COUNSELING AND PSYCHIATRIC SERVICES

DEPRESSION

Am I depressed - or is it something else?

Our mood naturally varies with time and from day to day and everyone gets down at times. We may say that we are "down", "fed up", or "feeling blue", or attribute it to "feeling under the weather"; we may get disheartened about something that happens or doesn’t go the way we would have liked. Although people often say "I'm depressed" to mean these things, this experience would likely not be diagnosed as depression as it is simply part of the normal ups and downs of life. Some people naturally experience frequent mood changes, while others have a relatively stable equilibrium.

Similarly, if we suffer a major loss, we readily understand that it is normal to grieve. Although some of the emotions we feel when we are bereaved appear similar to depression, grieving is a natural and ultimately healing process. Sometimes, though, past losses which were not fully mourned at the time may appear as depression much later.

So, what is depression?

Put simply, the distinction between feeling "down" and being depressed is one of both degree and duration. Depression certainly includes a persistent low mood and loss of interest or pleasure in life; it also commonly involves symptoms from the following list:

a change in eating, weight and/or sleep patterns
lowered energy levels and a reduced level of physical activity
difficulty with concentration
feelings of worthlessness
loss of interest, enthusiasm and enjoyment
feeling irritable and short-tempered, or tearful
being unable to continue as usual with work and interests, possibly as a result of feeling listless, (e.g., “I cannot be bothered" or “things feel pointless”).
sometimes people feel hopeless; s/he may feel like life is not worth living and may even have thoughts of suicide.

Please note that one may feel some of the above for reasons other than depression, or even several together for a brief while, without this being of major concern. Someone who is depressed will experience a number of these changes persisting for quite some while.

Nonetheless, depression is very common. Depression affects people of all ages and backgrounds. Women are twice as likely as men to develop depression and it is one of the most common reasons for people seeking help from counselors or medical doctors.

Why do people get depressed?

Often depression is a response to events or circumstances that are felt to be deeply troublesome or distressing, or which seem to threaten our personal identity. Usually these circumstances seem too hard or even impossible to change. There can be a sense of powerlessness, hopelessness and an all-pervasive gloom.

However, sometimes people seem to become depressed for no obvious reason. In these cases, it may be that something that hurt deeply some time ago (even years ago) begins to surface now. Although this is perplexing and just as distressing, this process is not uncommon. Sometimes, though, the onset of depression may be caused by nothing other than chemical/hormonal changes affecting our body-chemistry.

It is understandable to feel down for a while after something upsetting has happened. For example, after a relationship has ended or upon feeling disappointed that one may have not performed up to his/her ability, a person’s disappointment usually passes with time, and the person finds the ability to come to terms with what has happened and start to look forward to the future in a more positive way. However, if the low mood persists or seems so severe that it affects one’s ability to function normally, it is time to seek out some help.

Negative thinking

When people are depressed they usually find themselves thinking very negative thoughts about themselves and the world; typically these thoughts are considered to be absolutely true with there being no way of things ever changing. However, studies have shown that when people are no longer depressed, they go back to seeing things in a more positive and balanced way.

Negative thoughts affect the way people feel; therefore, seeing things in a strongly negative way will exacerbate feelings of depression. Negative thoughts are usually:

about yourself:
- nobody likes me
- I am doing really badly on this course
- I am a fraud - I should not be here
- nobody will ever want to have a relationship with me
about your situation:
- Dallas is a horrible place
- I will never be able to do all the work
- I have nothing in common with anyone here
and/or about the future:
- it's hopeless
- things will never get any better
- I am always going to feel like this

Situations which people describe as making them vulnerable to becoming depressed include -

feeling lonely and thinking that nobody cares much about them
finding work difficult
thinking that they are a failure.

How to help yourself

There are some things you can try which have been shown to help lift a depressed mood. These involve changing your behavior and challenging your negative thoughts.

Changing behavior

People who are depressed often stop doing pleasurable activities which would make them feel better in the short term, for example they may stop going out, opt out of regular sporting activity, or stop going to see friends or to lectures. Encourage yourself to start doing things again. Activity can lift your mood and you may well find that you can do things better than you fear. Most activities will be helpful, but enjoyable activities and physical exercise/sport are particularly effective. If you usually enjoy going to the movies or swimming, for example, try starting with these things.

break tasks down into steps or manageable "chunks" and tackle these one at a time. Although it may not seem so to you, you will probably be able to do things just as well as when you are not depressed
Start with easier tasks and then progress to more difficult ones; this will help you to regain your confidence
Be realistic and allow yourself more time to do fewer things
Allow yourself to feel pleasure at what you have achieved and reward yourself for each achievement
It is very important to spend time with people who are supportive. Isolating yourself increases depression, while social support helps lift a low mood
Find people with whom you can be honest about how you are feeling, and with whom you do not have to put on any pretence; however, don't take up all of their time.

Changing negative thoughts

As already stated, there is a link between negative thoughts and increased feelings of depression. If you are not aware of any specific negative thoughts and are confused about why you are depressed, you may find it helpful to talk with someone. A trained psychologist can help you understand the depression and find the most effective and appropriate ways of dealing with what you are experiencing.

There are different ways of challenging your thoughts. One way is to use a structured cognitive approach (such as described here) which involves being aware of your negative thoughts and allowing yourself to consider alternative explanations for your situation. Some examples are given in the table below.

Situation	Negative thoughts	Other explanations
Getting critical feedback for an essay	I am stupid	I didn't have much time to do this essay - the workload has been very heavy recently. I chose to do other things as well. The work is supposed to be challenging. Constructive criticism helps me to improve. I've done well in the past - which shows I can do well.
My partner does not want to see me tonight.	He/She doesn't care about me any more.	He/She said he/she had to work tonight - this is most likely true. We saw each other at the weekend and had a good time. He/She said some nice things to me lately and seemed caring the last time we met.

Do not automatically believe your negative thoughts no matter how strong they feel at the time. By considering other explanations, your at worst "possible" conclusion will be seen as only one of a number of possible explanations for your situation. This allows you to consider each explanation and see which is most likely to be true, or to try to collect "evidence" which will help you to test the different explanations. If you feel it is appropriate, try talking to other people to help you get a balanced perspective on which are the most likely explanations.

Medication

Modern antidepressant medication is not chemically addictive and can be safely taken over extended periods of time. Usually it takes two to three weeks before having any beneficial effect.

Physicians will probably remind you that medication of this kind is not in itself a cure. If there are difficult circumstances contributing to your depression, medication won't make them go away, but it may help you to rediscover your natural abilities to address these issues.

If you feel medication may be an appropriate way forward, you will need to speak to your physician. Be as open as you can with her/him about how you feel and your circumstances, so that you can decide together on the best course of action. It is important that you only change your use of medication after talking to your physician.

When to seek further help

If your low mood and negative thoughts persist or are so strong that you feel powerless to do anything about them
If you have nobody to confide in who can help you look at why you are feeling depressed
If your low mood is interfering with your life, work or relationships
If you experience feelings of hopelessness or feel suicidal.

Where to seek help

Come to University Counseling and Psychiatric Services to talk to one of the counselors or psychiatrists
Talk to your physician who can discuss the range of treatments available to you, including medication
If you feel really desperate and despairing outside of normal working hours, call 214-768-2277 and a trained clinician will be available to talk to you.