Living with a chronic illness
isn't a bowl of cherries, it's very common for anyone with a chronic illness
such as Still's Disease to develop depression. The level of depression can
vary from person to person. Talk to your doctor if you are feeling
depressed or just not yourself. Your doctor can help you with any
treatments or counseling you may need.
The following article from
the AMA examines the aspects of depression.
Living with and treating the disorder
This guide is intended to help people who may have depression—and their
families and friends—understand the symptoms and causes of this sometimes
confusing disease. It explains the various therapies and medications that are
used to treat depression.
The guide also discusses what you can do to help a depressed person and how you
can find the professional help he or she needs. Early detection and treatment of
depression can limit the damage caused by this destructive disease and help a
depressed person enjoy life again.
Depression is a disabling disease that affects millions of Americans—men,
women, and children—regardless of race, income, or family background. It's one
of the most common, most dangerous, and most treatable of all diseases.
Left untreated, depression can destroy families, careers, lives, and, all too
often, can lead to suicide. But there is still reason for hope. With proper
diagnosis and treatment, most people can control their depression and prevent
its unpleasant symptoms from disrupting their daily lives.
Everyone has felt depressed from time to time. A death in the family, a failed
romance, a lost job, a serious illness, or other life crisis will cause most
people to feel sad, lonely, or down for a time. A period of grief or sadness is
a normal reaction to such stressful events. It's even normal to feel
"blah" sometimes for no particular reason. However, it also is normal
to recover after a short time and feel like yourself again.
When the blues don't go away—when sad, lonely, irritable, or weary feelings
prevent getting on with life—you, or someone you know, may have the mood
disorder called depression. A mood disorder is an extreme, persistent disruption
of a person's usual emotional state.
Depression is a "whole body" illness—one that affects a person's
physical health as well as how he or she feels, thinks, and behaves toward
others. A person who has depression may have problems sleeping, eating, working,
and getting along with friends.
Depression can cause many different kinds of unhappy feelings. A depressed
person may cry all the time, be very fearful, have panic attacks, argue with
friends and coworkers, lose self-confidence, even have hallucinations. On the
other hand, he or she might feel numb; not really sad, but not happy either.
People who are depressed will often try to self-medicate their bad feelings with
drugs or alcohol, which only makes matters worse. Alcohol is a depressant, the
last thing a depressed person needs.
Depression can come on suddenly, seemingly for no reason, or be triggered by a
stressful event. It can also grow slowly over months and years, gradually
draining away happiness and hope.
It is important for a person who is depressed—and his or her family, friends,
and coworkers—to understand that depression is a disease. A depressed person
has not caused these feelings and cannot simply decide to snap out of it and
stop being depressed.
Depression is a very common health problem, and it is frequently misunderstood.
People who have this illness often are embarrassed to admit they are depressed
and to seek help for what they may see as a character flaw or weakness. This may
be the reason two thirds of all people who are depressed never seek professional
Weakness has nothing to do with depression. Trying to ignore these feelings only
gives them time to grow. Depression is a physical disorder that causes chemical
changes inside the brain. These changes will not go away on their own. Recovery
from depression may require psychotherapy, medication, or a combination of these
or other treatments.
you—or a family member or friend—depressed?
Following is a brief description of various depressive disorders. If the
symptoms seem familiar, read on to learn what you can do. There are several
basic types of depression:
Of the estimated 17.5 million Americans who are affected by some form of
depression, about 9.2 million have major or clinical depression.
Listed below are typical symptoms of major depression. If
you have any of these symptoms, you should talk to your doctor. Some people who
have this disorder experience only a few symptoms, while others may have almost
all these feelings. If the symptoms of depression persist for at least 2 weeks,
a major depression is likely, and you should see your doctor. If you have
recurrent thoughts about suicide or death, talk to your doctor immediately.
|feeling sad or anxious
most of the day, every day|
|losing interest in
activities you once enjoyed, including sex|
|losing weight (when not
dieting) or gaining weight|
|sleeping too much or too
little or waking too early|
|feeling drained of energy
or physically slowed down|
|feeling tired or weak all
|feeling worthless, guilty,
|feeling irritable or
restless all the time|
concentrating, making decisions, or remembering things|
digestive disorders, or chronic pain that doesn't respond to medical
|having repeated thoughts
of suicide or death or actually making a suicide plan or attempt|
(false perceptions) or delusions (false beliefs)|
Some people react to a very stressful event—loss of a job, breakup of a
marriage, accident or major illness—with serious symptoms of depression that
pass within a few months and do not return. This condition, called an adjustment
disorder with depressed mood, may not require treatment. However, if the
symptoms do not pass, you may have a more serious disorder (such as major
depression) that requires treatment.
A milder, but more lasting form of depression, dysthymia can go untreated for
years, draining happiness and energy from the person's life and from the lives
of his or her family and friends.
Dysthymia is diagnosed when a person has a generally depressed mood for most of
the day, more days than not, for a period of at least 2 years (1 year in a
A person who has dysthymia is unable to find any fun in life. He or she may be
always pessimistic, guilt-ridden, irritable, easily hurt by others, or
withdrawn. Dysthymia can make it difficult for a person to get along with others
at home, at school, and at work.
Children who have dysthymia may often be irritable, cranky, difficult, generally
sad, and have low self-esteem.
People with treatable dysthymia rarely seek medical help. Always depressed, they
are usually unable to imagine feeling better. Friends, family members, and even
doctors may sometimes assume the person is just gloomy or grouchy by nature.
Treatment of dysthymia, which may involve psychotherapy, drug treatment, or a
combination of the two, can offer the person a whole new outlook on life.
Psychotherapy changes a person's attitudes and behavior through discussion and
interaction with a therapist.
Manic-depressive illness is also called bipolar disorder because of the way a
person who has this form of depression will swing between opposite extremes or
poles of emotion.
During a depressive phase, the person has symptoms of major depression (see list
During a manic phase, the person may feel very happy, agitated, irritable, or
energized. He or she may sleep very little, make all kinds of wild plans, or
Some of the difficult "high" symptoms in the manic phase of this
|inappropriate displays of
happiness or excitement|
|inability to sleep
(sometimes for days) or a decreased need for sleep|
|a high energy level|
|the need to talk
constantly, often loudly|
|wild, racing thoughts|
|being easily distracted|
|inflated ideas of
|sudden increase in sexual
|impaired judgment, such as
making wild plans or going on buying sprees|
embarrassing social behavior|
|taking dangerous risks|
Some people with bipolar mood
disorder will spend months in one phase or the other, while others will swing
back and forth between the two phases. How low the depression or high the manic
phase feelings go differs from person to person.
Manic depressive illness usually is treated with a mood-stabilizing drug such as
lithium or divalproex, which may be combined with antidepressant medication.
Although there is no medical test for depression, research has discovered a link
to an imbalance of chemical messengers (called neurotransmitters) that enable
brain cells to communicate with each other.
Heredity appears to play a role in the risk of depression. People who have a
strong family history of depression are more likely to become depressed.
However, many people who have a strong family history of depression are never
troubled by a mood disorder, even when under constant stress.
Personality type also plays a role in the development of depression. People who
are very pessimistic, have low self-esteem, and get easily stressed-out by their
problems also are more likely to become depressed.
Often, depression is triggered by a stressful event, such as the death of a
loved one, failure in school, or financial problems. It also may occur for no
apparent reason, when everything in life seems to be running smoothly.
Many people struggle with depression during the winter holiday season. People
with seasonal affective disorder become depressed because of the decrease in
sunlight during short winter days.
Biochemical changes in the brain, family history, personality, and the stresses
of life all are significant in the development of depression. Exactly how these
causes interact is not known. Depression may be more likely for some people than
for others, but no one is immune. Depression is an illness that can happen to
anyone at any time in life.
to get help
When you—or a family member or friend—have symptoms of depression:
|See your doctor. Your
family doctor or a doctor at a clinic can perform a thorough examination and
run laboratory tests to rule out other illnesses that may cause symptoms of
|Be open and honest about
your feelings. Depression can be difficult to diagnose because it affects
people in so many different ways. Talk about headaches, tiredness, eating
problems, whatever you are experiencing. Be sure to tell your doctor that
you think you are depressed.|
|Get a referral for ongoing
help. Your doctor may prescribe an antidepressant medication. He or she can
also direct you to a therapist experienced in treating depression.
Psychiatrists, psychologists, social workers, and other counselors all can
|A psychiatrist is best
equipped to treat depression. As a medical doctor with training in mental
and emotional disorders, a psychiatrist can perform a thorough physical and
mental evaluation, prescribe and carefully monitor the effects of
medication, and provide psychotherapy.|
|If you are unable to get a
referral to a psychiatrist, contact the nearest university-affiliated
hospital or a hospital with a psychiatric clinic. Medical staff there will
be able to direct you to help. There are several national depression
helplines listed at the end of this guide, or you can call your state
psychiatric society for a referral.|
|Make a change. If you—or
a family member or friend—have been in treatment for depression for more
than 3 months and feel no relief, you may need a different form of treatment
or a different counselor. Try to get a referral to a psychiatrist who
specializes in treating mood disorders.|
How is depression treated?
Today, depression can be successfully treated with a variety of antidepressant
medications, various forms of psychotherapy, or some combination of these or
other treatments. Your doctor will choose the best treatment plan for you or
your loved one.
Antidepressant drugs are the main medications used to treat depressive mood
disorders. There are four types of antidepressants that work in different ways
to correct a chemical imbalance in the brain.
Nine out of ten people who have depression can be helped by antidepressant
medication. However, which type of medication works best varies from person to
person. You may need to try several before your doctor finds the best drug for
It is important to understand that, though these drugs are powerful in the
treatment of depression, they are not addictive. Antidepressants do not provide
an unnatural high and are not intended to change your personality. When taken by
a healthy, nondepressed person, they have no noticeable effect.
Before taking an antidepressant, it is important to tell your doctor about any
other medication you may be taking and carefully follow his or her instructions
about diet, other drugs, and alcohol.
The following four categories of antidepressant drugs differ in their side
effects, with the newer drugs usually causing fewer problems. Side effects can
include dry mouth, drowsiness, constipation, headaches, nausea, nervousness, and
insomnia. If you have side effects that last for more than a few weeks, tell
your doctor. He or she may be able to adjust the dose or prescribe a different
Tricyclic antidepressants (TCAs) These drugs alter the balance in the brain of
the neurotransmitters (chemical messengers) norepinephrine and serotonin. Some
TCAs are imipramine hydrochloride, amitriptyline hydrochloride, desipramine
hydrochloride, and nortriptyline hydrochloride.
Monoamine oxidase inhibitors (MAOIs) These drugs slow the breakdown in the brain
of the neurotransmitters (chemical messengers) norepinephrine and serotonin,
letting them assist brain cells in sending messages for longer periods. When
taking MAOIs, you must follow a special diet to avoid problems; follow your
doctor's advice on which foods to avoid. A number of medications (including cold
pills) must also be avoided to prevent adverse interactions. MAOI drugs include
phenelzine sulfate and tranylcypromine sulfate.
Selective serotonin-reuptake inhibitors (SSRIs) These drugs work by enhancing
the neurotransmitter (chemical messenger) serotonin. By not interfering with
other chemical messengers, SSRIs treat depression without causing the serious
side effects often associated with TCAs and MAOIs.
SSRI drugs include fluoxetine hydrochloride, sertraline hydrochloride, and
New-generation antidepressants The chemical actions and side effects of several
newer antidepressants do not fit into any of the above categories. These
medications include bupropion hydrochloride, mirtazapine, nefazodone
hydrochloride, and venlafaxine hydrochloride.
Not an overnight cure As a rule, antidepressant medications must be taken for 4
to 6 weeks before they begin to cause substantial improvements in a depressed
person's mood. Finding the right antidepressant at exactly the right dosage is
likely to involve a period of trial and adjustment. The medication should
usually be continued for at least several months after recovery to prevent a
recurrence. This should also be discussed with your doctor.
Often when a combination of drugs and psychotherapy will be used, a doctor will
prescribe antidepressants and other necessary drugs immediately, easing the
depression to help make psychotherapy more successful once it begins.
Antidepressant medications have been used safely by children under a doctor's
close supervision, although they are usually not recommended for use by
children. Though few problems with immediate side effects of antidepressant
drugs have been reported, long-term effects of these drugs on children are not
yet known. Whether to give antidepressant medications to a child must be
carefully considered by the doctor and the child's parents.
Sometimes, an antianxiety medication or a mild tranquilizer may be prescribed
along with the antidepressant medication at first to help curb the troublesome
symptoms of depression. Occasionally lithium or other drugs may be taken with an
antidepressant to bring about or enhance a therapeutic effect.
At the start of treatment a person who has depression may be hospitalized for a
brief period. Hospitalization can be used to ensure that the depressed person
does not harm him- or herself or others. It also provides the doctor with an
opportunity to monitor drug levels closely and adjust medical therapy.
Electroconvulsive therapy (ECT)
In some cases where major depression deepens despite treatment with both drugs
and psychotherapy, ECT may be used. ECT sends a low-level electrical signal
through the brain to induce a 30- to 60-second general seizure. The result is
almost always quick relief (1 to 2 weeks) from depression. ECT is then followed
by treatment with antidepressant medication and psychotherapy.
Today's ECT is nothing like the crude shock treatments of the past. The
electrical currents used are much lower and patients are sedated and do not feel
pain during the procedure. However, temporary memory loss is a possible side
effect, so careful consideration should always be given before choosing ECT.
Some depressions, particularly those that are seasonal in nature, may respond to
treatment with specially designed bright light therapy.
Psychotherapy or talk therapy can be very effective in treating depression.
Psychotherapy may be used alone or in combination with drug treatment. During
psychotherapy, a psychiatrist, psychologist, or other trained counselor talks
with the depressed person about his or her feelings and experiences and helps
him or her to find ways to overcome the mood disorder.
Psychotherapy alone (without drug treatment) is most successful in treating mild
to moderate depression. Therapy sessions continue for about 3 to 6 months,
depending on the needs of the individual. The following types of psychotherapy
are used to treat depression:
Cognitive behavioral therapy In this form of talk therapy, the therapist helps a
person to recognize his or her own negative thought patterns and behaviors and
to replace them with positive ones. The depressed person shares his or her
thoughts and problems with the therapist. This form of treatment can be used to
quickly bring important changes to the depressed person's daily life and outlook
for the future.
Interpersonal therapy This form of therapy focuses on the problems a person has
in his or her personal and social relationships. The therapist helps the
depressed person review how he or she interacts with other people, then works on
how to change that behavior to improve relationships. By learning to deal more
effectively with other people, the person with depression can stop creating
conflict in his or her life and gain support from family and friends.
Psychodynamic therapy In this form of treatment, the therapist helps a depressed
person look inside him- or herself to uncover and understand emotional conflicts
that may be causing his or her depression. This may be long-term therapy that
involves looking back at unresolved problems from childhood and attempting to
work them out.
it isn't depression
Many symptoms of depression can be caused by other conditions that require
attention and treatment. A long list of medical conditions such as multiple
sclerosis, stroke, hypothyroidism, heart disease, and cancer can produce
symptoms of depression. When depression occurs along with another medical
problem, both conditions must be treated. Also, reactions to some medications,
exposure to a toxin (poison), or drug or alcohol abuse can resemble depression.
A complete medical examination, including a health history, laboratory tests,
and a psychological evaluation, can help determine what type of help the person
needs. However, depression is more difficult to diagnose when another health
problem is present. If you think depression may be a part of your problem, be
sure to tell your doctor.
yourself—or a friend
Once a person gets treatment, there are plenty of things you can do to help
speed recovery from depression and help keep depression from returning. Look
over the list below, then check with local hospitals, clinics, the YMCA, and
other community organizations for help.
|Reduce stress. Look at
your life honestly. Be realistic about what you can handle. Cut back. Give
yourself a break here and there.|
|Learn stress management
techniques. Stress is everywhere and you can't avoid it all. Learning how to
live with necessary stress can make the difference between depression and
|Set realistic, reachable
goals. Celebrate small victories along the way to a big success.|
|Exercise. Join a class,
ride a bike, take a walk, go dancing, go outside, and get into a healthy new
|Get nutritional counseling
and learn to enjoy healthy eating. Depression has a way of destroying good
eating habits and damaging good health.|
|Socialize. Push yourself
to go out more often. See friends, see a movie, eat out.|
To help a friend:
|Offer your friend
reassurance. A depressed person needs to hear that there is hope, that
things will get better with time and effort.|
|Encourage your friend to
get professional help.|
|Listen and talk openly
about the depression. Let your friend tell you how he or she feels. Accept
his or her feelings and be willing to talk about them.|
|Compliment and encourage
your friend. If you have good things to say, this is the time to say them.|
|Don't criticize or judge
your friend. A depressed person already feels very bad about him- or
herself. Don't add to those feelings.|
|Smile, hold hands, hug a
lot. Affection can go right to the heart and give real comfort.|
|Don't be easily pushed
away. Depressed people may lash out at the people around them. Stick by your
friend, no matter what happens.|
|Encourage your friend to
go out. Take him or her to a restaurant or a movie. Even going for walks
together is a step in the right direction.|
Depression can occur at any time in life. Statistics tell us that:
|About 17.5 million
Americans currently have some form of depression.|
|About 35 million Americans
living now will have moderate to severe depression at some time in their
|About 10 percent of all
American adults are diagnosed with depression each year.|
|About 10 percent of all
children under 13 and about 5 to 10 percent of all adolescents are
|Women are more than twice
as likely as men to seek help and receive a diagnosis of clinical
|The first episode of
depression often occurs early in life, typically during adolescence or young
|It is estimated that
untreated depression costs American employers as much as $43 billion per
year through sick days, lost productivity, employee turnover, and medical
The traditional view in our society is that women are far more likely to be
depressed and are more likely to seek help for depression. In 1970, statistics
showed that women in the United States were three times as likely as men to be
diagnosed with clinical depression. However, in the 1980s, the difference
dropped to 2.4 women to every man receiving medical treatment for depression.
More recent statistics on treatment for depression show women leading men by a
ratio of 1.7 to 1.
Is depression more common among women? As children, boys and girls appear
equally susceptible to depression. However, once children become sexually mature
adults, women take the lead. This suggests that hormonal changes or gender roles
may play a part in triggering depression.
In our society, it has always been acceptable for women to express their
feelings, while men were expected to keep their feelings inside. Under these
conditions, women were more likely to acknowledge the problem and seek help for
depression; men would tend to deny the problem or refuse to get help.
Symptoms of depression in men may not always be obvious. In our culture,
depression in men is sometimes expressed in terms of silent withdrawal, alcohol
and drug abuse, even violence.
Why are the numbers of men increasing? Depression is an illness that is
affecting more people than ever before in general, and more men than ever before
in particular. Changing gender roles, job layoffs and downsizing, and the aging
of baby boomers add up to more people who are more susceptible to depression. At
the same time, the changing roles of men and women in society may be making it
easier for men to seek help for depression rather than keeping their feelings
is a nervous breakdown?
Most of us have heard of a person having a nervous breakdown. What does this
mean? "Nervous breakdown" is a popular term sometimes used to describe
what has happened to a person who has a major depression (see list
of symptoms) or a manic episode. When a depression is
severe enough to prevent the person from functioning normally in daily life, or
when the symptoms of depression are severe and appear suddenly, it may seem as
if the person has "broken down." Hallucinations (false perceptions)
and delusions (false beliefs) can occur in episodes of major depression and
With appropriate diagnosis and treatment of depression, the person can get well
and start enjoying life again.
How long does
A depression can last days, weeks, months, or a lifetime. Some people have a
brief depression, recover, and the problem never returns. Others have bouts of
major depression throughout their lives. And some people never recover from a
Depression is usually a recurring disease. After one episode of depression, a
person has a 50 percent likelihood of having another within 5 years. After three
episodes, the odds go up to 90 percent that depression will return again.
The sooner depression is diagnosed and treated, the better. Left untreated, a
mild episode of depression can progress into a major depression; a few
bothersome symptoms can grow into a disabling condition. A person can overcome
an episode of depression without any help, but it generally takes much
longer—up to 1 1/2 years—and the risk of a return episode is greater.
dangerous is depression?
Depression is a whole body disorder that can cause "whole life"
problems. The disabling moods of depression can damage a person's marriage,
family relationships and friendships, job performance, and health. The longer a
depression is allowed to continue, the more the damage is spread.
A major depression can cause a person to shut him or herself off from the love
and support of friends and family or strike out violently, verbally and
physically attacking others.
Most threatening is the connection between depression and suicide. It is
estimated that 15 percent of all people who have a major depression will take
their own lives. Prompt treatment and continuing support for a person with
depression can mean the difference between life and death.
After a person commits suicide, family and friends may realize that there were
warning signs they missed. Learn to look for these warning signs and get help
right away if you suspect someone you know is considering suicide. Watch for:
|Talk about suicide or
death. About 80 percent of people who kill themselves talk about suicide
before taking action.|
|Writings or drawings about
suicide. This clue is often presented by children and adolescents.|
|A failed suicide attempt.
Many people who take their own lives do so after one or more failed
attempts. Any suicide attempt is a call for help.|
|Puzzling comments. Sayings
such as "Things will be different soon," "You won't have to
worry about me much longer," or "All this will be over soon"
may refer to planning suicide.|
behavior. Taking big chances and casually risking injury may reveal a wish
|Drug or alcohol abuse.
Alcohol consumption is involved in up to 50 percent of all suicides.|
|Putting things in order
and tying up loose ends. An adult may get all his or her business affairs in
order, revise a will, check the insurance, pay bills off. A child may catch
up on all of his or her schoolwork.|
|Giving away treasured
objects. A person planning suicide may give away favorite possessions. Both
adults and children do this.|
|Saying good-bye. A person
planning suicide may contact relatives or old friends one more time before
|Making a plan and getting
the tools ready. A person contemplating suicide may plan ahead. For example,
he or she may buy a gun or hoard prescription drugs.|
|A sudden good mood—even
happiness. A very depressed person, once having decided on a plan to commit
suicide, may feel relief.|
Suicide is most likely to occur when it seems that the threat has passed. Many
people who have been struggling through a major depression will kill themselves
when things seem to be getting better, 2 or 3 months into recovery. For some
very depressed people, this may be the first time they have had enough emotional
energy to act. Others may be overwhelmed by the problems depression has caused.
prevention: what to do
|Keep guns and any lethal
amounts of drugs in an inaccessible location—preferably a locked cabinet.|
|Watch for warning signs.|
|Never ignore talk about
suicide, no matter how unlikely it seems.|
|Get medical help
immediately. Call 911. Call your doctor or psychiatrist.|
|If you think the person
may harm him- or herself, stay close by until help arrives. Don't leave the
|Go to the nearest hospital
emergency department as soon as possible. Don't wait until the person
attempts suicide. Major depression is a dangerous disease and medical
personnel are trained to deal with it.|
is at risk for depression?
Everyone is at risk. There are stressful events in every part of life that can
lead to depression. For example:
|A neglected infant can
become listless and refuse to eat.|
|A new mother may have
postpartum blues that last indefinitely.|
|Working women and men deal
daily with family- and job-related stresses that can trigger depression.|
|People who are seriously
ill often find their health problems compounded by depression.|
|It is reassuring to know
that most people, especially when they have the love and support of family
and friends, are able to handle stress, recover in a short time, and enjoy
particularly at risk
Three specific groups that appear to have particular difficulty battling
depression are children, adolescents, and older people.
Though depression generally first appears in the teen years or during adulthood,
no one is too young to be depressed.
A newborn whose mother is inattentive may become depressed and stop eating or
developing normally (this is called "failure to thrive"). Depressed
children as young as 5 years old have committed suicide.
Because we often think of childhood as a happy, carefree time of life, some of
us may mistakenly consider children to be immune to depression. As many as 10
percent of children under age 13 may be depressed. Research has shown that the
younger a child is when he or she has a first depression, the more likely that
child is to have recurrent episodes of depression throughout life.
Even a mild depression can cause a child to have low self-esteem and make
childhood's business of making friends and learning to get along with others
very difficult. The sooner a depression is discovered and treated, the sooner a
child can get back to "feeling like a kid" again.
Children are naturally joyful beings. A child may not understand his or her own
feelings of depression or know the words to express those feelings. Often,
depressed children just say they are sad or they may complain of headaches or
stomachaches. A child may have depression when he or she:
|looks sad most of the time
and never smiles or laughs|
|frequently reports feeling
sad, bored, or sick|
|is negative and
|isn't cheered by happy
events or fun activities|
"heavy" legs or reports having no energy|
|has trouble in school or
|is unusually irritable|
|has sleep problems or
|talks about death or about
hurting him or herself|
If such symptoms continue for
2 weeks or more, take your child to see his or her doctor and ask for a referral
to a child psychiatrist. Your doctor will rule out any medical conditions or the
possibility of abuse, which can also cause depression, then help determine the
best course of treatment.
Psychotherapy designed to help a child learn positive thinking habits at an
early age can head off years of unhappiness. Children who can think positively
can lighten a current depression and possibly prevent future episodes.
Psychotherapy may include family counseling or therapy.
A simple, gentle backrub performed by a parent for 30 minutes a day also can
help depressed children to feel happier and less anxious, and enable them to
sleep better. Research shows that such a massage, and the parent-child closeness
it promotes, can improve the balance of chemicals (neurotransmitters) in the
brain. Hugs help, too.
Antidepressants are also sometimes used to treat depression in children. Drugs
used successfully to treat adults often work differently on children's still
developing minds and bodies. Although these drugs can sometimes speed recovery
from depression, their use in treating children is still under investigation and
should be carefully considered.
The teenage years are tough times. The trip from childhood to adulthood is
filled with emotional ups and downs, new challenges, and new concerns. As
teenagers begin to mature, it is normal for them to be moody and to have
feelings of frustration, anger, and sadness.
Depression in teenagers, however, is not normal—but it is all too common. It
is estimated that 5 to 10 percent of all teenagers have depression or
With professional help, teenagers can overcome depression and prevent its
recurrence. But less than half of all adolescents with depression will get
Depression in teenagers is always a cause for concern. Suicide is the third
leading cause of death among teenagers, after accidents and homicide. And if you
consider the role depression plays in many accidental deaths involving alcohol
or driving, the number of depression-related deaths rises even higher.
Even when there is no threat of suicide, depression can cause eating disorders
and self-destructive habits that can lead to serious lifelong health problems.
Also, studies show that as many as 55 percent of depressed teens turn to alcohol
or drugs in an attempt to self-medicate, making matters worse.
Teenagers who have depression may simply say they're sad. While they feel all
the frustration, isolation, and other symptoms that depressed adults describe,
they may not fully understand their feelings or know how to describe them.
Teenagers may not talk about their depression, but it will show in their
expressions, body language, and behavior.
Teenagers are famous for bad attitudes. A teenager will rebel, sulk, stomp
around the house, or slam the door to his or her room. How can you tell the
difference between normal teenage behavior and real depression?
Adolescents are moody, but when a teenager is sad—or irritable, anxious,
negative, or uncooperative—for more than 2 weeks, a parent should talk to the
child about his or her feelings and seek professional help.
Review the general list of symptoms of depression. Consider
also these warning signs of depression in a teenager:
|looks different and worse
than usual—with dirty hair, dirty clothes, or an exceptionally messy room|
|does badly in
school—gets lower grades or cuts classes|
|drops out of favorite
activities such as music or sports or stops getting together with friends|
|becomes angry, irritable,
aggressive, or uncooperative without cause|
|seems to sleep all the
time or almost never|
|begins using drugs or
|is involved in dangerous
or risky behavior|
|feels guilty for no real
|has trouble thinking or
|withdraws from friends and
|complains of constant
headaches or stomachaches|
|talks about death or about
hurting him- or herself|
If you suspect your teen is
depressed, get help right away. Your attention to the problem can help a mildly
depressed teen make a quick and complete recovery. For a seriously depressed
adolescent, prompt action can mean the difference between life and death.
How to help a depressed child or teenager
|Be there. A child who is
depressed needs you to be available both physically and emotionally. He or
she may try to push you away, so gently but firmly insist on helping.|
|Listen. Nothing you can
say will matter as much as what you let your child say. Encourage your child
to talk about his or her feelings. Then really listen. Loving parents may be
tempted to interrupt gloomy or frightening statements with, "Don't be
silly, you're the greatest kid in the world," or "You have
everything going for you," or "Don't say such terrible
things." Don't do it. It is very hard to hear your child say
self-destructive things, but you need to know what he or she is thinking if
you want to be able to help. Sad and frightening feelings have to be
expressed or your child will feel more isolated. He or she will become
harder to reach and help.|
|Don't criticize or try to
fix things. This is a learning opportunity for the parent, not the child.
Don't lecture and don't expect to "make it all better" right away.|
|Reassure. A depressed teen
thinks the bad feelings will last forever. Help your child understand that
he or she will feel better. Show that you understand his or her feelings.
Make it clear that this bad time is temporary and that you will get the help
he or she needs.|
|Get help. Don't hesitate.
Call your pediatrician, family doctor, or a hospital with a psychiatric
clinic right away. Your doctor can rule out physical problems that may be
causing the symptoms of depression and can refer you to a psychiatrist or
other counselor skilled in working with teenagers.|
|Stay involved. Make sure
your child is getting the help that he or she really needs. You may have to
change counselors, or medications may need to be adjusted. Recovery may take
weeks or months, and depression can recur. Learn all you can about
depression so you can help make the best choices for your child and provide
support at home (see Suicide prevention: what to do).|
|Guard against suicide.
Take every self-destructive comment or action seriously. The terrible truth
is that about 15 percent of all depressed teenagers commit suicide. Watch
for warning signs (see Suicide warning signs) and get
threat is real
Depressed teenagers are in real danger of choosing a permanent
solution—death—to the temporary problems they are facing. Increasing the
risk is the inability of most teenagers to understand fully that death is final.
No threat of suicide by a child or adolescent, no matter how wild or crazy
sounding, should ever be ignored. Even a terribly painful death may look like
relief to a child or adolescent who is dealing with the pain of a deep
Whenever a child or teenager is depressed, friends and family must be aware of
the danger of suicide. Don't be afraid to talk frankly about your child's
intentions. And don't hesitate to get help.
Many older people experience loss, illness, and loneliness. And depression can
sometimes make this time of life much more difficult.
Often a depression that could easily be treated and relieved is mistaken for a
natural part of aging, both by the older person and by family and friends. In
most cases, medical treatment can help a depressed older person return to
Symptoms of depression in older people may sometimes be mistaken for symptoms of
senile dementia (Alzheimer disease). When an older person seems disoriented or
distracted or has memory loss (all symptoms of senile dementia), he or she may
actually be depressed.
Many health problems related to aging can cause symptoms of depression. And
medications for high blood pressure, Parkinson's disease, and other medical
problems common to older people can also produce symptoms similar to those
caused by depression.
The rates of suicide from depression rise substantially with advancing years.
The highest suicide rates are for single or widowed white males over age 55.
How to help an older person who is depressed
|Take him or her to a
doctor for a thorough medical evaluation.|
|Check the medicine cabinet
and make sure his or her doctor knows about all of the
medications—prescription and over-the-counter—the person uses.|
|Be sure depression is
discussed and fully considered by the doctor.|
|Take him or her to therapy
|Remind him or her to take
any medication as prescribed.|
|Be an available friend. Be
a person who calls, visits, and keeps in touch.|
|Get physical. Few older
people get enough physical affection. Hug often.|
|Take him or her out. It
won't always be easy to get him or her to go, but don't give up.|
|Get him or her back into
life. Help find activities, interests, or groups to brighten each day. For
senior citizen activities, check churches, synagogues, or community centers.|
|Know suicide warning signs
and watch for them. Don't be afraid to say something or take action.|
out for support
Depression can make you feel lonely, but you are not alone. There are many
people around you who know how it feels to be depressed and who can help you.
For assistance finding medical help or support groups in your area, contact:
The National Foundation for Depressive Illness (NAFDI)
PO Box 2257
New York, NY 10016
NAFDI's hotline has a
recorded message about depressive illnesses and helps callers receive a referral
list of local support groups and doctors who specialize in treating depression.
It also can provide a list of useful magazine and newspaper articles and books
The Depressive and Related Affective Disorders Association (DRADA)
600 N Wolfe St
Baltimore, MD 21287-7381
DRADA works in cooperation
with The Johns Hopkins University School of Medicine. Like centers at many large
teaching hospitals, DRADA provides a variety of outreach programs, classes, and
support groups for people who have depression and their families in their area.
DRADA also reaches out to people across the country to help them find help
locally. Write DRADA, Meyer 3-181, 600 N Wolfe St, Baltimore, MD 21287-7381.
The National Depressive and Manic-Depressive Association (NDMDA)
730 N Franklin, Suite 501
Chicago, IL 60610
This association is a source
of information about mood disorders.
The National Mental Health
1021 Prince St
Alexandria, VA 22314-2971
The National Institute of
Mental Health (NIMH) Depression Awareness, Recognition, and Treatment Program
5600 Fishers Lane
Room 7C-02, MSC 8030
Bethesda, MD 20892-8030
The National Alliance for the
200 North Glebe Road, Suite 1015
Arlington, VA 22203-3754
|Don't fight the
depression--try and accept it as an illness.|
|You cannot will the
depression away, only accept it.|
|Delay any big decisions
about work, marriage or money until you feel better.|
|Don't trust your memory
right now--take notes and make lists. This will improve when you feel
|Waking through the night
is very common. It's better to get out of bed until you feel sleepy again.|
|Mornings are usually
terrible. The day usually gets better towards evening.|
|Avoid being home alone for
long periods--the depressive thoughts can get worse when no one is around.|
|Forget about trying to
read technical or complicated material--you need your concentration to do
this--stick to light novels and People magazine.|
|Be careful about
television--comedy and cartoons are okay, but anything else can depress you
even more than you already are.|
|Get outside at least once
a day for a walk by yourself.|
|Light exercise of any kind
can be very helpful to your recovery.|
|if you have to do some
work, do it in the afternoon or early evening. Your energy and interest are
best at these times.|
|Try and keep busy, but
only with projects that involve your hands, not heavy thinking tasks.|
|Talking to loved ones or
friends will be difficult for a while. Sympathetic people can actually make
you feel worse. Until you feel better, cancel all non-essential social
|Suicidal or hopeless
thoughts are common in depression and will go away once you start feeling
better. Talking to someone about these thoughts can help make them go away.|
|Your appetite for food is
probably low and you may have lost weight. These are core symptoms of
depression and will return to normal with treatment. In the meantime, eat
small nutritious snacks and have other people cook for you.|
|When you start to get
better, you will notice a few minutes or more of feeling quite normal, but
it doesn't last. These minutes become hours and then most of the day is
pretty good. Full recovery takes longer, sometimes a couple of months.|
|Don't be surprised if most
people are confused by your condition and don't know what to say to you. No
one can really understand your suffering unless they have had a major
depression or have treated many depressed people--like your doctor.|
|Once again, don't fight
the depression--try and accept it as an illness. Your will be back to normal
Most families worry about a
member who is depressed. Some people feel angry and overwhelmed. It is difficult
to understand why a depressed person is not "snapping out of it". The
first thing to keep in mind is the depressed person cannot help feeling
depressed. Sudden crying spells, angry outbursts, and hopeless statements like,
"what's the point?" are common. This behaviour will disappear with
treatment. You can help by distracting the depressed person by keeping them busy
with tasks they can accomplish easily. Be patient and reassuring; help with
decision-making and make sure the person gets to appointments with the doctor
and takes the medication. Short conversations are better than long talks. As the
person recovers, encourage them to be more active and resume their previous
responsibilities. Suicide can be a worry. Asking about thoughts of suicide is
not going to encourage a suicide attempt.
Talking about suicidal
thoughts is often a great relief to the depressed person. However, anyone
seriously thinking about taking their life is in need of urgent professional
help to prevent a tragedy. Families should inform the doctor of any concerns
Feeling Good: The New Mood
Therapy - D. Burns, Signet, New York, 1980.
A persuasive self-help guide for treating depression by a cognitive therapist.
Includes charts, homework assignments to offer mechanisms for coping with
problems such as procrastination, loneliness and negative thinking. Gives clear
indicators for need of professional treatment. Highly recommended.
Overcoming Depression - D.F.
Papolos, Harper and Row, New York, 1987.
Excellent, practical overview of the symptoms and cause of depressive disorders
with much useful advice for the patients and families. Highly recommended.
Your Brother's Keeper - J.R.
Morrison, Nelson Hall Publications, Chicago, 1982.
Also difficult to find in bookstores, but available in libraries. Good practical
advice for families in regard to the treatment of mood disorders.
Rapid Relief From Emotional
Distress - G. Emery, Fawcett Columbine, 1986.
Practical, cognitive techniques to master mild depression.
Unfinished Business: Pressure
Points in the Lives of Women - M. Scarf, Doubleday and Company, New York. 1980.
A very useful description of psychological problems that can cause depression in
women. Useful as a resource in the psychotherapy of depression.
Reprinted with permission.
Internet Mental Health
copyright © 1995-1997 by Phillip W. Long, M.D.
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