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Depression commonly manifests physically, through stomach pains, headaches, disrupted or excessive sleep, and motor control difficulty. While the causes of depression are unknown, a predisposition for it runs in families and it can be triggered by trauma and adverse life circumstances. Depression is diagnosed more frequently in women and tends to display differently in women than in men.
People tend to suffer higher rates of depression after giving birth and in late fall. Depression and anxiety often exacerbate each other and people with depression commonly have difficulty concentrating on tasks and conversations. Some people abuse alcohol and drugs or overeat as a way of coping, causing them to develop other medical problems. Depressed people are also at increased risk for self-harm.
Depression is a mental illness which is characterized by prolonged emotional symptoms including:
- Apathy
- Sadness
- Guilt
- Exhaustion
- Irritability
Diagnosing depression involves a psychiatric evaluation and physical tests to determine whether a person’s symptoms are actually being caused by a different disorder. A person must have been experiencing symptoms for at least two weeks to be diagnosed with depression. Every case is unique and requires individual attention, but there are a number of effective complementary ways of treating depression, including:
- Talk therapy
- Medication
- Adopting a healthier lifestyle
The Causes of Depression
Sometimes depression is biologically caused by hormones, neurotransmitters, lack of sunlight, genetics, low testosterone, thyroid, etc. Sometimes, depression is psychologically caused by stress, burnout, divorce, or the consequences of a wrong choice. Sometimes, depression is caused by stuffing anger can also cause depression. Instead of exploding into anger or rage, they implode with depression. Sometimes, depression is spiritually caused. The consequences of sin, such as guilt or shame, can make people very depressed. There is a spiritual disorder that looks a lot like depression, but it is not depression. It is called “Spiritual Desolation.” Sometimes, depression is caused by unforeseen situations. Most often, it is some combination of all the above.
Types of Depression
Major Depressive Disorder - The patient has symptoms of depression most of the day, nearly every day for at least two weeks, that interfere with the ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a person’s lifetime, but more often, a person has several episodes. Major Depressive Disorder is sometimes called depression, clinical depression, or unipolar depression.
Persistent Depressive Disorder- This disorder used to be called Dysthymia. It’s a chronic depressed mood that lasts for at least two years. The disorder may include periods of major depression and also less severe symptoms. Typically, symptoms include low self-esteem, low energy, poor concentration, feeling hopeless, difficulties sleeping and eating. These symptoms look similar to major depressive disorder. Still, their duration is much longer, and they are also less severe than major depressive disorder. An episode can occur only once in a person’s lifetime, but more often, they have several episodes.
Seasonal Affective Disorder - This type of depression occurs during the winter months when there is less natural sunlight. The depression generally lifts during spring and summer.
Disruptive Mood Dysregulation Disorder - This is a newer disorder that wasn’t defined until the publication of the DSM-5. It’s similar but different from Intermittent Disruptive Disorder. The clinical picture includes explosive outbursts of rage. They are usually irritable and angry.
Vascular Depression - See Seniors and Depression.
Depression and Dementia - See Seniors and Depression
Depressive Disorder Due to Another Medical Disorder - This type of depression is caused by chronic diseases, like heart disease, cancer, and multiple sclerosis.
Post Partum Depression - See Depression in Women
Treatment Resistant Depression - This diagnosis is given to patients who don’t respond well to medications or counseling. Despite treatments that would work on 99.9% of patients, treatment doesn’t help them.
Substance/Medication-Induced Depression Depressive Disorder - This is caused by using alcohol, benzodiazepines, opiates, and other drugs.
Psychotic Depression -This type of depression occurs when a person has severe depression plus some form of psychosis, such as delusions and or hallucinations. Technically, the term “Psychotic Depression” is very outdated and not an official diagnosis. Insurance companies would not pay for a diagnosis of “Psychotic Depression” any more than they would the diagnosis of “alcoholic” or “nervous breakdown.” Diagnostic terms have changed over the decades, and presently, the contemporary diagnostic labels for a patient who simultaneously presents with symptoms of depression and psychosis are Major Depressive Disorder with Psychotic Features, Bipolar Disorder with Psychotic Features, and Schizoaffective Disorder. Since all three diagnoses have mood and psychotic features, accurate diagnosis is complicated and requires a highly competent clinician who is capable of performing a very complex assessment. A thorough review would look at which symptoms, either the mood or psychotic symptoms, presented first in the patient’s development.
If the patient had depression and later developed psychosis, then their accurate diagnosis would be “Major Depressive Disorder with Psychotic Features.” If the patient had depressive symptoms with mania and later developed a psychosis, they would accurately be diagnosed as “Bipolar Disorder with Psychotic Features.” If the patient was initially diagnosed with a psychotic disorder and later developed a mood disorder, the accurate diagnosis would be “Schizoaffective Disorder.” Diagnosis becomes even more complicated since many bipolar patients are misdiagnosed as depressed because they only see a doctor when they are feeling depressed. Somehow, the mania of bipolar is missed.
Diagnosis becomes even more complicated; for example, when the same patient is diagnosed by ten different doctors and presents with depression, delusions, and hallucinations, there is a good chance some mental health professionals would diagnose the patient as having “Major Depressive Disorder with Psychotic Features,” others with, “Bipolar Disorder with Psychotic Features,” and others might make the diagnosis of, “Schizoaffective Disorder.” It is difficult for a mental health professional to catch these subtle distinctions because patients don’t often have much insight into their minds’ interior movements. In addition, they don’t always present coherently.
Atypical Depression - The clinical picture for Atypical Depression is different than regular depression. It’s a type of depression that does not follow what is the typical presentation of the disorder. Unique to the distinction of atypical depression is heaviness in the arms and legs, oversleeping, and overeating. Also, they may have relationship problems and are especially sensitive to interpersonal rejection, and their mood spontaneously improves when something good happens to them. At other times, they meet the diagnostic criteria for depression but aren’t sad.
Adjustment Disorder with Depressed Mood - This is an official diagnosis. The patient’s disorder is triggered by a lot of overwhelming stress. The death of a loved one, divorce, losing a job, etc., can trigger this disorder.
Depressive Episode with Insufficient Symptoms - To be diagnosed with depression, a patient must present with five of the nine symptoms. This diagnosis is given when a patient doesn’t meet the diagnostic criteria for the major depressive disorder diagnosis because they only have 3 or 4 of the depression’s nine symptoms.
Symptoms of Depression
The most severe and dangerous symptoms of depression are thoughts of suicide or suicide attempts. If you think someone is contemplating harming themselves, immediately call 911 or directly bring them to an emergency room.
The depressed person is often unable to meet work and family responsibilities.
They cry a lot.
Physical symptoms without a physical cause. For example-headaches and body aches
Feelings of hopelessness and worthlessness
Feeling helplessness
Loss of interest in hobbies
Feeling empty or sad most of the time
Some depressed people never feel sadness
Increased fatigue and irritability
Difficulty concentrating and remembering
Insomnia
Unwarranted guilty feelings
Unwanted weight changes
Psychomotor retardation or agitation
How is Depression Treated?
Treatment for depression may require dietary and lifestyle changes, talking with a physician or counselor, and possibly taking medications. If you or someone you know is very depressed and/or suicidal, call 911 ASAP or get to an emergency room ASAP.
The best practice is to combine counseling with antidepressant medications. Whether it’s a physician, psychiatrist, scientific counselor, or pastoral counselor, when combined with the proper medicine at the appropriate dosage, the healing synergy is much more effective than either one by itself. Yet medication without counseling or counseling without medication can be beneficial.
Counseling can often help you to manage your depression. You may become less sad, sleep and concentrate better, have less negative self-talk, cry less, be less irritable, have more energy, and be less angry and disappointed. Once these depressive symptoms lessen, you may find that your stress level is significantly decreased, and you are more happy in your marriage, work, and life in general.
Antidepressants are often beneficial but come with some suicidal risks for children, teens, and young adults. When beginning or weaning off, suicidal thoughts or suicide attempts can increase. Discuss this with your doctor, and always follow the doctor’s recommendations. Pay very close attention to your child during these critical periods.
There are also more aggressive treatments like electroconvulsive shock. In this treatment, an electric current is passed through the brain to relieve depression. Ketamine is also being used to treat stubborn depression.
Many non-medical treatments fall under the homeopathic umbrella, like St. John’s Wart, Omega-3 Fatty Acid, SAM-e, etc. It’s essential to check with your physician and pharmacist before taking these supplements because they may dangerously interact with the prescribed medications you are taking.
Self-Help for Depression
Here are some excellent ideas to help yourself. Try to do things that you used to enjoy. Be easy on yourself. Diet and exercise. Spend time outside in the sun. Get enough sleep, try to go to bed, and wake up around the same time every day. Don’t do drugs or alcohol. Try not to do too many things at once. Spend time with supportive family members or friends who are understanding, patient, and encouraging. Try fun things. Postpone important life decisions until you feel better. Discuss decisions with trusted others. Seriously, consider talking with your doctor about antidepressant medications.
Depression and Suicide
What should I do if someone I know is considering suicide?
If you know someone considering suicide or in a suicidal crisis, do not leave them alone, not even for a few seconds. Get immediate help. Call 911 or get an ambulance to bring them to the nearest emergency room. Immediate action is very important. If you or someone you know has some of these warning signs, get immediate help.
Here are some resources:
National Suicide Prevention Lifeline: 1–800–273–TALK (8255) available 24 hours a day, 7 days a week.
Veterans Crisis Line: 1–800–273–8255, press 1.
Many people have suicidal risk factors but never attempt suicide. Still, suicidal thoughts and behaviors are not harmless cries for help. If you notice warning signs, take action; don't ignore them. Take them very seriously and never minimize them. Most suicides can be prevented.
Here is a worst-case scenario: if you either don't recognize or ignore the warning signs right before you, and they were not only a mere cry for help, but your loved one died. You may suffer excessive guilt for the rest of your life, blaming yourself for not catching the warning signs and preventing suicide.
The risk for suicidal behavior is complicated. People who attempt suicide differ from others in how they think, react to events, and make decisions. These differences often occur with disorders like depression, substance use, and anxiety. Sometimes, suicidal behavior is triggered by events such as personal loss or violence. To help prevent suicide, knowing the warning signs is necessary.
To catch the warning signs, you need to know what they are. The main warning signs for suicide are:
Personally having or having a family history of depression, anxiety, substance abuse disorder, or other mental health disorders. Feeling empty, feeling hopeless, Acting agitated, and behaving recklessly. Acting out in rage. Having frequent and/or extreme mood swings. Feeling very overwhelmed by stress. Not wanting to be around family and friends. Feeling like there is no reason to live. Not caring about anything anymore.
Family history of suicide or a prior suicide attempt
Talking about wanting to die or wanting to kill oneself. Talking about being a burden to others. Making statements like, "You don't have to worry about me much more," "I wish I was never born," or "I'd be better off dead." Saying goodbye to loved ones.
Putting their affairs in order. Giving away prized possessions.
Looking on search engines for a way to kill oneself.
Having unbearable chronic pain
Domestic violence, including physical or sexual abuse
Either being in prison or jail or having recently been released.
Being exposed to the suicidal behavior of friends and family.
With children, there are some additional warning signs to watch out for:
Writing about death.
Talking about death.
Having dreams about death.
Drawing morbid pictures.
While taking anti-depressant medication can help reduce suicidal ideation or intent, for some children and teenagers, suicidality increases during the first few weeks after starting and when tapering off the anti-depressant medication. These are critical periods of high risk, and the child must be monitored very closely. Be very sure to talk to the drug prescriber about the increased risk of suicide and also carefully read the paperwork about the medication given by the pharmacy.
What if someone seems suicidal on social media?
YouTube, Facebook, X, Tumblr, and Google+ each have ways to report suicidal content and get help for the content creator. Each social media site has a different reporting procedure, so search the site's help page for assistance.
What about gender?
Women are more likely to attempt suicide, but men are more likely to die by suicide than women. Women are more likely than men to attempt suicide by poisoning. In contrast, men are more likely to use deadlier methods like firearms.
Can suicide be prevented? YES!
Seeking personal help is a sign of strength. Reaching out to a friend you are concerned about is also a sign of strength.
Counseling or Psychotherapy can be beneficial in reducing suicide. It can help the suicidal person learn different ways to deal with stress. When stress triggers suicide, they can practice more healthy ways to manage it. Counseling has been shown to reduce the rate of suicide by teaching them to notice when their thoughts, feelings, or actions are dangerous and unhealthy and teaches them the skills needed to deal better with upsetting situations.
Taking anti-depressant medication can also help reduce suicidal ideation or intent. I have witnessed many depressed patients with suicidality have it go away after a few to several weeks.
Prayer can also help prevent suicide. Go to any search engine and type "Prayers to prevent suicide." or "Spiritual Warfare Prayers to prevent suicide." Ask the Holy Spirit to lead you to the prayers that speak to your heart.
Some Christian writers identify evil spirits associated with suicide. These spirits of suicide are not listed in the bible, and different writers have different groupings. Still, these are the most commonly identified demons for those who group them. Modern counseling science does not accept these spiritual causes, and many traditional denominations do not include "the spirits of suicide" concept within their theology. Still, it is more common in Charismatic communities. One of the earlier books that embraced this concept is, "Pigs in the Parlor."
Spirits of:
anxiety,
apprehension
anger,
death,
depression
despair,
despondency,
discouragement,
defeatism,
dejection,
dread,
envy
fear
gloom,
guilt
hopelessness,
insomnia,
morbidness
negativism,
rebellion
self-pity
sexual perversion
worry
Below is an excerpt from the Catechism of the Catholic Church on the subject of suicide.
2280 Everyone is responsible for his life before God, who has given it to him. It is God who remains the sovereign Master of life. We are obliged to accept life gratefully and preserve it for his honor and the salvation of our souls. We are stewards, not owners, of the life God has entrusted to us. It is not ours to dispose of.
2281 Suicide contradicts the natural inclination of the human being to preserve and perpetuate his life. It is gravely contrary to the just love of self. It likewise offends love of neighbor because it unjustly breaks the ties of solidarity with family, nation, and other human societies to which we continue to have obligations. Suicide is contrary to love for the living God.
2282 If suicide is committed with the intention of setting an example, especially to the young, it also takes on the gravity of scandal. Voluntary co-operation in suicide is contrary to the moral law. Grave psychological disturbances, anguish, or grave fear of hardship, suffering, or torture can diminish the responsibility of the one committing suicide.
2283 We should not despair of the eternal salvation of persons who have taken their own lives. By ways known to him alone, God can provide the opportunity for salutary repentance. The Church prays for persons who have taken their own lives.
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