Depression For Dummies

Introduction

Decadent luxuries, dazzling technology, and startling new knowledge flood the senses and excite the imagination. What was the domain of science fiction less than a generation ago is now commonplace in many living rooms. Today, cable companies beam recently released movies to inches-thick televisions that hang on walls. All you have to do is press a few buttons on your remote control and your home is a cinema. And, with a couple of words to your virtual assistant, you can order a pizza that arrives in time for the start of the movie.

In the field of healthcare, advancing knowledge of the immune system promises new cancer treatments that go to the source of the disease. Nanotechnology eventually will allow inconceivably small machines to clean out congested arteries like a plumber’s snake. And the human genome project begins to solve the mysteries behind countless inherited diseases. Sure, the world still has plenty of problems, but solutions for many of them lie on the horizon.

Yet the World Health Organization paints a less optimistic picture. It estimates that on any given day, 264 million people worldwide suffer from depression. Over the course of a year, about 10 percent of the world’s population suffer from an episode of depression. Depression rates continue to increase. And most experts believe that the increase is real — not just a result of more people seeking help.

Theories abound concerning the alarming increase in depression today. But regardless of the cause, this scourge robs its victims of happiness, joy, and the capacity to give and receive love.

The good news is that more weapons exist for defeating depression than ever before. Clinicians have devised new psychotherapies that have been verified as effective in treating depression and preventing relapse. Medications, methods of stimulating key nerve centers, and other psychotherapies continue to be refined and developed. The majority of people no longer need to suffer with long-standing, intractable depression.

About This Book

We have two primary goals in writing this book. First, we want you to understand the nature of depression. Understanding depression makes the idea of dealing with it less frightening. Second, we present what you’re probably most interested in discovering — how to overcome your depression or help someone you love who has depression.

We leave no stone unturned in our quest to bring you every possible means for battling depression. We draw strategies for defeating depression from the fields of medicine and psychotherapy. We tell you about the arsenal of medications and other strategies that can combat depression. We show you how focusing on your overall health with exercise and nutrition can pay off. Plus, we extract elements from the psychotherapeutic approaches that have stood up to the tests of rigorous research and been verified as highly effective treatments for depression. These approaches include

Cognitive therapy

Acceptance and commitment therapy (ACT)

Behavior therapy

Interpersonal and relationship therapy

Then we go one step further. We turn to the field of positive psychology for ideas on navigating your way from feeling good again to feeling even better. We want you to make your life more joyful and more meaningful.

Depression For Dummies offers you the best advice available based on scientific research. We believe that, if you practice the techniques and strategies we provide in this book, you’ll very likely feel better. For some people, this book may be a complete guide for defeating mild depression. Numerous studies show that self-help often works.

However, depression frequently needs more care and attention than you can receive through self-help. If your depression significantly hinders your ability to work or play, you need to get professional help. No book can completely replace therapy. Start by seeing your family doctor. If you’re seeing a therapist or counselor, you may find that Depression For Dummies can help augment your therapy. Be sure to discuss that possibility with your therapist. Depression can be conquered, so please don’t give up.

Foolish Assumptions

Who would want to read this book? We assume, perhaps foolishly, that you or someone you love suffers from depression. We also figure that you want to banish depression from your life. Finally, we imagine that you’re curious about a variety of helpful strategies that can fit your lifestyle and personality. If these descriptions strike a chord, this book is for you.

On the other hand, you may be a professional who is looking for a good, easy-to-understand resource for your patients who suffer from depression. Readers over the years have told us that our For Dummies books on mental health issues have been helpful in both their recovery and their understanding of what they’re dealing with in therapy.

Icons Used in This Book

Throughout this book, we use icons in the margins to quickly point out different types of information. Here are the icons you’ll see and a few words about what they mean.

Remember As the name of this icon implies, we don’t want you to forget the information that accompanies it.

Tip This icon emphasizes pieces of practical information or bits of insight that you can put to work.

Warning This icon appears when you need to be careful or seek professional help.

Technical stuff This piece of art alerts you to information that you may find interesting, but not reading it won’t put you at a disadvantage in the battle against depression.

Beyond the Book

There is a free Cheat Sheet available online. Go to www.dummies.com and type Depression For Dummies Cheat Sheet in the Search box. The cheat sheet gives you signs that you may be depressed, some depression dos and don’ts, as well resources to get professional help.

Where to Go from Here

Most books are written so that you have to start on page one and read straight through. But we wrote Depression For Dummies so that you can use the detailed Table of Contents to pick and choose what you want to read based on your individual interests. Don’t worry too much about reading chapters and parts in any particular order. Read whatever chapters apply to your situation. However, we suggest that you at least skim Part 1 because it contains a variety of fascinating facts as well as important ideas for getting started.

In addition, the more severe your depression, the more we urge you to start with Chapter 5 and continue with Part 3. These chapters contain a variety of ways for overcoming the powerful inertia that keeps severely depressed people from taking actions. After you read those chapters, feel free to continue picking and choosing what topics you want to explore.

Part 1

Discovering Depression and Preparing a Plan

IN THIS PART …

Understand the costs of depression.

Find out what depression looks like.

Figure out how to cope when bad things happen.

Take a closer look at ways to get help.

Chapter 1

Demystifying and Defeating Depression

IN THIS CHAPTER

Bullet Defining depression

Bullet Calculating the costs of depression

Bullet Treating depression

Bullet Going beyond depression

Like solitary confinement, depression isolates those who experience it. Alone, fearful, and feeling powerless, sufferers withdraw. Hope, faith, relationships, work, play, and creative pursuits — the very paths to recovery — seem meaningless and inconceivable. A cruel, inhuman punishment, depression incarcerates the body, mind, and soul.

Though depression feels inescapable, we have a set of keys for unlocking the jail cell of depression that confines you or someone you care about. You may find that the first key you try works, but more often than not escape requires a combination of keys. We’re here to help, and we have a ring of keys for you to try out. We also tell you how to choose a great locksmith (mental health professional) if you can’t find the right key.

In this chapter, we clarify the difference between sadness and depression; they’re not the same. Next, we show you how depression looks among various groups of people. We calculate the costs of depression in terms of health, productivity, and relationships. We tell you about the treatment options for depression. And finally, we offer a glimpse of life beyond depression.

Just Singing the Blues or Depressed?

Life delivers death, divorce, disaster, disease, disorder, disgrace, and distress. Inescapable and inevitable. Even if nothing else goes wrong, you’re eventually going to die. Expecting to live a life absent of sharp episodes of sadness, despair, or grief is unrealistic. In fact, without times of sorrow, how would you truly appreciate life’s blessings?

Yet, misfortunes and loss need not lead to depression. What’s the difference? Sadness and grief lessen in intensity as time passes. (See Chapter 2 for more information about grief and types of depression.) Sadness and grief may seem fairly overwhelming when they occur. But time does eventually heal (unless the grief turns into depression over time).

Remember Unlike episodes of despair, depression involves deep feeling of guilt and loss of self-esteem. People suffering from depression feel hopeless, helpless, and unforgiving of themselves. Depression disrupts the body, often impacting sleep, appetite, concentration, energy, and sex. And depression profoundly diminishes the ability to love, laugh, work, and play.

Depression is a mood disorder in which a person feels profoundly sad, joyless, despondent, and unable to experience pleasure. Depression comes in various types that have somewhat different symptoms. We describe these categories of depression in Chapter 2, but all involve a low mood or diminished sense of pleasure.

The Varying Faces of Depression

Depression doesn’t discriminate; it can affect anyone regardless of race, social class, or status. Typical symptoms of sadness, loss of energy and interests, low self-esteem, feelings of guilt, and changes in appetite and sleep appear in men, women, children, and the elderly. Such symptoms also manifest themselves across different cultures. However, a depressed preschooler may not exactly look the same as a depressed 80-year-old.

In Chapter 2, we dissect the various categories of depression. In this chapter, we show you how depression looks in different people at different life stages. The cases we present in this chapter, and throughout this book, don’t represent real people. However, they’re loosely based on the people we’ve worked with in our collective careers.

Young and depressed

Depression can be found among children of any age, from preschool through young adulthood. However, preschoolers have relatively low rates of depression. Depression increases throughout childhood and is most common in adolescence.

Warning The rates of depression in children are likely underreported because parents and professionals often fail to recognize the problem. Children rarely spontaneously report depression to others. Instead, they more typically remain unaware of their feelings, which manifest themselves through changes in their behavior, appetite, and sleep.

Mackenzie’s mom surprises her by bringing cupcakes to school on her eighth birthday. The teacher leads the class in singing Happy Birthday, but Mackenzie barely smiles. After quickly devouring the two overloaded trays of cupcakes, the kids all race out to the playground for recess. Mackenzie trails behind.

Mackenzie’s teacher approaches her mother, I’m concerned about Mackenzie. She seems quiet and less interested in her schoolwork. I often see her alone on the playground. She doesn’t raise her hand in class like she used to, either. Is something wrong?

When children are depressed, they lose interest in activities that they previously enjoyed. If you ask them if they’re sad, they may not be able to connect their feelings with words. However, they will show various signs of depression, such as low energy, sleep problems, appetite changes, irritability, and low self-esteem.

KIDS, DEPRESSION, AND OBESITY

In a study reported in the journal Pediatrics, more than 9,000 teens participated in a study on the relationship between depression and obesity. The researchers gave the kids a questionnaire that measured depression and calculated their body mass index (BMI), a measure of obesity. They assessed the kids once again a year later. Kids who were obese and depressed at the first assessment tended to become more obese by the second assessment. Kids who were not obese at the first assessment, but were depressed, had double the risk of becoming obese a year later. Much remains to be discovered about exactly how depression may increase this risk of obesity; however, these findings underscore the importance of addressing depression when it occurs.

Tip Watch children at play for subtle signs of depression. Depressed children may weave themes of death or loss into their play. All children’s play includes such themes on occasion, but dark topics show up more often in kids who are depressed. You may need to observe kids over a period of time because their moods change. They may not look as continuously depressed as adults with depression. Their moods may fluctuate throughout the day. Consult a professional if you have any doubts.

Depression in seniors

Some people view old age as inherently depressing. They assume that upon reaching a certain age, quality of life deteriorates. In fact, there is some truth to these assumptions: Old age brings increases in illness and disability and losses of friends, family members, and social support. Therefore, some sadness is to be expected.

Tip Nevertheless, depression is absolutely not an inevitable consequence of old age. Most symptoms of depression in the elderly mimic those of depression in anyone. However, the elderly are a little more likely to focus on aches and pains rather than feelings of despair. Furthermore, they commonly express regret and remorse about past events in their lives.

Depression interferes with memory. If you notice increased memory problems in grandpa or grandma, you could easily chalk the problem up to the worst-case scenario: Alzheimer’s or dementia. However, such memory problems also occur as a result of depression.

And depression in the elderly increases the chances of death. Yet, if asked about depression, elders may scoff at the idea. Denying depression, the elder person may not get needed treatment.

Warning Elderly men are at particularly high risk of suicide. Men older than 60 are more likely to take their own lives than any other combination of age and gender. If you have any doubts, check the possibility of depression with a doctor or mental health professional.

Real men don’t get depressed, or do they?

Most studies show that men get depressed about half as frequently as women. But then again, men tend to cover up and hide their depression; they feel far more reluctant to talk about weaknesses and vulnerabilities than women do. Why?

Many men have been taught that admitting to any form of mental illness or emotional problem is unmanly. From early childhood experiences, these men learn to cover up negative feelings.

Scott looks forward to retirement from his job as a marketing executive. He can’t wait to start traveling and pursuing long-postponed hobbies. Three months after he retires, his wife of 20 years asks for a divorce. Shocked, yet showing little emotion, Scott tells his friends and family, Life goes on.

Scott starts drinking more heavily than usual. He pursues extreme sports. He pushes his abilities to the limit in rock climbing, hang gliding, and skiing in remote areas. Scott distances himself from family and friends. His normal, even temperament turns sour. Yet Scott denies the depression so evident to those who know him well.

Remember Rather than own up to disturbing feelings, men commonly turn to drugs or alcohol in an attempt to cope. Some depressed men express anger and irritation rather than sadness. Others report the physical signs of depression, such as lack of energy, poor sleep, altered appetite, and body aches, but adamantly deny feeling depressed. The cost of not expressing feelings and not getting help may account for the fourfold greater rate of suicide among depressed men than women.

Women and depression

Why do women around the world appear to suffer from depression about twice as often as men? Biological and reproductive factors may play a role. The rate of depression during pregnancy, after childbirth, and prior to menopause is higher than at any other time in women’s lives.

However, cultural or social factors likely contribute to women’s depression as well. For example, women who have been sexually or physically abused outnumber men with similar experiences, and such abuse increases the likelihood of depression. Furthermore, risk factors, such as low income, stress, and multiple responsibilities like juggling housework, childcare, and a career, occur more frequently among women than men.

Janine gently lays her baby down in the crib. Finally, the baby has fallen asleep. Exhausted after a challenging day at work, she desperately longs to go to bed herself. But, laundry waits, the bills need to be paid, and the house is a disaster. Six months ago, her husband was called to active duty in the Army Reserves and life hasn’t been the same since. Janine realizes her overwhelming fatigue and loss of appetite are due to depression setting in.

Depression and diversity

Everyone experiences depression in unique ways. Attempting to generalize about depression based merely on ethnicity or membership in a certain group can lead to misperceptions. But risk factors for depression include discrimination, social ostracism, poverty, and major losses (like loss of a job or loved one). And unfortunately all these risk factors occur more frequently among minorities. Being different may take the form of race, culture, physical challenge, or sexual orientation.

In addition to these risk factors, many groups face special obstacles when dealing with depression. For example, some ethnic populations have limited access to mental health care because of language differences, embarrassment, economic difficulties, and lack of nearby facilities. More resources designed at helping these groups access care are clearly needed.

Adversity and depression

People who undergo traumatic events (especially repeatedly) have an increased risk of depression. For example, the social isolation that came during the pandemic increased rates of depression and anxiety. Those who experience chronic financial difficulties can easily succumb to a sense of hopelessness and depression. Those who live in high-risk areas such as forests in western states and coastal areas vulnerable to extreme weather events such as hurricanes may also be susceptible to higher risks of depression.

Adding Up the Costs of Depression

Depression has existed since the beginning of humankind. But today depression is a worldwide epidemic. No one knows why for sure, but the risk of depression for those born after World War II has mushroomed.

Estimates vary considerably, but today depression appears to hover around 20 percent of all people over the course of a lifetime. Furthermore, in any given 12-month period, about 10 percent of the population experiences an episode of significant depression. And at this very moment, the World Health Organization estimates that 264 million people are suffering from depression throughout the world. That’s an awful lot of people.

Tip Guess what? Estimates on depression are only rough approximations. Because most people with depression fail to seek treatment and many folks with depression don’t even realize they’re depressed, reliable statistics are few and far between. Whatever the real figures are, huge numbers of people suffer from depression at some point in their lives. And depression has all kinds of costs associated with it.

Financial costs of depression

The World Health Organization (WHO) has created a statistic called the Global Burden of Disease (GBD) that puts a number on the worldwide economic cost of various diseases. Depression is now one of the top-five largest contributors to the GBD.

The financial cost of depression is staggering. In the United States alone, the American Psychiatric Association pegs the price tag of depression at $210.5 billion per year.

Where do these costs come from? Depressed people miss work more often and get less done when they do work. Parents of depressed kids may have to miss work to get their children to treatment appointments. Treatment also represents part of the total tab, but remember that alleviation of depression increases productivity, reduces absenteeism, and reduces medical costs.

Previewing personal costs of depression

Economic facts and figures do little to describe the human costs of depression. The profound suffering caused by depression affects both the sufferer and those who care. Words can’t adequately describe these costs:

The anguish of a family suffering from the loss of a loved one to suicide

The excruciating pain experienced by someone with depression

The diminished quality of relationships suffered both by people with depression and those who care about them

The loss of purpose and sense of worth suffered by those with depression

The loss of joy

Detailing depression’s physical toll

Depression’s destruction radiates beyond personal and economic costs — depression damages the body. Scientists discover new information almost daily about the intricate relationship between mood and health. Today, we know that depression affects:

Your immune system. Your body has a complex system for warding off infections and diseases. Various studies have shown that depression changes the way the immune system responds to attack. Depression depletes the immune system and makes people more susceptible to disease.

Your skeletal system. Untreated depression increases your chances of getting osteoporosis, though it’s unclear exactly how depression may lead to this problem.

Your heart. The relationship between depression and cardiovascular health is powerful. Johns Hopkins University studied healthy doctors and found that among those people who developed depression, their risk of heart disease increased twofold. This risk is comparable to the risk posed by smoking.

Another study reported in the journal Circulation followed more than 4,000 elderly people who were initially free of heart disease. Researchers found that elderly persons with depression were 40 percent more likely to develop heart disease and 60 percent more likely to die. Intriguingly, they discovered that every increase in depression scores led to even greater increases in heart disease risk. This risk occurred above and beyond the risks posed by smoking, high cholesterol levels, and age.

Your mind. Although depression can mimic dementia in terms of causing poor memory and concentration, depression also increases the risk for dementia. We’re not sure why, but scientists have discovered that an area in the brain thought to govern memory is smaller in those with chronic depression.

If left untreated, depression can disrupt and possibly damage connections in your brain and may lead to the degeneration and death of brain cells.

Your experience of pain. Of course depression inflicts emotional pain. However, depression also contributes to the experience of physical pain. Thus, if you have some type of chronic pain, such as arthritis or back pain, depression may increase the amount of pain you feel. Scientists aren’t entirely sure how depression and pain interact, but the effect may be due to disruption of neurotransmitters involved in pain perception. As a matter of fact, many people with depression fail to realize they’re depressed and only complain of a variety of physical symptoms such as pain.

Depression likely affects the entire way the body functions. For example, altered appetite may lead to obesity or malnourishment and serious weight loss. In addition, depression is associated with disrupted hormonal levels and various other subtle physiological changes. In a sense, depression harms your body, mind, and soul.

Remember Don’t let yourself get depressed by all these frightening effects caused by depression. If you’re depressed, you can feel better — and we spend the remainder of this book helping you to do so. Effective treatments currently exist and new ones are emerging.

Feeling Good Again

Depression is treatable. With good diagnosis and help, most folks can expect to recover. If you feel a loss of pleasure, reduced energy, a diminished sense of your worth, or unexplained aches and pains, you may be depressed. Please pursue help. See Chapter 5 for ideas on how to find the right help for you.

Many types of help exist for depression. This book is one of them and falls under the category of self-help. Self-help does work for many people. However, self-directed efforts are often not enough (although self-help often can supplement professional assistance). In the following sections, we briefly outline the different kinds of help that you may find useful.

Remember You don’t have to choose only one option. You may need or want to combine a number of these strategies. For example, many people with depression have found the combination of medication and psychotherapy helpful. And combining more than one type of psychotherapy sometimes proves useful as well.

Warning If your depression doesn’t start to lift or if you have severe symptoms such as thoughts of suicide, please seek professional assistance immediately.

Exploring cognitive therapy

Cognitive therapy is based on the premise that the way you think strongly influences the way you feel. Studies support the value of cognitive therapy above any other approach to the alleviation of depression. Dr. Aaron T. Beck, who developed cognitive therapy, discovered that depressed people

View themselves in distorted, overly negative ways

See the world in bleak, dark terms

Envision a future of continual gloom and doom

Depression causes people to believe that their dark views are completely accurate and correct. Cognitive therapy helps untangle twisted thinking. You can find out more about this approach in Part 2 of this book. We encourage you to give cognitive therapy a try. Research shows that cognitive therapy even protects you against future recurrences of depression. Skeptical? Try it anyway!

Trying behavior therapy

Another well-tested approach to the alleviation of depression is what’s known as behavior therapy, which is based on the premise that changing behavior changes moods. The problem: When you’re depressed, you don’t feel like doing much of anything. So in Part 3 we help you figure out how to take small steps and overcome this mind hurdle using behavior-therapy based tools. In addition, we tell you how

Exercise can kick-start your battle with depression.

You can bring small pleasures back into your life.

Problem-solving strategies can improve coping.

Reinventing relationships

Depression sometimes follows the loss of a significant relationship and such losses often come in the form of death of a loved one or divorce. But depression can also come on the coattails of other types of relationship losses — like changing a way you relate to the world. For example, retirement requires you to give up (to lose) one role, that of an employee, and take on another. Major life changes or transitions sometimes lead to depression if you don’t have a way of dealing with them. So in Chapter 15, we tell you how to handle loss and transitions.

Depression also often causes problems with important current relationships. In Chapter 16, we provide you with various ways of enhancing your relationships. The process of improving your relationships may decrease your depression as well.

Finding biological solutions

Perhaps you think the easiest approach to treating depression is found at the pharmacy or health food store. Simply pop the right potion and voilà, you’re cured! If only getting better were so easy!

In Chapter 17, we review the pharmacological therapies. You’ll find quite a few to choose from and we help you sort out the options. We also give you strategies for making the complicated decision as to whether antidepressant medication makes sense for you or if you’d prefer alternative approaches.

In Chapter 18, we discuss the so-called natural way of treating depression. We also bring you information about shock therapy and other not-so-common treatments for depression.

Feeling Better Than Good

After you’ve overcome your depression, you will likely feel much better. However, you’ll want to sustain that improvement. Depression, like the common cold, has a nasty habit of returning. But you can do much to hold off or prevent future depression. We show you how to avoid future bouts in Chapter 19. Should you catch another round of depression, we also show you how to recover more quickly and keep the symptoms mild.

So, you feel better. You feel good. But guess what? You don’t have to settle for good. We want you to feel better than good; perhaps better than you have ever felt in your life. That may sound too good to be true. However, in Chapter 21, we give you ways to add purpose and meaning to your life. In addition, we provide secret keys for unlocking your potential for happiness — those keys probably aren’t what you would imagine them to be.

Celebrating Sadness

We begin this book with promises of relief from depression. However, no therapy, behavior, or pill provides a life free from sadness. We’re glad that one doesn’t exist. And if such a cure existed, we wouldn’t take it.

Because without sadness, how could one feel happy? Who would write great plays or create emotionally powerful works of art or songs that sing to the depths of the soul? Human emotions serve a purpose. They distinguish us from computers and give life meaning.

Thus, we write this book wishing you a life of happiness interspersed with moments of pain. To have pain is to live.

Chapter 2

Detecting Depression

IN THIS CHAPTER

Bullet Looking at the symptoms of depression

Bullet Discovering the many forms of depression

Bullet Understanding the causes of depression

Bullet Keeping track of your moods

Depression has a variety of symptoms, from subtle to obvious. Sometimes depression slowly and silently possesses the mind and soul, virtually shutting down day-to-day living. Other times, depression explodes, bursts through the door, and robs its victims of joy and pleasure. Some people are unaware that they have depression, although other people fully recognize depression’s presence in their lives. Sometimes depression has no obvious signs, masquerading as a set of physical complaints like fatigue, poor sleep, changes in appetite, and even indigestion.

Depression is a disease of extremes. Its power can not only depress appetite but also create insatiable hunger. People with depression may find sleep distressingly evasive; others may find that fatigue is overwhelming, confining them to bed for days at a time. Depressed people sometimes pace frantically or collapse and hardly move. Depression can take root and endure for months or years. Other times it blows through like a series of afternoon thunderstorms.

In this chapter, we help you recognize whether you or someone you care about suffers from depression. We do so by categorizing the effects depression has on individuals. We outline the major types of depression and their symptoms. We explore the connections between disease and depression, and we look at the grief/depression link. We delve into the causes of this disorder. And finally, we tell you how you or a loved one can monitor and track your moods if you suspect that you may be battling depression.

Recognizing the Ravages of Depression

Everyone feels down from time to time. Stock market plunges, health problems, natural disasters, loss of a friend, pandemics, divorce, or failure to reach sales quotas — events like these can make anyone feel sad and upset for awhile. But depression is more than a normal reaction to unpleasant events and losses. Depression deepens and spreads well beyond sadness, disrupting both the mind and the body in serious, sometimes deadly ways.

Depression impacts every aspect of life. In fact, even though a number of types of depression exist (see "The Faces of Depression" later in this chapter), all types of depression affect people in four areas, although each individual may be affected in different ways. Depression disrupts

Thoughts

Behaviors

Relationships

The body

In the following sections, we touch on the ways that each form of depression affects individuals.

Dwelling on bleak thoughts

When you get depressed, your view of the world changes. The sun shines less brightly, the sky clouds over, people seem cold and distant, and the future looks dark. Your mind may fill with recurrent thoughts of worthlessness, self-loathing, and even death. Typically, depressed people complain of difficulty concentrating, remembering, and making decisions.

For Ellen, depression emerges about one year after her divorce. She finds herself thinking that she’ll never find a good relationship. Ellen is quite attractive, although when she looks in the mirror, she only sees the beginning of wrinkles, a bad haircut, and an occasional blemish. She concludes that even if there are any good people left, they’ll be repulsed by her awful looks. She feels tense. Her concentration is shot, and she starts to make careless errors at work. Her boss understands that she’s been under stress lately, but Ellen sees her mistakes as proof of incompetence. Although she believes that she’s in a job well below her skill level, she doesn’t see herself as capable of doing anything better. She begins to wonder why she bothers to go to work every day.

Tip Does your mind dwell on negative thoughts? If so, you may be suffering from depression. The following quiz in Table 2-1 gives you a sample of typical thoughts that go along with depression. Check the box preceding each thought that you often have.

TABLE 2-1 Depressed Thoughts Quiz

Unlike many of the self-tests you may have seen in magazines or online, no specific score indicates depression here. All the items are typical of depressed thinking. However, merely checking one or two doesn’t mean you’re depressed. But, the more items you check, the greater the concern of possible depression. And if you check any of the items related to death or suicide, that’s plenty of cause for concern.

Tip Don’t get too depressed about your depressive thinking. Depression is treatable. If you checked a lot of boxes in Table 2-1, we urge you to consider seeing your primary care provider for a depression screening and a possible referral for treatment.

Warning If you’re having serious suicidal thoughts, you need an immediate evaluation and treatment. If the thoughts include a plan that you believe you may actually carry out now or in the very near future, go to a hospital emergency room. They have trained personnel who can help. If you’re not able to get yourself to an emergency room, call 911 for more rapid attention. The National Suicide Helpline is particularly useful and is staffed 24/7: Call 800-273-TALK (800-273-8255). For more information, but not for emergencies, see Chapter 10.

For more information about depressive thinking and what you can do about it, see Part 2.

Dragging your feet: Depressed behavior

Not everyone who’s depressed behaves in the same way. Some people speed up and others slow down. Some folks sleep more than ever, while others complain of a dreadful lack of sleep.

Darryl drags his body out of bed in the morning. Even after ten hours of sleep, he feels depleted of energy. He starts showing up at work late. He uses up his sick leave. He can’t make himself go to the gym, an activity he used to enjoy. He reasons that he’ll work out again when he gets the energy. His friends ask him what’s going on, because he hasn’t been spending much time with them. He says that he doesn’t really know; he’s just tired.

Cheryl, on the other hand, is averaging about three and a half hours of sleep each night. She awakens at about 3 a.m. with racing thoughts. When she gets up, she feels a frantic pressure and can’t seem to sit still. Irritable and cranky, she snaps at her friends and co-workers. Unable to sleep at night, she finds herself drinking too much. Sometimes she cries for no apparent reason.

Tip Although everyone is different, certain behaviors tend to go along with depression. Do your actions and behaviors concern you? Depressed people tend to either feel like they’re walking in wet cement or running full speed on a treadmill. The following quiz in Table 2-2 can give you an idea as to whether your actions indicate a problem. Check each item that applies.

All these items are typical of depressed behavior or, in some cases, a health problem. On a bad day, anyone might check off a single item. However, the more items you check, the more likely it is that something’s wrong, especially if the problem exists for more than a couple of weeks.

TABLE 2-2 Depressed Behavior Quiz

For more information about depressed behavior and what you can do about it, see Part 3.

Reflecting upon relationships and depression

Depression damages the way you relate to others. Withdrawal and avoidance are the most common responses to depression. Sometimes depressed people get irritable and critical with the very people they care most about.

Antonio trips over a toy left on the living room floor and snaps at his wife Sylvia, Can’t you get the kids to pick up their damn toys for once? Hurt and surprised by the attack, Sylvia apologizes. Antonio fails