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.
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 fact, 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.
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.
Many people experience thoughts of suicide at some point in their lives. If you’re having suicidal thoughts, know that you’re not alone. You should also know that feeling suicidal isn’t a character flaw, and it doesn’t mean you’re crazy or weak. It only signifies that you’re experiencing more pain or sadness than you can cope with right now.
In the moment, it may seem as though your unhappiness will never end. But it’s important to realize that with help, you can overcome suicidal feelings.
Remember that problems are temporary, but suicide is permanent. Taking your own life is never the right solution to any challenge you may be facing. Give yourself time for the circumstances to change and for the pain to subside. In the meantime, you should take the following steps when you’re having suicidal thoughts:
Eliminate access to lethal methods of suicide
Get rid of any firearms, knives, or dangerous medications if you worry that you might act on suicidal thoughts.
Take medications as directed
Some anti-depressant medications can increase the risk of having suicidal thoughts, especially when you first start taking them. You should never stop taking your medications or change your dosage unless your doctor tells you to do so. Your suicidal feelings may become worse if you suddenly stop taking your medications. You may also experience withdrawal symptoms. If you’re experiencing negative side effects from the medication you’re currently taking, speak with your doctor about other options.
Avoid drugs and alcohol
It may be tempting to turn to illegal drugs or alcohol during challenging times. However, doing so can make suicidal thoughts worse. It’s critical to avoid these substances when you’re feeling hopeless or thinking about suicide.
No matter how bad your situation may seem, know that there are ways of dealing with the issues you face. Many people have experienced suicidal thoughts and survived, only to be very thankful later. There is a good chance that you’re going to live through your suicidal feelings, no matter how much pain you may be experiencing right now. Give yourself the time you need and don’t try to go it alone.
Talk to someone
You should never try to manage suicidal feelings on your own. Professional help and support from loved ones can make it easier to overcome any challenges that are causing suicidal thoughts. There are also numerous organizations and support groups that can help you cope with suicidal feelings. They may even help you recognize that suicide isn’t the right way to deal with stressful life events.
Pay attention to warning signs
Work with your doctor or therapist to learn about the possible triggers for your suicidal thoughts. This will help you recognize the signs of danger early and decide what steps to take ahead of time. It’s also helpful to tell family members and friends about the warning signs so they know when you may need help.
The Risk of Suicide
According to Suicide Awareness Voices of Education, suicide is one of the leading causes of death in the United States. It takes the lives of approximately 38,000 Americans each year.
There’s no single reason why someone may try to take their own life. However, certain factors can increase the risk. Someone may be more likely to attempt suicide if they have a mental health disorder. In fact, over 45 percent of people who die by suicide have a mental illness at the time of their death. Depression is the top risk factor, but many other mental health disorders can contribute to suicide, including bipolar disorder and schizophrenia.
Aside from mental illnesses, several risk factors may contribute to thoughts of suicide. These risk factors include:
- substance abuse
- family history of suicide
- poor job security or low levels of job satisfaction
- history of being abused or witnessing continuous abuse
- being diagnosed with a serious medical condition, such as cancer or HIV
- being socially isolated or a victim of bullying
- being exposed to suicidal behavior
People at a higher risk for suicide are:
- people over age 45
- Caucasians, American Indians, or Alaskan Natives
Men are more likely to attempt suicide than women, but women are more prone to having suicidal thoughts. In addition, older men and women are more likely to attempt suicide than young men and women.
Possible Causes of Suicide
Researchers don’t know exactly why some people develop suicidal thoughts. They suspect that genetics may offer some clues. A higher incidence of suicidal thoughts has been found among people with a family history of suicide. But studies haven’t yet confirmed a genetic link.
Aside from genetics, life challenges can cause some people to have suicidal thoughts. Going through a divorce, losing a loved one, or having financial troubles may instigate a depressive episode. This can lead people to begin contemplating a “way out” from the negative thoughts and feelings.
Another common trigger for suicidal thoughts is the feeling of being isolated or not being accepted by others. Feelings of isolation can be caused by sexual orientation, religious beliefs, and gender identity. These feelings often become worse when there’s a lack of help or social support.
The Effect of Suicide on Loved Ones
Suicide takes a toll on everyone in the victim’s life, with aftershocks being felt for many years. Guilt and anger are common emotions, as loved ones often wonder what they might have done to help. These feelings may plague them for the rest of their lives.
Even though you may feel alone right now, know that there are many people who can support you during this challenging time. Whether it’s a close friend, family member, or doctor, talk to someone you trust. This person should be willing to listen to you with compassion and acceptance.
Getting Help for Suicidal Thoughts
When you meet with a doctor about your condition, you’ll find a compassionate person whose primary interest is helping you. Your doctor will ask you about your medical history, family history, and personal history. They’ll also ask you about your suicidal thoughts and how often you experience them. Your responses can help them determine possible causes for your suicidal feelings.
Your doctor may run certain tests if they suspect that a mental illness or medical condition is causing your suicidal thoughts. The test results can help them pinpoint the exact cause and determine the best course of treatment.
If your suicidal feelings can’t be explained by a health problem, your doctor may refer you to a therapist for counseling. Meeting with a therapist on a regular basis allows you to openly express your feelings and discuss any problems you may be having. Unlike friends and family, your therapist is an objective professional who can teach you effective strategies for coping with suicidal thoughts. There’s also a certain degree of safety when you speak to a mental health counselor. Since you don’t know them, you can be honest about your feelings without fears of upsetting anyone.
While occasional thoughts of escaping life are part of being human, serious suicidal thoughts need treatment. If you’re currently thinking about suicide, get help immediately.
If you think someone is at immediate risk of self-harm or hurting another person:
• Stay with the person until help arrives.
• Remove any guns, knives, medications, or other things that may cause harm.
• Listen, but don’t judge, argue, threaten, or yell.
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.
If you’re having suicidal thoughts, it’s important to first promise yourself that you won’t do anything until you seek help. Many people have experienced suicidal thoughts and survived, only to be very thankful later.
Make sure to talk to someone if you’re having trouble coping with suicidal thoughts on your own. By seeking help, you can start to realize that you aren’t alone and that you can get through this difficult time.
It’s also important to speak with your doctor if you suspect depression or another mental illness is contributing to your suicidal feelings. Your doctor can prescribe treatment and refer you to a licensed counselor who can help you work through the challenges of your condition. Through therapy and medication, many formerly suicidal women and men have been able to get past suicidal thoughts and live full, happy lives.
Active Minds: Mental health education and stigma reduction through college student–run chapters
American Foundation for Suicide Prevention: Raises awareness, funds research, and provides resources and aid to those affected by suicide
Half of Us: Raises awareness about mental health for college students, sponsored by mtvU and the Jed Foundation
HelpGuide.org: Trusted guide to mental, emotional, and social health
Jed Foundation: Mental health education and support for college students
National Alliance on Mental Illness (NAMI): Advocacy and support for people with mental illness and loved ones
National Institute of Mental Health (NIMH): Part of the National Institutes of Health (NIH), a component of the U.S. Department of Health and Human Services
Steve Fund: Education and advocacy to mental health in college students of color