suicidal. If you talk candidly with the individual regarding your concerns for his or her well-being, it will often bring the problems out into the open. Emphasize that your primary objective is to convey feelings of concern and assist them in receiving appropriate, professional help. If the person expresses thoughts of suicide, but refuses to seek assistance, you should consult with a mental health professional.

Suggestions for intervening with a depressed friend
• Be empathic and understanding
• Don’t try to "cheer up" a depressed person
• Avoid critical or shaming statements (“You shouldn’t feel this way.”, “Just pray more and God will help you.”
• Challenge expressions of hopelessness
• Empathize with feelings of sadness, grief, anger and frustration
• Don’t argue about how bad things are
• Don’t insist that depression or sadness are the wrong feelings to be experiencing
• Don’t become angry even though your efforts may be resisted or rejected
• Advocate for their recovery from depression
• Emphasize that depression is treatable
• Seek consultation if a depressed friend refuses necessary treatment

Treatment for Depression
Some individuals may choose not to get treatment for depression; however, several interventions can be useful in helping a person recover from depression more quickly and with less impairment in functioning. Primary modes of treatment modes are: 1) individual or group counseling and 2) medication therapy. Individual and/or group counseling might include interventions such as discussion of patterns of thinking, exploring unresolved feelings such as grief or anger, increasing pleasurable activities and social support, developing strategies for managing stress, improving assertion skills, clarifying values, problem solving, etc. Most counselors, whatever techniques they employ, attempt to offer a client a safe, supportive, respectful environment in which to explore concerns and to develop coping strategies.

Particularly for clients with moderate to severe depression, antidepressant medication can be very helpful. Although taking medication is sometimes effective by itself in helping to alleviate symptoms of depression, many professionals believe that the combination of antidepressant medication AND counseling can be the best treatment for many depressed individuals.

Resources:

NNU Counseling Center:  For appointments dial 467-8466
http://www.nimh.nih.gov/publicat/depression.cfm