Everybody Gets the Blues

Everybody gets the blues
There’s hope for depression
Take the depression quiz
Depression can take many forms
The many faces of depression
Why do women get depressed
Depression is not a normal part of aging
Stress and depression are connected
Symptoms of depression are not permanent
Don’t let your funk turn into depression
You can provide support to someone who is depressed
How do you handle comments about suicide?
Depression by the numbers
Find help for yourself or someone else

Everybody gets the blues

Everyone has days when they feel down.

It's normal. Life has its ups and downs. You may experience a feeling of profound grief after a life-changing accident, illness or the loss of a loved one. You may feel an emptiness and loss of purpose following the completion of an important event or project. Financial stress may be pulling you down. These are normal human emotions.

But when do the "blues" become the murky grays of depression?

When we talk about depression, we are referring to overwhelming feelings of hopelessness, emptiness and gloom that last for more than two weeks. These depressive feelings also interfere with a person's ability to function in daily life.

When this happens, it's time to ask for help.

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There is hope and help for people with depression.

According to the Centers for Disease Control and Prevention, one in 10 people experience depression. It affects all genders, cultures and socio-economic groups. But, only half of these people will seek treatment.

Rarely, does depression impact just one person. It also affects the lives of loved ones, friends and co-workers. People who suffer from depression often isolate themselves and push others away. This detachment makes depression more challenging to treat.

Depression is not an emotional weakness.

The onset of depression can be genetic or can be caused by a stressful life event like the birth of a baby or the loss of a loved one. It may also be the result of a hormonal imbalance, medications, an illness or surgical procedure. Sometimes, it's a combination of factors over time.

"If I could tell people one thing about depression, it would be, 'You don't have to feel like this for the rest of your life,'" said Michelle Nelson, LCSW, mental health unit, Ascension Saint Michael's Hospital in Stevens Point. "Depression is a treatable condition. There is help for depression. People don't have to live through it alone."

Depression can be treated with talk therapy, positive lifestyle changes, medication and the support of family and friends.

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If you think that you are depressed or you wonder if someone else may be depressed, take this short quiz.
 

1. Do you have persistent feelings of sadness, anxiety or emptiness that have lasted longer than two weeks?
2. Do you sleep too much or too little?
3. Do you wake up in the middle of the night or early morning?
4. Do you have a reduced appetite; have you lost weight?
5. Do you have an increased appetite; have you gained weight?
6. Have you lost interest in hobbies, friends, work, or sports that you once enjoyed?
7. Do you avoid people, including family and friends?
8. Do you have a negative outlook on life or talk negatively to yourself?
9. Do you have critical feelings or feelings of restlessness and irritability?
10. Are you short-tempered?
11. Do you have chronic back pain, headaches, digestion problems or other symptoms that do not respond to treatment?
12. Do you have difficulty concentrating, remembering or making decisions?
13. Do you feel fatigued, tired or drained all the time?
14. Do you feel guilty, hopeless, helpless or worthless?
15. Do you drink or use sleeping pills or painkillers more often?
16. Do you have thoughts of suicide or death?

If you answered yes to five or more questions and have had symptoms lasting longer than two weeks, you should contact your healthcare clinician. You may be suffering from clinical depression.

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Depression is often thought of as sadness, but it can take many forms.

People who are depressed may experience isolated episodes of depression, persistent depression with cycles of symptoms lasting two years or longer, or depression associated with seasons or events. The three most common types of depression are below.

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The many faces of depression

Depression may show itself in many ways, based on age and gender.

Men experience the typical symptoms of depression, but may express these feelings differently.

They aren't likely to talk about feelings of helplessness or hopelessness. Instead, these feelings may come out through negative language, anger or a negative outlook on life.

Men tend to "tough it out" rather than seek help. They become moody, irritable or short-tempered. A man who is depressed may not get excited about controversial issues like he once did. He may lose interest in hunting, bowling, biking or getting together with friends. You might think that he is sick because he's complaining more about health-related issues such as:

• headaches
• back pain
• not sleeping
• feeling tired and worn out

Some men drink more alcohol and use sleeping aids or painkillers to go to sleep. Other men become workaholics. Still others develop an interest in extreme sports or take part in high-risk behaviors as a way to escape the negative and empty feelings that depression creates.

Because men feel more anger than sadness, they do not recognize these as signs of depression. It's important to be aware of personality changes. If the signs point to depression, seek treatment. Men suffering from depression are four times more likely to complete suicide.

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Why Do Women Get Depressed?

During the course of a lifetime, a woman has many occasions for joy; ironically, many of these same occasions become triggers for depression.

Women in all races and ethnic groups have a high rate of depression. In most countries, women are affected by depression at twice the rate of men.

Depression often goes undiagnosed. Women tend to have anxiety and physical symptoms such as headaches or stomach problems. For both men and women, symptoms often get overlooked or diagnosed as something else.

Women are more likely to seek help for depression. They are also more likely to develop depression earlier in life and to have more recurring episodes.

Women may have different patterns of the circadian rhythms  that regulate sleep and activity.  A woman, who is depressed, is more likely to sleep excessively as opposed to experiencing insomnia.

As to why women are particularly vulnerable, researchers have explored numerous biological, genetic and psychosocial reasons.

Biological. Neurotransmitters that affect mood are believed to be affected by the female hormone estrogen. This fact may explain at least some of the mood changes a woman experiences during puberty, pregnancy, after childbirth and around the time when estrogen production declines during menopause. As many as 40 percent of women experience some changes in mood and behavior around the time of their menstrual period (premenstrual syndrome or PMS).

Genetic. Both men and women have a 25 percent risk of depression when someone else in the immediate family has been depressed. This family link is more common among females than males. Symptoms of depression caused by genetics often appear between the ages of 15 and 30 years.

Genetic factors undoubtedly play a role in this increased vulnerability, but a depressed parent can also have a negative effect. Depression in a parent often hinders normal bonding and sometimes even contributes to physical, emotional or sexual abuse.

Psychosocial. Cultural factors can influence depression during pregnancy or after the birth of a child. Young single mothers - whether divorced, separated or never married - have a three-fold higher rate of depression. At least some of this vulnerability may be related to a lower income status.

Women who have suffered physical or sexual abuse at any time in life are much more likely to develop depression. Any traumatic experience, such as the loss of a parent during childhood, or loss of social support from family members increases the risk of depression.

While it may be difficult to change these psychosocial and cultural conditions, the depression that results is highly treatable. It's important to recognize the symptoms and seek help promptly to halt the downward spiral.

Adolescent angst may be a rebalancing of hormones, or it may be more serious. Many teens dealing with depression may slip into a dark, funky mood, get into trouble, feel misunderstood or feel cranky. If the condition persists for more than two weeks without a known cause, it may be time to seek professional help.

According to the National Institutes of Mental Health, small children who suffer from depression show it differently than adults. Young children may complain of feeling sick, not want to go to school, cling to parents, or express fear that their parents may die.

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Depression is not a normal part of aging.

Many times depression in the elderly population goes untreated. There's no question that many people over 65 years of age endure many life-changing events: loss of friends, family and spouses, chronic illnesses and maybe even the loss of independence.

Older people show signs of depression differently. Instead of intense sadness, they may complain of aches and pains, move a bit slower, become more demanding or irritable.

Depression diagnosis for older adults is challenging. This generation's stigma of mental health may cause them to resist asking for help. Instead, people in the retired generation who suffer depression may withdraw or seek medical treatment for other ailments.

According to the National Alliance on Mental Illness, late-life depression causes the highest rate of suicide in men. Of the older men who committed suicide, 20 percent visited the doctor for physical ailments the day they died; 40 percent made a doctor's visit during the same week and 70 percent that same month.

People express depression differently
	Children	Adolescents	Women	Men	Older Adults
Communication	Whiney	Negative	May talk freely	Shut down	Demanding
Work/School	Refuse to go to school	Get into trouble	Will just do it	Tend toward workaholism	May feel a loss of purpose
Family	Clingy	Withdrawn	Withdrawn	Withdrawn	Withdrawn
Social	Withdrawn	Withdrawn	Withdrawn	Withdrawn	Withdrawn
Escapism		Get into trouble, sense of self-harm	Food, friends, love	Alcohol, television, sex
Self-talk	Worrisome	Negative	Negative, self-critical	Negative, blame others	Negative
Feelings	Feel sick	Worthlessness, Sadness, Hopeless, misunderstood	Sad, apathetic, fearful, anxious, hopeless	May complain of physical ailments, angry, aggressive	Instead of sadness, may complain of aches and pains, move slower
Attitude	Cranky	Belligerent	Apathetic	Irritable, Suspicious	Demanding

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Stress and depression are connected.

Most of us realize negative stress has an impact on our lives and our risk for depression. But, did you know that positive stress (welcoming a new baby or getting that long awaited promotion) can also contribute to depression?

One tool that can help you monitor the stress level in your life or the life of a loved one is the Social Readjustment Rating Scale. Originally created in 1967 by Thomas Holmes and Richard Rahe at the University of Washington School of Medicine, the scale can give us an indication of how life events might impact our emotional well-being.

The scale assigns stress points to a list of common life events. Simply read through the list and mark each event that has occurred in your life in the last 12 months. Add the stress points to determine your stress score. The higher the score, the higher your risk of depression.

Consider the following example of how positive life events can increase your risk for depression.

After working for 27 years, you get that promotion at work (29 stress points), and your youngest child leaves for college (29 stress points). Since all the children have gone on to live lives of their own, your spouse decides to get a part-time job (26 stress points).

Your new job requires more hours at the office and at home (20 stress points). Your spouse also has to work a few nights and weekends, which causes you to rearrange your schedule a bit (24 stress points). You decide to get in shape so you join the YMCA and start running (19 stress points) and make some dietary changes to eat healthier (15 stress points).

If this scenario, which is not all that far from reality, happened in a person's life in one year, the "stress" points would total 162. A person who experienced these life changes would be at a moderately high risk of depression and other illnesses, even though many of the changes were healthy and positive.

A score of more than 300 points may put you at a high risk for depression and other illnesses.

Click here to access the Social Readjustment Rating Scale.

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Symptoms of depression are not permanent.

Let's face it, when you're depressed, it's exhausting just to think about going for a walk or attending a friend's birthday party. Going to work may even seem insurmountable.

In addition to medical and professional support, there are coping techniques you can use to overcome depression. Here are eight.

1. Add brightness to your life. Go outside for 15 minutes every day. Open your curtains. Throw a few bright-colored pillows on the couch to create a bright spot.
2. Stop negative messages from coming into your life. Change your radio station. Stop watching the news. Minimize social media use. Stop negative self-talk. It will be easier to think positive thoughts. Reach out and ask for help. The support of family and friends is important and can encourage you to take more positive steps. Talk to your friends, parents, teachers, school counselors, pastors, church or youth group leaders, brothers, sisters, relatives, coaches, community group leaders, support groups, or find community outreach programs like the YMCA. Having a group of people you can count on for support will help you combat depression.
3. Choose to go against your feelings. Depression leaves people feeling isolated, lonely and excluded. When friends ask you to join them for a walk, to see a movie, or to have dinner, go, even when you don't feel like it.
4. Volunteer. Knowing you are making a difference can offset the negativity of depression. If dealing with people seems too overwhelming, volunteer at the humane society. Pets are often powerful antidotes to depression.
5. Get moving and eat well. Studies show that just 30 minutes of exercise, such as walking, can be as effective as antidepressant medication. Eating nutrient-rich foods also will help you feel better.
6. Have your vitamin levels checked. Deficiencies of vitamin B and vitamin D can make you more susceptible to depression. Ask your healthcare clinician about these and other supplements that can boost your mood and your energy.

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Do you feel a "funk" coming on?

Here are ten simple ways to prevent temporary "blue" feelings from becoming depression.

1. Just stand a little taller at work. According to a Journal of Behavior Therapy and Experimental Psychiatry article, the way we walk impacts how we feel. 
2. Enjoy the reality of the moment. Don't take pictures of everything. According to Psychological Science, viewing the world through the camera lens detracts our focus from the actual event or scenery.
3. Move your body. National Center for Biotechnology Information reported a strong correlation between depression and lack of exercise.
4. Stop procrastinating. People tend to put off overwhelming or unpleasant tasks. This approach often makes the task more stressful. The American Heart Association encourages people to take action to cure procrastination.
5. Reevaluate relationships. How are things REALLY going? Are you in a relationship that makes you feel "less"? Toxic relationships at home, in the workplace or in friendships can eat away at your self-esteem and cause feelings of guilt, incompetence and worthlessness. If you are in a toxic relationship, seek help to deal with it or end it.
6. Sleep. Seven to nine hours of sleep each night gives your body and mind time to re-charge. Sleep enables you to deal with the challenges and issues of the day.
7. Find a quiet, refreshing moment or two. Always being "on" or committed saps energy. Find a place to be still, relax, refresh, meditate and be thankful for the little things in life.
8. Unplug. Turn off the screens, phones, and televisions for an hour a day. Unplugging before bed may provide a more restful sleep. A Swedish study warns that heavy mobile use increases depressive symptoms.
9. Stop multitasking. Break your day into 25-minute segments and focus on just one thing. You'll feel more productive.
10. Put on some tunes. Playing uplifting, instrumental music can act as a mood booster during your day.

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How can you help someone who is depressed?

When depression gets in the way of living everyday life, it hurts many people. Often you will recognize behavioral changes in your loved one before he or she realizes there is an issue.

Depression is serious. Many people need the help of a medical professional to overcome it. However, there are still ways you can provide support. Here are six.

1. Be there and listen. Let the person know he or she is not alone

   Ask your loved one how he or she is feeling. This is the first step. Since feelings of depression often leave people believing they are misunderstood. It's important to affirm the person who is depressed. Let your loved one know that depression is common. It is not a reflection of who they are.

   "There is no script," said Randy Ahrens, LPC, Ascension Koller Behavioral Health in Crandon, Wisconsin. "Sometimes just physically being there and listening will help. It's the small things - holding a hand or sending a text message that says 'I'm thinking about you,' - it lets people know you care. It helps combat their feelings of isolation and loneliness, which are common with depression."

   Be willing to listen. Non-judgmental listening helps the speaker work through feelings of depression, especially if you respond with encouragement and hope.

2. Remind the person, that the symptoms of depression are temporary.
3. Understand the pain. Sometimes the words and actions of a person who is depressed are hurtful and unkind. He or she may lash out. Depression often causes deep emotional pain. At these times, it's important to not take it personally and remember hurting people often hurt people. Honestly, but gently, express your thoughts and feelings. You may have to set boundaries for conversations and involvement. You don't want to set up a relationship where you become responsible for all the needs of the depressed person.
4. Invite your loved one on outings. Continue to invite him or her to join you for walks. Ask him or her to attend events or go to the movies.
5. Suggest professional help. When the time is right, you may want to point out behavioral changes and suggest a visit to a healthcare clinician.

One of the most important things that you can do is take care of yourself. Dealing with depression can be exhausting. Make sure that you are taking care of yourself, so the stress and emotional investment you make for someone else doesn't wear you down.

Seeking talk therapy or a medical consultation can help you balance the negative feelings of helplessness, frustration, anger, guilt and sadness as you try to help. For your own health, you may want to seek professional help to deal with emotions and feelings without reflecting negatively on the person that you are trying to help.

Remember, you cannot fix someone with depression. You can only be there to guide, encourage and understand.

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How do you handle comments about suicide?

Sometimes, people who are depressed or going through a hard time will make comments about "ending it all" or "not being here anymore".

Don't ignore these comments.

Instead, Michelle Nelson, LCSW, mental health unit, Ascension Saint Michael's Hospital in Stevens Point says that we should ask more questions and listen. Find out if there is actually a plan in place. Ask them the question, "Are you thinking about killing yourself?" If the person says "yes," call 911 and stay with him or her until help arrives.

"It goes back to the whole idea of being with someone and listening to that person," said Shawn Pflugardt, PsyD, Psychologist, Ascension Koller Behavioral Health. "Don't rush the person, which is a normal response for someone who is hearing about suicidal tendencies. Just remember, Q-P-R question, persuade and refer."

Dr. Pflugardt says you should not be surprised if your conversation takes some interesting directions. You may get into discussions about self-harm, like cutting or drinking too much. While those behaviors may indicate a need for help, they don't mean the person is suicidal. It just means the person is experiencing intense emotional pain and trying to deal with it.

"People have a great deal of anxiety when someone talks about suicide," said Nelson. "But, the truth is if you get involved, you may prevent a suicide. If you think or see signs that a person might be suicidal, ask them. You will not put thoughts in their head; that's a complete myth. Odds are if you are thinking the person is at risk of committing suicide, they have probably already thought about it too."

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Find help for yourself or someone else

In the Ascension Saint Clare's Hospital and Ascension Good Samaritan Health Center service area, talk to your primary care clinician, call the Crisis Hotline at 715.845.4326; call 800.273.TALK or chat at www.suicidepreventionlifeline.org. You will remain anonymous and will be connected to local resources.

In the Crandon, Eagle River, Rhinelander, Tomahawk and Woodruff service area, contact Ascension Behavioral Health for services in all our northern region communities. For the location nearest you, please call 800.779.2881.

In the Ascension Saint Michael's Hospital service area, talk to your primary care provider or call the Portage County Crisis Line at 866.317.9362; the National Crisis Line at 800.273.TALK; or visit www.suicidepreventionportagecounty.org. You will remain anonymous and will be connected to local resources.

In the Saint Elizabeth's Medical Center service area, talk to your primary care clinician or call Hiawatha Valley Mental Health Center, Wabasha, 651.565.2234; or Associates in Psychiatry & Psychology, Wabasha, at 507.288.8544.

In the Ascension Our Lady of Victory Hospital service area, talk to your primary care provider or call the Crisis line at 715.384.5555 or 715.421.2345. Call 800.273.TALK or chat at www.suicidepreventionlifeline.org. You will remain anonymous and will be connected to local resources.

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