***Recognizing Depression's Warning Signs

Depression is a serious illness, not a harmless part of life. It is a complex disorder with a variety of causes. It is never caused by just one thing. It may be the result of a mix of factors, including genetic, chemical, physical, and sociological. It is also influenced by behavior patterns learned in the family and by cognitive distortions. Depression affects millions of people in this country. It is always troubling, and for some people it can be disabling. Depression is more than just sadness or "the blues." It can have an impact on nearly every aspect of a person's life. People who suffer from depression may experience despair and worthlessness, and this can have an enormous impact on both personal and professional relationships. In this newsletter, I will describe many of the factors that may cause depression, and I will explore strategies for preventing it. Depression Is Pervasive When a person suffers from depression, it can affect every part of his or her life, including one's physical body, one's behavior, thought processes, mood, ability to relate to others, and general lifestyle. Symptoms of Depression People who are diagnosed with clinical depression have a combination of symptoms from the following list:

• Feelings of hopelessness, even when there is reason to be hopeful
• Fatigue or low energy
• Much less interest or pleasure in most regular activities
• Low self-esteem
• Feeling worthless
• Excessive or inappropriate guilt
• Lessened ability to think or concentrate
• Indecisiveness
• Thinking distorted thoughts; having an unrealistic view of life
• Weight loss or gain without dieting
• Change in appetite
• Change in sleeping patterns
• Recurrent thoughts of death
• Suicidal thoughts
• A specific plan for committing suicide
• A suicide attempt
• Feelings of restlessness or being slowed down

When a person is suffering from depression, these symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. This means that the person's family and social relationships, as well as work life, are impaired. When a person is suffering from depression, symptoms such as these are not the result of a chronic psychotic disorder, substance abuse, general medical condition, or bereavement. Grief, Sadness, and Depression Depression may include feelings of sadness, but it is not the same as sadness. Depression lasts much longer than sadness. While depression involves a loss of self-esteem, grief, disappointment and sadness do not. People who are depressed function less productively. People who are sad or disappointed continue to function. Depression and Socioeconomic Factors Depression does not seem to be related to ethnicity, education, income, or marital status. It strikes slightly more women than men. Some researchers believe that depression strikes more often in women who have a history of emotional and sexual abuse, economic deprivation, or are dependent on others. There seems to be a genetic link; depression is more common among parents, children, and siblings of people who are diagnosed with depression. The average age at the onset of a depressive episode is the mid-20s. People born more recently are being diagnosed at a younger age. Physical Causes Many physicians believe that depression results from a chemical imbalance in the brain. They often prescribe antidepressant medication, and many people find relief as a result. However, there is no reliable test to identify such a chemical imbalance. It is unknown whether life experiences cause mood changes, which create changes in brain chemistry, or whether it works in reverse. Depression may be associated with physical events such as other diseases, physical trauma, and hormonal changes. A person who is depressed should always have a physical examination as part of the assessment process to determine the role of physical causes. Signs That Professional Treatment Is Needed If you or someone you know is depressed and exhibits any of the following signs, it is extremely important to seek the assistance of a medical or mental health professional. 1. Thinking about death or suicide. This is always dangerous and you should see a professional therapist immediately. 2. When symptoms of depression continue for a long time, you may need professional help. Acute responses to events are normal, but they should not last beyond a reasonable time. 3. Your ability to function is impaired by your depression. Seek help before your life situation deteriorates to a serious level. 4. You have become so isolated that you have no one with whom to check reality. Seek out someone to share your thoughts and feelings with. 5. Depressive symptoms have become severe.