Wednesday, October 9, 2013

Recognizing Depression in Yourself and Those You Love

Theresa, 16, stared at the floor during the entire intake session.

"We don't know what is wrong with our daughter," Theresa's mom began. "She used to be a straight-A student, and now, she doesn't even seem to want to do her school work at all. All she wants to do is sleep. Or eat potato chips! Look at her--she's gained 10 pounds eating those chips. We just don't know what to do with her any more!"

Tears streamed down Theresa's face. If I could read her inner thoughts, I'm sure it went like this: "I'm a loser. I'm disgusting. I'm a disappointment. Maybe it would be better for my parents and everyone else if I just wasn't around any more."

Theresa is clearly depressed. Her parents think she has become "lazy," or "undisciplined" or even "rebellious." That's because they don't understand the symptoms of depression and/or they believe their daughter "should" be able to "pull herself together." The problem is that it's just not that simple. If Theresa could merely go back to being a straight-A student, she would. If she could just stop crying, she would do that too.

In fairness to Theresa's parents, it is difficult to watch a loved-one struggle with depression. It's not that depression is contagious, but when one person in the family is depressed, it affects the other members of the family. As evidence of that fact, Theresa's parents are frustrated and anxious that they can't help their daughter "snap out of it." They are becoming impatient with her and also have started snapping at each other. They also report that Theresa's sister seems more needy and complains, "All you ever do is cater to Theresa! What about me?"

Depresson, therefore, can become a family illness.

So, what is depression and how is it recognized? Depression feels like an overwhelmingly dark and deep pit of despair. It's symptoms include:

  • feelings of sadness or emptiness most of the day, nearly every day

  • markedly diminished interest in activities once found pleasurable

  • significant weight loss or weight gain

  • marked increase or decrease in need for sleep

  • feeling agitated or irritated

  • decreased energy or feeling slowed or weighed down

  • feelings of worthlessness, powerlessness, helplessness

  • a false sense of guilt

  • unexplained aches and pains

  • inability to concentrate or focus or make decisions

  • recurring thoughts of death or suicide

Theresa had many of these symptoms. She felt sad and cried many times a day. She had gained weight and was sleeping any time she got the chance. She was not spending time with friends. She felt guilty about her grades, but try as she might, she could not concentrate enough on her school work to complete an assignment. In addition, Theresa reported daily headaches and stomach aches. And, to her parents surprise and horror, Theresa also had been contemplating whether her life had value or should even continue.

Theresa was immediately referred to her family physician to begin taking antidepressant medication. She and her family were educated about the nature and course of depression and the role medication can play in recovery. Her parents were relieved to learn that depression often runs in families and is a brain chemistry condition, not the result of faulty parenting or a "weak character." Theresa was doing her best just to get up in the morning and go to school, but she was worn out from struggling with depression and needed both pharmacological and therapeutic help to get well.

After a few weeks on her medication and a handful of therapy sessions to offer support and teach some coping strategies, Theresa can now look me in the eye and talk about the stresses of her life. She is catching back up on her school work and is going for walks, instead of taking naps, every day after school. She is engaging with friends again and reports improved relationships with her parents and her sister. She still has work to do in therapy to understand and accept herself and to realize that depression is not her fault, but Theresa has stopped crying on a daily basis and is making plans for a summer job. Theresa is clearly feeling much better.

There is help for depression. But the illness must first be recognized and understood before the cure can be found. People do not just "snap out of" their depression. Depression is a real illness, with difficult symptoms, and is not the patient's fault. The good news is that help is available and people do get better with time and treatment.

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