Learning to Listen

Depression

Depression may be either reactive depression, which is an entirely normal reaction to difficult circumstances, or may be an endogenous depression, which is the result of a diagnosable mental illness with other underlying causes.  It may also be a combination of the two.

Clinical depression is an illness.  It can occur without people realizing they have it.  Most people experiencing depression feel a sense of relief when they learn it is not a personal weakness.  Depression can affect anyone.  Four out of five cases of depression can be treated successfully.  The first step for a person who suspects they may have depression is to see a doctor or health professional who is trained to diagnose depression.

Signs and Symptoms

A depressive disorder is a “whole-body” illness, involving your body, moods and thoughts.  Not everyone who is depressed or manic experiences every symptom.  Also, the severity of symptoms varies with individuals.  Some of the indications that you or a friend may be clinically depressed include:

• When a depressed mood continues for weeks, eventually interfering with work, school and social life
• Persistent sad, anxious or “empty” mood
• Feelings of irritability
• Loss of interest or pleasure in activities once enjoyed
• Changes in weight or appetite
• Changes in sleeping patterns
• Feelings of guilt, hopelessness or worthlessness, pessimism, helplessness
• Inability to concentrate, remember or make decisions
• Fatigue or loss of energy
• Restlessness or decreased activity noticed by others
• Complaints of physical aches and pains for which no medical cause can be found
• Making negative comments about self
• Recurring thoughts or fantasies of suicide or death

Sadness may not always be the dominant feeling of a depressed person.  Depression can also be experienced as a numb or empty feeling, or perhaps no awareness of feeling at all.

If depression is not treated, it can last for many months, even years.  It may build gradually or appear suddenly.  It is important to realize that “cheering up” and “keeping a stiff upper lip” cannot make depression go away.  Exercise, vitamins and vacations are equally unsuccessful treatments

A person with depression needs help from health professionals.  Depression should be looked upon as a physical illness, not a personal failing.  Friends and family should not feel guilty or responsible for what is happening.  To make things easier for a depressed friend, don’t criticize, push, patronize or lose your temper.  Be willing to listen, support and provide sympathetic understanding.

Causes of Depression

No one knows what causes depression.  However, several factors, alone or combined, may contribute.

The life events that are most often associated with depression are varied, but  the distinguishing features of suchevents are loss of self-determination, empowerment, or self-confidence.  More profoundly, a loss of self; of the abilities or activities that a person identifies themselves with.

There are certain periods in one’s life when we are more vulnerable to depression.  These include:

• Periods when family, work or school pressures are high
• 3 months following childbirth
• Menopause
• Death of a loved one
• Retirement
• Loss of a job or key relationship

All these are times of major changes when we may not be prepared psychologically or financially to deal with increased stress.

Some people may have an inherited tendency toward depression.  For these people, the stresses they encounter and the way they handle stress may cause depression.

Depression causes a biochemical imbalance in one or more neurotransmitters – important brain chemical mes-sengers that transmit information across various pathways of the brain.  The resulting alteration in brain chemistry is similar to temporary, normal variations in brain chemistry which can be triggered by illness, stress, frustration or grief.  It differs in that it is self-sustaining and does not resolve itself upon removal of such triggering events (if any triggering event can be found).  The alteration continues, producing depressive symptoms and through those symptoms enormous new stresses on the person.  (Depression triggered by loss of a spouse leads to being too depressed to work or communicate, which leads to loss of job, etc.)

After one to  three  years, a  more  normal  chemistry reappears, even without medical treatment.  However, if the alteration is profound enough to cause suicidal impulses, a majority of untreated depressed people will attempt suicide and as many as 17% will eventually succeed.

Who it Affects

Depression can strike anyone, but most often it begins between ages 24 and 44.  This is a critical period in life when the demands of career, relationships and family are high and constantly changing.  Thoughts of real or perceived inadequacies or failure may surface.

Other high risk groups include high school and college students.  Their depression can be hard to recognize because it may resemble normal teenage problems such as changes in mood, irritability, risk-taking behaviour, and troubles with friends, school or work.

Elders also have high rates of depression.  Their sad moods, fatigue and withdrawal from life can be mistaken as part of the normal aging process.  Depression may be linked to the death of a spouse, admission to a nursing home, prolonged illness, or a major operation.

How Family and Friends Can Help

The most important thing anyone can do for depressed people is to help them get appropriate diagnosis and treatment.  The second most important thing is to offer emotional support.  This involves understanding, patience, affection and encouragement.  Engage the depressed person in conversation and listen carefully.  Do not disparage feelings expressed, but point out realities and offer hope.  Do not ignore remarks about suicide.  Always report them to the doctor.  Depression can shut down the survival instinct or temporarily suppress it.  (Depressive suicides give less warning, need less time to plan, and are willing to attempt more painful and immediate means, such as jumping out of a moving car.  They may also fight the impulse to suicide by compromising on self-injury). Invite the depressed person out.  Be gently insistent if your invitation is refused.  Encourage participation in some activities that once gave pleasure but do not push the depressed person to undertake too much too soon.  The depressed person needs diversion and company but too many demands can increase feelings of failure.

If You Are Feeling Particularly Depressed

Do not set yourself difficult goals or take on a great deal of responsibility.  Break large tasks into smaller ones, set some priorities and do what you can as you can.  Do not expect too much from yourself.  Perfectionism leads to increased depression.  Try to be with other people.  Do not make any major life decisions such as quitting your job or getting married or separated while depressed.  If pressured to make such a decision, explain that you will make the decision as soon as possible after the depression lifts.  You are not seeing yourself, the world, or the future in an objective way when you are depressed.  Your negative thoughts are not a rational way to think of things.  The feeling that nothing can make the depression better is part of the illness of depression.  Things are probably not as hopeless as you think.

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Learning to Listen | Active Listening Skills
Suicide | Postvention | Printable Version

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