My friend says she's bipolar. What is that?

Q: My friend has these crazy moods that go from being depressed to having lots of energy. She says she is bipolar. What is that?

A:  Everyone has ups and downs in mood. Feeling happy, sad and angry is normal. Bipolar disorder, or as it used to be called, manic-depressive illness, is a serious medical condition that causes people to have extreme mood swings and it affects how people think and behave.

Bipolar disorder usually consists of three states:
1. High state called mania
2. Low state called depression
3. Well state - feel normal and function well  

Bipolar Disorder (manic-depressive) is much less common than major depression but it's important to understand that it is different. Bipolar disorder is distinctive by the dramatic changes in mood, energy and behaviour including cycling mood changes of extreme highs (mania), mixed episodes, extreme lows (depression), and periods of normal functioning (wellness) which can last from hours to months at a time. Bipolar disorder affects approximately 1% of the population, typically starting in late adolescence or early adulthood, usually between ages 15 – 25, and affects men and women equally. The exact cause is unknown, but it occurs more often in relatives of people with bipolar disorder.

Bipolar disorder is commonly misdiagnosed as depression. One of the reasons is that most people with bipolar disorder seek help when they’re in the depressive stage of the illness. When they’re in the manic stage, they don’t recognize the problem. What’s more, most people with bipolar disorder are depressed a much greater percentage of the time than they are manic or hypomanic. Being misdiagnosed with depression is a potentially dangerous problem because the treatment for bipolar depression is different than for regular depression. In fact, antidepressants can actually make bipolar disorder worse.

In a depressed phase, people with bipolar disorder may have some or most of the symptoms of major depression. When in a manic phase, which may last from days to months, people with bipolar disorder can be extremely energetic, active, talkative, and irritable and often talk about big plans for fame or success which often gets them into trouble. They can also get into trouble because of their increased interest in sex and sexual activity, and wanting to spend lots of money.

After an initial episode, people with bipolar disorder usually experience alternating periods of mania, depression and wellness for the rest of their lives. There is currently no cure for bipolar disorder. But staying with treatment, even when you’re feeling well, can help keep the condition under control and reduce the chance that the episodes will worsen over time.

Bipolar disorder is mainly treated with medication and psychotherapy. Medication helps to stabilize moods, while therapy helps people detect patterns and triggers and develop strategies for managing stress.

Only recently has there been an increasing acceptance that children can have Bipolar disorder because of the difficult diagnosis symptoms that overlap with other disorders and the course of the disorder in children is often quite different. However, Bipolar disorder among children is generally treated in much the same way as it is among adults, with a combination of therapy and medication.

Types of Bipolar Disorder

Bipolar disorder is actually a spectrum of disorders, usually measured in terms of severity and duration of mania and one disorder that combines symptoms of both bipolar disorder and schizophrenia.

The spectrum runs from:

Severe mania – hypomania – normal mood – mild depression - severe depression

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Bipolar I Disorder (mania or a mixed episode) – The classic manic-depressive form of the illness, characterized by at least one manic episode or mixed episode. Usually—but not always—Bipolar I Disorder also involves at least one episode of depression.

Bipolar II Disorder (hypomania and depression) – In Bipolar II disorder, the person doesn’t experience full-blown manic episodes. Instead, the illness involves episodes of hypomania and severe depression.

Cyclothymia (hypomania and mild depression-sometimes called Bipolar III disorder) Cyclothymia is a milder form of bipolar disorder. It consists of cyclical mood swings. However, the symptoms are less severe than full-blown mania or depression.

Hypomania: Hypomania is a less severe form of mania. People in a hypomanic state feel euphoric, energetic, and productive, but they are able to carry on with their day-to-day lives and they never lose touch with reality. To others, it may seem as if people with hypomania are merely in an unusually good mood. But it can escalate into full-blown mania or be followed by a major depressive episode.

Schizoaffective Disorder: Schizoaffective disorder combines symptoms of bipolar disorder with symptoms of schizophrenia, including hallucinations.

Symptoms

A Manic Episode condition:

• An elevated mood is a mood described as feeling “high” or “on top of the world”.
• An expansive mood is a mood where someone shows little restraint in expressing one’s emotions, has an exaggerated sense of one’s own abilities and is easily agitated.
• An irritable mood is unfortunately poorly defined in the DSM IV .It is a folk concept referring to easy provocation to anger and aggression.

In addition to these one of these three types of moods, one must also have at least three of the following symptoms (or four if the mood is irritable):

• They can have an inflated sense of self-esteem and feel that they are far more important than they actually are which can become delusional, like believing that they are very important people or have some special mission.
• People in manic episodes will often stop sleeping, sometimes nearly entirely. They simply never get tired and are unable to rest. When they do rest, they may feel that they are completely rested after only a few hours sleep, but in reality they are becoming sleep-deprived and physically exhausted.
• They may become extremely talkative, making it difficult to have conversations with them, as they may not let you talk. They often talk very fast too called pressured talk. Where there speech just can’t keep up with their thoughts and they trying to push out words as quickly as possible.
• Manic people’s thoughts and ideas race through their minds incredibly quickly and they often become incoherent and they may feel like they have no conscious control over how fast they come and go.
• They are often easily distracted. The person focuses on small things others wouldn’t notice but may not see the “big picture”.
• People in manic episodes especially “driven and will tend to work toward specific goals, which are often unattainable.
• Someone in a manic state usually finds it difficult to sit still, and will feel uncomfortable doing so. They may constantly fidget, scratch continuously or rock back and forth.
• They will often excessively engage in a number of pleasurable activities such as shopping, gambling or sex, but significantly underestimate or ignore the consequences.

Bipolar Disorder and Suicide

Bipolar disorder has one of the highest rates of suicide among mental illnesses The depressive phase of bipolar disorder is often very severe and suicides usually take place during depressive states or mixed states. In fact, people suffering from bipolar disorder are more likely to attempt suicide than those suffering from regular depression. In addition, their suicide attempts tend to be more lethal.

The risk of suicide is even higher in people with bipolar disorder who have frequent depressive episodes, mixed episodes, a history of alcohol or drug abuse, a family history of suicide, or an early onset of the disease, so it is important to be aware and seek help if you need it from a distress center, suicide line or other trusted person.

What causes Bipolar Disorder?

It is not known what causes bipolar disorder. Research suggests that it tends to run in families and drug abuse and stressful or traumatic events may contribute to or trigger episodes as well.

What are the triggers for Bipolar Disorder?

Bipolar disorder also has what is called an “onset”. Often times, this first onset is especially severe. Most people with bipolar disorder don’t simply become manic at random. Instead, there are standard triggers that bring about the “onset” of the disorder, which is the first of usually many episodes.

The disorder makes people more vulnerable to emotional and physical stress. As a result, stresses, such as upsetting experiences, substance use or lack of sleep, can trigger episodes, even though they do not actually cause the disorder. These things do not cause the illness but they can trigger or set off new episodes of mania or depression or make existing symptoms worse. However, many bipolar disorder episodes occur without an obvious trigger.

• Stress – Stressful life events can trigger bipolar disorder in someone with a genetic vulnerability.
• Substance Abuse – While substance abuse doesn’t cause bipolar disorder, it can bring on an episode or make the disease worse. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression.
• Medication – Certain medications, especially antidepressant drugs, can trigger mania as well as common things like cold medicine and caffeine.
• Seasonal Changes – Episodes of mania and depression often follow a seasonal pattern. Manic episodes are more common during the summer, and depressive episodes more common during the fall, winter, and spring.
• Sleep Deprivation – Loss of sleep—even as little as skipping a few hours of rest—can trigger an episode of mania           

What can you do?

While medication is an important part of treating bipolar disorder, a combination of medication and therapy is far more likely to help people prevent relapses and to provide a better life overall.

It is important to remember that depression and bipolar disorder are treatable. Friends and family can be supportive by learning all they can about the condition affecting their loved one. If you spot the symptoms of bipolar depression in yourself or someone else, don’t wait to get help. Ignoring the problem won’t make it go away; in fact, it will almost certainly get worse.

What are the things I need to do to get well? 

The most effective treatment is a combination of medication and psychotherapy. There are also certain lifestyle choices that can help:

• Stick to your treatment plan. Don’t skip psychotherapy sessions. Even if you’re feeling well, continue to take medication as prescribed.
• Pay attention to the warning signs. Find out what triggers episodes. Make a plan so that you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes. Ask friends or family to watch out for warning signs.
• Get exercise. Physical activity reduces symptoms of depression. Consider walking, jogging, swimming, gardening, or any other physical activity.
• Medication – Medication is the cornerstone on bipolar disorder treatment. Taking a mood stabilizing medication can help minimize the highs and lows of bipolar disorder and keep symptoms under control.
• Psychotherapy – Therapy is essential for dealing with bipolar disorder and the problems it has caused in your life. Working with a therapist, you can learn how to cope with difficult or uncomfortable feelings, repair your relationships, manage stress, and regulate your mood.
• Get educated. Learn as much as you can about bipolar disorder. The more you know, the better you’ll be at assisting your own recovery.
• Make healthy choices. Healthy sleeping, eating, and exercising habits can help stabilize your moods. Keeping a regular sleep schedule is particularly important, avoiding alcohol and drugs, following a consistent exercise program, minimizing stress, and keeping your sunlight exposure stable year round.
• Seek support. It’s important to have people you can turn to for help and encouragement. Try joining a support group or talking to a trusted friend.
• Keep stress in check. Avoid high-stress situations, maintain a healthy work-life balance, and try relaxation techniques such as meditation, yoga, or deep breathing.
• Monitor your moods. Keep track of your symptoms and watch for signs that your moods are swinging out of control so you can stop the problem before it starts.

What are Anxiety Disorders?

Q: A lot of my friends talk about having anxiety problems. Are they all the same thing?

A: No. Although they are all grouped into a category called Anxiety disorders, and have a common theme of anxiety attached to them, these anxieties affect people and their behaviors in different ways.

Anxiety disorders are the most common of all mental health problems. They are more prevalent among women than among men, and they affect children as well as adults. Anxiety disorders are illnesses. They can be diagnosed and they can be treated. But all too often, they are mistaken for mental weakness or instability, and the resulting social stigma can discourage people with anxiety disorders from seeking help. It is common for people to suffer from more than one anxiety disorder; and for an anxiety disorder to be accompanied by depression, eating disorders or substance abuse.

What is anxiety?

Anxiety is a natural response to a stressful or dangerous situation. The body reacts to a situation with a racing heart, sweaty palms and shortness of breath. For those with an anxiety disorder, this reaction is more intense, occurs frequently and can last hours, even days.

Anxiety may coexist with depression or bipolar disorder and make coping more difficult. It is important that symptoms of anxiety and a mood disorder be treated.

What causes anxiety disorders?

There are no clear-cut answers as to why some people develop an anxiety disorder, although research suggests that a number of factors may be involved. Like most mental health problems, anxiety disorders appear to be caused by a combination of biological factors, psychological factors and challenging life experiences, including:

•        stressful or traumatic life events

•        a family history of anxiety disorders

•        childhood development issues

•        alcohol, medications or illicit substances

•        other medical or psychiatric problems.   

Anxiety disorders include: Panic Disorder with or without Agoraphobia, Social and Specific phobias, PSTG or Post Traumatic Stress Disorder, OCD or Obsessive Compulsive Disorder and GAD or General Anxiety Disorder. 

 I will talk briefly about a few of them here.

Types of Anxiety

Panic Disorder and Agoraphobia

Panic disorder is a real illness that is characterized by sudden attacks of terror, usually accompanied by a pounding heart, sweatiness, weakness, faintness, or dizziness. During these attacks, people with panic disorder may flush or feel chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain, or smothering sensations. Panic attacks usually produce a sense of unreality, a fear of impending doom, or a fear of losing control.

The signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. Most panic attacks end within 20 to 30 minutes, and they rarely last more than an hour. Panic disorder is twice as common in women as men often beginning in late adolescence or early adulthood but not everyone who experiences panic attacks will develop panic disorder. Many people have just one attack and never have another.

The cause of panic disorder is unclear but it does tend to run in families. There also appears to be a connection with major life transitions or from severe stress.

A full-blown panic attack includes a combination of the following signs and symptoms:

Shortness of breath or hyperventilation Heart palpitations or a racing heart Chest pain or discomfort Trembling or shaking Choking feeling Feeling unreal or detached from your surroundings

Sweating Nausea or upset stomach Feeling dizzy, light-headed, or faint Numbness or tingling sensations Hot or cold flashes Fear of dying, losing control, or going crazy

While a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life

Panic attacks may progress into Agoraphobia which is being afraid of having a panic attack in a situation where escape would be difficult or embarrassing or where you wouldn’t be able to get help. It may cause you to avoid many situations like crowded places such as shopping malls cars, airplanes or subways. In severe cases, you might only feel safe at home and be scared to leave the house at all.

Panic disorder is often accompanied by other serious problems, such as depression, drug abuse, or alcoholism.

Phobias - Phobias are divided into two categories: Social phobia, which involves fear of social situations, and Specific phobias, such as fear of flying, blood and heights.

Social phobia is the diagnoses of a person being excessively anxious and self-conscious in everyday social situations. People with social phobia have an intense, persistent, and chronic fear of being observed and judged by others doing something that will embarrass them. They may worry long before the situation occurs and may become so severe that it interferes with your daily activities. Many people with social phobia understand that their fears are excessive or unreasonable but they are unable to overcome them. Even if they manage to confront their fears and be around others, they are usually very anxious beforehand, they are intensely uncomfortable throughout the encounter, and they worry about how they may have been judged for hours after the situation or event has passed.

Physical symptoms that often accompany social phobia include blushing, profuse sweating, trembling, nausea, and difficulty talking. When these symptoms occur people with social phobia feel as though all eyes are focused on them and they are the center of everyone’s attention.

Women and men are equally likely to develop the disorder, which usually begins in childhood or early adolescence. Social phobia is often accompanied by other anxiety disorders or depression, and substance abuse may develop if people try to self-medicate their anxiety.

Specific Phobias - People suffering from a specific phobia are overwhelmed by unreasonable, irrational fears, which they are unable to control. Exposure to feared situations can cause them extreme anxiety and panic, even if they recognize that their fears are illogical. A specific phobia is an intense, irrational fear of something that poses little or no actual danger such as heights, escalators, tunnels, highway driving, water, flying or dog. Facing them or even thinking about them, result in bring on a panic attack or severe anxiety. Symptoms can include sweating, muscle tension, dizziness, or a need to escape.

Generalized Anxiety Disorder - GAD is characterized by excessive and uncontrollable anxiety and worry about events or activities, experienced most days for a period of at least six months. The person will anticipate the worst possible outcomes, even if there is no reason to expect such an outcome.

Worries, doubts, and fears are a normal part of life and it’s natural to be anxious about things sometimes but the difference for those suffering with generalized anxiety disorder (GAD) is that the worrying is excessive, intrusive, persistent and disabling.

People with GAD can’t seem to dispose of their concerns, even though they realize that their anxiety level is higher than the situation calls for. Their day is filled with exaggerated worry and tension with little or nothing to provoke it. They anticipate disaster and are excessively worried about any number of issues like, health, money, family work.

Psychological symptoms:

·         Your worrying significantly disrupts your job, activities, or social life.

·         Worrying is uncontrollable.

·         Worries are exceptionally distressing and stressful.

·         Worry about a variety of things, and seem to expect the worst.

·         Worrying almost every day for at least six months.

·         Can’t seem to relax,

·         Startle easily,

·         Have difficulty concentrating

·         Have trouble falling asleep or staying asleep.

Physical symptoms:

·         Feeling exhausted and tired all the time

·         headaches

·         Muscle aches or muscle tension

·         Trembling or twitching,

·          Irritable

·         Sweating,

·         nausea,

·         Lightheadedness,

·         Frequently having to go to the bathroom

·         Feeling out of breath,

·         Hot flashes.

GAD affects about twice as many women as men. The disorder develops gradually and can begin at any point in life but the years of highest risk are between childhood and middle age. GAD rarely occurs alone and is often accompanied by other anxiety disorders, such as depression, or substance abuse.

Treatments

When to seek professional help for anxiety disorders

While self-help coping strategies for anxiety can be very effective, if your worries, fears, or anxiety attacks have become so great that they’re causing extreme distress or disrupting your daily routine, it is important to seek professional help.

However, most experts agree that the most effective form of treatment for the anxiety disorders include medication, Cognitive Behavioral Therapy (CBT), along with exposure therapy. Many people with anxiety disorders also benefit from the addition of supportive counseling or family therapy.

Once you start to recover it is important to be proactive and work on things to prevent a relapse. Anxiety is not an illness that has a specific cure. Medication and therapy can help to keep symptoms under control, while the person receives therapy, but many symptoms of anxiety, like worrying and fear, occur for almost everyone during everyday life. Therefore it is important to be ready with a plan to manage symptoms as they appear.

What is Cognitive Behavioral Therapy: CBT has been found to be effective for all the anxiety disorders and is the first-choice psychological treatment for anxiety disorders.

CBT is a problem-focused treatment that allows the individual to change unproductive thought patterns and gain control over unwanted behaviours. An important part of CBT is helping people with anxiety disorders to identify, question and correct their tendencies to overestimate danger and their perceived inability to cope with danger. The cognitive part helps people change the thinking patterns that support their fears, and the behavioral part helps people change the way they react to anxiety-provoking situations.

With therapy and repeated practice, people can develop skills that enable them to identify anxiety-related thoughts and beliefs, identify common distortion in their thinking, examine the evidence that supports and does not support their fearful appraisals, and develop less-threatening alternative responses to the feared object or situation.

Specific CBT techniques for people with panic disorder, for instance, can benefit from breathing retraining, which shows them how to slow their breathing and use meditation when they're feeling anxious.

Exposure therapy: When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties. Exposure therapy is also known as desensitization treatment, is a systematic process wherein an individual with a fear or phobia is taught relaxation techniques and is then gradually exposed to the object of fear in a controlled situation until it can be tolerated. This is done either directly or through the person’s imagination, to his or her feared situation that triggers anxiety. Over time, the fear reaction is neutralized.  

The theory of exposure therapy is that by practicing exposure to their fears, people have the opportunity to learn that their fears are excessive and irrational, and that the anxiety decreases with more and more practice.

Additional therapies

Support groups and educational resources can also be included in treatment. Anxiety disorders place a great burden on the individuals affected, their families and their friends. Learning all you can about the particular condition touching your life can help you develop tools for living with an anxiety disorder, or living with someone who has an anxiety disorder.

Many people with anxiety disorders benefit from joining a self-help or support group and sharing their problems and achievements with others. Talking with a trusted friend or member of the clergy can also provide support, but it is not a substitute for care from a mental health professional.

Other things you can do

• Stick to your treatment plan. Don’t skip psychotherapy sessions. Even if you’re feeling well, continue to take medication as prescribed.
• Pay attention to the warning signs. Find out what triggers your anxiety. Make a plan so that you know what to do if your symptoms get worse.
• Get exercise because physical activity can help reduce anxiety whether it is walking, swimming, gardening, or other physical activities.
• Make sure you are eating a healthy diet.
• Avoid alcohol and illicit drugs. It may seem like it may help your worries, but they generally just make things worse.
• Get your sleep, especially if you’re having trouble sleeping.

Do I have depression?

Q: I feel so down, so empty and hopeless all the time. Do I have depression?

A: Everyone experiences problems and unhappiness and lots of people may feel down or become depressed temporarily when things aren’t going so well. Sometimes its just an experience that made you feel bad or you blame yourself for something, or are disappointed, feeling the loss of an object, person or pet, which can make a person sad, and empty. Many of these feelings are normal, and most people feel down in the dumps sometimes and those feelings pass.

Depression is not like that. If you have depression those feelings persist and you need to take action to feel better as soon as you can.

If you think you’re suffering from depression, you’re not alone because studies suggest that the majority of the population will experience depression at least once in their lives. About 1 in 5 people will experience depression at some point during their life. Depression is most common in adults but it may occur at any point in a person's life.

For many people depression can start in childhood or adolescence but goes unnoticed because symptoms of moodiness, irritability, and risk-taking behavior may resemble typical teenage problems.

Before puberty, boys and girls are equally likely to develop depression. By age 15, however, girls are twice as likely as boys to have had a major depressive episode. Depression during the teen years comes at a time of great personal change when boys and girls are forming an identity apart from their parents, grappling with gender issues and emerging sexuality, and making independent decisions for the first time in their lives. Depression in adolescence frequently co-occurs with other disorders such as anxiety, eating disorders, self harm or substance abuse. It can also lead to increased risk for suicide.

 What is depression?

Depression is a clinical term used by psychiatrists to describe a long period when a person feels very sad to the point of feeling worthless, hopeless or helpless and is linked to the inability to concentrate, making it hard to carry out normal daily activities. Depression hits adults, teens and children; it does not discriminate!

Depression is an illness with a wide range of physical and psychological symptoms, which can make it hard to recognize. Everyone thinks of depression as feeling sad or down, but sadness may not always be the main feeling experienced. Depression can also make you feel numb or empty, or maybe you feel nothing at all losing your ability to feel pleasure about anything. Depression as a significant depressive disorder ranges from short in duration and mild to long term and very severe, even life threatening.

A common myth is that depression affects only those who can't handle life's ups and downs because of personal weakness, failure or willpower. This is not true. A person with depression can't change his or her mood much like a person can’t make a head ache go away just by having more willpower.

There are many causes of depression but studies are showing that depression involves a chemical imbalance in the areas of the brain that regulate mood and emotion. Just as a head ache needs attention and some medication, people with depression often require therapy and medication to help them feel better.

There are 3 common forms of depression

Major Depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once-pleasurable activities. Major depression is disabling and prevents a person from functioning normally. Some people may experience only a single episode within their lifetime, but often a person may have multiple episodes.

Minor depression is characterized by having symptoms for 2 weeks or longer that do not meet full criteria for major depression. Without treatment, people with minor depression are at high risk for developing major depressive disorder.

Dysthymia?

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep you from functioning at your best or from feeling good. Sometimes people with dysthymia also experience major depressive episodes.

Bipolar depression (manic-depressive illness)

Another type of depressive disorder is called Bipolar depression or manic-depressive illness. It is not as common as other forms of depression. Being bipolar means a person will have cycles of depression and euphoria or mania - feeling really down and then feeling really great. Sometimes a person’s mood can switch very rapidly, but most of the time they are gradual transformations. When in the depressed cycle, you can have any or all of the symptoms of a depression and when in the manic cycle, any or all symptoms of mania may be experienced.

What causes depression?

Depressive illnesses are disorders of the brain. There is no one cause of depression, but many factors may make some people more prone to depression like their environment, major stressful events, an imbalance in brain chemistry or a family history of depression. Unfortunately, once a person has had a depression, they are more likely to suffer from depression again.

These factors can increase the risk of developing or triggering depression:

• ·         Having relatives with depression
• ·         Being a woman
• ·         Having traumatic experiences as a child
• ·         Having family members who have committed suicide
• ·         Experiencing stressful life events
• ·         Having few friends or other personal relationships
• ·         Recently having given birth (postpartum depression)
• ·         Having a serious illness
• ·         Abusing alcohol or drugs
• ·         Taking certain medications from a doctor

What are the signs of depression?

Depression is most often associated with four types of symptoms:

Changes in mood

Physical symptoms

Changes in thought patterns

Anxiety

Below is a list of examples of the 4 common types of symptoms. People may suffer from two or three of these symptoms but are unlikely to experience them all.

• ·         suddenly become quiet and withdrawn and stop seeing or going out with friends
• ·         Feeling useless, inadequate, bad and an overwhelming need for reassurance
• ·         A noticeable loss or gain in weight
• ·         Self injury or self harm
• ·         Being vulnerable and "over-sensitive"
• ·         Changes in behavior
• ·         feeling empty, worthless, helpless or hopeless
• ·         feeling irritable
• ·         A loss of energy and motivation, that makes even the simplest tasks or decisions seem difficult
• ·         grades becoming poor
• ·         Changes in sleeping pattern; sleeping more or less than usual,
• ·         Changes in eating patterns; eating more or less than usual,
• ·         having difficulty concentrating or making decisions, forgetful  
• ·         trivial matters seem immense to you
• ·         Neglecting responsibilities
• ·         loss of interest in taking part in previously pleasurable activities,
• ·         decreased sex drive,
• ·         avoiding other people,
• ·         overwhelming feelings of sadness or grief,
• ·         feeling unreasonably guilty,
• ·         Fatigue, loss of energy.
• ·         Physical aches and pains, sometimes with the fear that you are seriously ill
• ·         unexplained changes in behaviour
• ·         You feel sad or cry a lot and it doesn’t go away
• ·         You don’t feel like doing a lot of the things you used to like — music, sports, being with friends, going out — you want to be left alone most of the time
• ·         You feel like you’re no good; you’ve lost confidence
• ·         Life seems meaningless or like nothing good is ever going to happen again. You have a negative attitude a lot of the time

 

In severe depression, these feelings may also include:

Thoughts of Death or Suicidal ideas

Failure to eat or drink

Delusions and/or hallucinations

How is depression treated?

If you have depression, it is important to get help immediately. Depression, even the most severe cases, can be effectively treated. There is no need to try to handle it alone. Sadness that evolves into depression can be treated with medicine and with counseling. Many studies have shown that the most effective way to fight depression is a combination of medication, self-care and therapy. The earlier treatment can begin the more effective it will be.

Unfortunately many people don’t seek treatment or don’t think they can be treated, and many who admit to depression are scared to tell someone because of the stigma and negative attitudes held by society towards mental illness.

How can I help myself if I am depressed?

• Depression can make you may feel exhausted, helpless, and hopeless but it is important to take action to help yourself so you will start to feel better.
• In addition to medication and talk therapy, continue to educate yourself about depression. Understanding depression and finding ways of managing it can reduce the feelings of helplessness and hopelessness
• Try to be active and exercise. Go to a movie, a ballgame, or another event or activity that you once enjoyed.
• Set realistic goals for yourself.
• Break up large tasks into small ones, set priorities and do what you can.
• Try not to isolate yourself, and let others help you.
• Try to spend time with others and confide a friend or relative about how you feel. Tell them you need a hug, some support and that you just need someone to listen
• Don’t expect your depression to end overnight but do expect that your mood will gradually improve and you’re sleeping and appetite will begin to improve as well.
• It may be better to postpone making important decisions, like replacing old friends, quitting activities or sports or quitting a job, until you feel better. Talk to others who may be able to give you a more objective assessment of your situation.
• Don’t give up hope. Positive thinking will replace those negative thoughts as your depression starts to responds to treatment.
• Try to eat nutritious foods and eat regularly
• Get regular exercise and sufficient sleep.
• Work on time management and stress skills for school and activities.
• See if you can find a way to relax with yoga or meditation tapes, aroma therapy or massage to reduce anxiety and tension.
• Try to manage some form of exercise and some fresh air, even a little may help you feel better and more positive.
• Change your lifestyle particularly if it is too stressful.
• Break up your routine and try different things to try to get you out of your rut.
• Try to occupy your mind with interests or hobbies.
• Avoid things like taking up smoking, non-prescribed drugs and alcohol. Alcohol and other drugs are depressants and can make matters even worse.

To help your friend or relative

• Offer emotional support, understanding, patience, and encouragement.
• Talk to him or her, and listen carefully.
• Never dismiss feelings, but point out realities and offer hope.
• Never ignore comments about suicide, and report them to your loved one's therapist or doctor.
• Invite your loved one out for walks, outings and other activities. Keep trying if he or she declines, but don't push him or her to take on too much too soon.
• Provide assistance in getting to the doctor's appointments.
• Remind your loved one that with time and treatment, the depression will lift.