When the moods would hit, he would go downstairs with a shovel and move that pile of dirt from one side of the basement to the other, one shovelful at a time. After a while, he would start feeling better. I have a sneaking suspicion that Charles might have been diagnosed with depression if he had had the opportunity to see a modern mental health professional.
What is Depression?
There is a range of symptoms that fall into the general definition of depression. People often describe feeling “down” or “blue.” Other signs of depression may include having trouble getting out of bed, of finding a reason to live.
Severe depression can be life-threatening, as a person may become dissociated and unintentionally a threat to self or others through inattention (i.e. while driving), or suicidal or intent on harming themselves.
A Note About Suicidal Ideation (SI)
There are two categories of suicidal ideation, passive and active:
This is where a person has an undefined desire for life to end. He or she may think “I kind of want to drive into that tree,” but what they’re really saying is, “I want my current suffering (whether emotional or physical) to end.” They don’t intend to actually do it, they’re just wishing they had an acceptable way out.Passive SI can also take the form of wishing to go to heaven or that “Jesus would come back.” Passive SI is more vague and non-committal. If we dwell on thoughts of passive SI, we can escalate into active SI, so it is good to disrupt passive SI as soon as you realize it is in play. Cycling on the negative thought will only lead to escalation.
This is where a person has both intent and a plan to carry out the suicide. If you have active SI, this is a medical emergency and you should call 911 or go to the emergency room and tell them you are struggling with suicidal thoughts.
Suicidality often follows a pattern, where the person begins to avoid thinking about the things that are bothering them significantly, then moving to escape fantasies (like quitting job or marriage and running away), then passive SI (as described above), and then active SI.
If active SI has gone on for more than 5 minutes and you can’t shake it off, call or go for help. IMPORTANT: if you have been down this path before, it will be easier to get to the danger zone more quickly, sometimes very quickly.
When assessing danger to self, consider these four indicators:
1) Immanency – how soon are you inclined to do it? “In six months, if things haven’t improved” is a call to a counselor to try and get things straightened out. “As soon as I get home tonight,” is a call to 911 or a trip to the ER.
2) Consider intent, plan, means – on a scale of 10, how serious am I about carrying this out? Do I have a plan for doing it? Do I have the means?
3) History – Have I been here before? As mentioned above, a history of SI makes it easier to move through the pattern quickly and end up at active SI.
4) Avoidance – avoiding our significantly distressing feelings, denying them, distracting from them, is probably the best indicator that we are on a path that, if uninterrupted, may eventually lead to suicidal ideation.
Middle-aged men age 45 to 65 have the highest incidence of completed suicides. Women age 25 to 40 have the highest % of attempts that do not end in completion. The elderly are the next at risk group, with adolescents next. Adolescents are developmentally more impulsive so immediate involvement of authority is critical; parents, pastor, foster parents, police, or legal guardian.
Some of the more susceptible populations include military, bipolar, psychosis, bullied/victimized populations, victims of substance use/abuse. If you are in any of these groups, be aware that you are at greater risk of SI leading to self-harm.
Signs of Depression: What the DSM-V Says
It is useful when trying to understand how significant our depression is, to have an idea what a clinical diagnosis looks like, and some of the signs of depression that go into making a diagnosis:
Major Depressive Disorder
Five (or more) of the following symptoms have been present during the same two week period and represent a change from previous functioning; at least one of the symptoms is either, (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical condition.
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful).
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, and nearly every day (as indicated by either subjective account or observation).
- Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% body weight in a month), or decrease or increase in appetite nearly everyday. (Note: in children, consider failure to make expected wait gain.)
- Insomnia (not sleeping) or hypersomnia (too much sleep) nearly every day.
- Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as by others).
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt, or a specific plan for committing suicide.
- The symptoms caused clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The episode is not attributable to the psychological effects of a substance or to another medical condition
Contributors and Workarounds
Sometimes depression comes on and we don’t feel like we know the cause. Some people slide into depression when the weather changes (Seasonal Affective Disorder), others feel depressed after the high from eating sugar wears off. Look for patterns.
You may find out something you’re eating, or watching, or some change at work or in a significant relationship is triggering you behind the scenes and contributing to the severity of your symptoms. If you are depressed, you don’t have to just sit down and suffer.
In fact, one of the worst things you can do with depression is nothing. You may feel like sitting in the dark and not moving, but it isn’t going to help your depression.
Here are a few workarounds that depression sufferers have reported some success with in lessening their symptoms:
Get Some Fresh Air
If the weather is cooperating, go outside and take some deep breaths. One of the side effects of depression can be a sense that the walls are closing in. Changing the view breaks up that sensation and at the very least gives our mind something different to look at.If you are working in a cubicle or at a desk, set the timer on your watch for 50 minutes and when it goes off, go outside and take a few deep breaths. It only takes a few minutes and it can refresh your body and may lessen your signs of depression.
Take a Walk
Exercise can be an effective way to lessen signs of depression. Here again, outside is better, but indoors if fine if it’s the only option. Running, riding a bike, or walking, it makes no difference. The important thing is to be outdoors and be active.
Inactivity can contribute to our feelings of depression because our body stores up energy when we sit, and when there’s no way to release it, we can feel a little jittery and not even know it, and even try to suppress it. This can actually contribute to the sense that the walls are closing in. Get up. Get out. Take a walk. Take some deep breaths.
Breathing and Mindfulness
Find a place you won’t be disturbed, sit comfortably with your arms at your sides and feet on the floor. Notice your breathing. Breath in through your nose and out through your mouth, three seconds in, hold for three, out for three. Keep the breathing going and locate yourself in the room.
Notice the things on the walls, shapes, textures, colors. As you continue your breathing, think, “I am here, now. The past is the past, it’s not happening now. The future is not written, it’s not happening now. All I have is now. And for right now, I don’t have anywhere else to be, I don’t have anything else to do, and I have nothing I am responsible for.” This can help with anxiety, too if you are experiencing any.
Review Your Intake
There are a number of clichés that seem appropriate here. You are what you eat. Garbage in, garbage out. We are what we repeatedly do. Look at the things you are eating, your sleeping habits, what you watch.
Notice if your favorite show increases your feelings of depression. Notice if that third can of diet soda makes you feel a little gross. Notice if your sugar, carbohydrate, or alcohol consumption increases your feelings of depression.
I know sometimes we feel like if we hear one more person talk about the importance of diet and exercise, we’re gonna scream, but there’s a reason so many people talk about it; it can make a difference. If the things you are allowing into your body and mind are contributing to your depression symptoms, its worth looking at. Then the challenge is actually making a change.
Be Curious and Kind to Yourself
When our steps are dogged by something we think we should be able to change, it can be very frustrating when resistance crops up. If you try to change your eating habits or try to start exercising regularly and it’s hard, don’t beat yourself up.
One of the most common symptoms of depression is not wanting to do anything. Add to that whatever emotional or congenital influences are at work behind the scenes, and motivation can get pretty complex pretty fast. A licensed mental health professional can be a great help in trying to understand the underlying emotional structure that drives our behavior.
Because it can be so debilitating, depression sufferers may be inclined to put off going to the doctor, or therapist, or psychiatrist. The longer it goes on, the harder it may be to do anything about it. You have to be able to clear your head enough to make a choice to get help.
A doctor can help you sort out somatic contributors and prescribe medication if appropriate. A therapist can help you understand how your traumatic narratives might be influencing your current functioning, and a psychiatrist can do all of that and prescribe medication.
You may be averse to taking pills for an emotional problem, but if your symptoms are moderate to severe and don’t respond to workarounds, there is medication out there that has proven effective in managing signs of depression. The sooner we get the help we need, the sooner we can begin moving toward growth and health.
“Handsome Guy,” courtesy of andy, CC0 Public Domain, ABSFreePic.com; “Fearless,” courtesy of Tegan Mierle, unsplash.com, CC0 License; “Look at Me,” courtesy of Christopher Campbell, unsplash.com, CC0 License; “Fresh Air,” courtesy of Anthony Delanoix, unsplash.com, CC0 License