How Do I Know If I'm Depressed?
How Blue Are You? Answer These Questions and Find Out...
1. Do you criticize yourself frequently for what you do, and who you are? Do you think of yourself as "weak," a "failure," "not good enough," "unlovable," “worthless,” "a loser," etc.?
2. Are you unable to feel compassion for yourself, or grant yourself forgiveness most of the time? Are you cruel to yourself when you make mistakes? Do you frequently fail to reach your standards for yourself? Do you ruminate about regrets you have from the past?
3. Do you lack energy, and have trouble motivating yourself to do things, including ordinary life tasks such as cleaning, laundry, dishes, showering, paying bills, etc? Do your arms, legs or back feel heavy, achy, or hard to move (not due to injury)?
4. Do you feel agitated, restless, or anxious much of the time?
5. Do you believe that things are unlikely to get better?
6. Do you feel irritable much of the time? Do you often lash out or explode at those around you and then condemn yourself for doing it, or try to justify it?
7. Do you think you are eating and sleeping way too much or way too little?
8. Do you feel overwhelmed by your life?
9. Do you feel emotionally numb, except for just feeling bad?
10. Are you frequently tearful; do you frequently feel sad for no apparent reason?
11. Are you having trouble enjoying anything? Have you lost interest in activities you used to enjoy? Have you lost interest in sex?
12. Are you having trouble concentrating, or making decisions? Does your mind feel foggy?
13. Do you find yourself compelled (meaning do you feel unable to stop when what you are doing causes serious risks or negative consequences to your relationships, work, health, self-esteem, integrity, etc.) to eat, drink alcohol, use drugs, have sex, put yourself in danger, gamble, shop, look at pornography, or anything else for the purpose of giving yourself emotional relief from your suffering?
14. Are you withdrawing from people when you can?
15. Do you wish for death to end your pain; do you sometimes think everyone would be better off if you were dead?
16. Do you have physical pain, or discomfort or other symptoms that doctors can’t diagnose? (Please note, there are many causes of symptoms doctors can’t diagnose; depression is just one of them).
17. Do you feel insecure, somewhat irrationally jealous, or a consistent lack of self-confidence?
18. Have you repeatedly been shamed (made to feel unworthy, disgusting, inadequate or otherwise bad about yourself), abused or traumatized, particularly when you were a child?
19. Do you have any of the above experiences regularly with the cycle of your period, or in the wintertime? Have you recently given birth?
If you answered "yes" to two or more of these, you may be experiencing some form of depression. Please consider getting a professional evaluation, and possibly some therapy to relieve your suffering. Please don't isolate yourself; that can make this disabling, painful, invisible condition worse. Counseling really can help. Call or email me, so we can get to work figuring out what you need in order to heal and live your life joyfully, and how to get it. You've already suffered too long; don't suffer any more.
If you want to know self-help techniques to help prevent and recover from depression, I've written an e-book with all the best techniques I've collected and invented over the past few decades. You can buy Ending the Blues: A psychotherapist's guide to living depression-free on this site, but I'm sharing six of the tools free:
What causes depression?
Depression is a complicated phenomenon. Almost everyone has experienced it to some degree and some depression is even normal. In fact, sometimes depression is even beneficial. But there is a broad range of how painful and debilitating depression is, how long it lasts, and how often it comes. There is also variety in what causes it, what helps it, what benefits it brings, what thoughts and behaviors come with it, and what aspects of each person it attacks.
Depression is caused by a variety of factors, including:
1. Negative, distorted thought patterns, including self-attack, which is basically: "I'm bad (unlovable, a failure, unworthy, defective, disgusting etc), I've always been bad, and I always will be bad", and hopelessness/helplessness, which is basically: "My life is bad, always was bad, and always will be bad."
2. Insufficient amounts of the brain chemicals that cause us to feel all the pleasures possible for humans--love, pride, desire, peace, connection, satisfaction, joy, self-love, etc. These chemicals include: serotonin, endorphins, dopamine, norepinephrine…I refer to these chemicals collectively as the “pleasure chemicals”.
3. Feelings that have not been expressed to and understood by a trusted person, especially feelings resulting from trauma and loss.
4. What we inherited in our genes.
5. Not setting limits for demands made on us, or otherwise getting depleted or drained emotionally.
6. What we eat and/or don’t eat and what chemicals (food, drugs) we ingest or produce, especially through addictions.
7. Electrical factors in the brain.
The causes of depression act in a circular fashion with one another. I say it’s circular, because, each cause can cause each other cause—got that? No? Okay, for example:
Negative thinking and self-attacking thoughts cause our brain chemistry to turn sour on us. On the other hand, chemical imbalances in the brain cause negative thinking. Negative thinking or brain chemistry imbalance can cause depression.
Trauma or grief that is not resolved through expressing one’s feelings to an empathic listener can cause self-attack. Self-attack leads to depression. But depression can also cause self-attack!
Trauma changes brain chemistry, and neurological structure, reducing pleasure chemicals, often for years until the trauma is processed.
Eating disorders, chemical dependency and other addictions wreak havoc on brain chemistry, and chemical imbalances can contribute to causing addictions. Addictions not only cause brain chemistry changes, but also negatively change self-image, and cause emotional stressors. So addictions can cause depression, and depression can make addictions seem appealing and necessary.
It is all inter-related. Intervention can happen at any point on the circle, and lead to a positive domino effect of change, or intervention can happen at several points on the circle to undermine the interlocking system’s tendency to keep things as they are. For example, psychotherapy can change the self-attack, which relieves the depression and re-balances the brain chemicals. Sometimes medication has to change brain chemistry first, before psychotherapy can work to resolve trauma or stuck feelings, or change patterns of thoughts or behaviors. A combination of both can be a very powerful treatment. If all contributing factors are addressed--physical health, emotional resolution, brain chemistry balancing, & abstinence from addictions, depression can be relieved in most people relatively quickly.
What are the symptoms of depression?
Depression comes in many forms, and people don’t always recognize that depression is the cause of their symptoms, because people think of depression as really bad sadness. I have listed the official definitions of the two types of unipolar depression (Major Depressive Disorder and Dysthymia) below. You can find these descriptions on most depression websites. In my real-life experience, these definitions don't always describe people's experience of depression. I have seen depression manifest as:
hopelessness and/or thoughts of suicide & dying,
physical pain (especially back, head, and stomach),
withdrawal from people,
addictive use of substances and/or activities,
tearfulness or uncontrollable crying
inability to sleep,
a major change in eating patterns,
making impulsive huge life changes,
lack of motivation,
lack of energy
poor work performance,
inability to accomplish ordinary life tasks such as cleaning, laundry, dishes, showering, paying bills, etc.,
feeling a heaviness in ones arms that make it difficult to lift them,
insecurity, self-hate, self-attack, feeling undeserving,
inability to love or feel joy or pleasure,
some loss of thinking ability in concentration, memory, or decisions,
hallucinations and/or delusions (rarely),
feeling numb or detached,
a loss of interest in sex and/or anything that previously felt pleasurable, because nothing really feels pleasurable anymore,
a loss of self-confidence
a lack of interest in food
criticalness, especially self-criticalness,
pessimism, or seeing mostly the negative in everything and everyone, especially the future,
chronically feeling overwhelmed.
The official symptoms of depression are:
According to the DSM-IV, a person who suffers from major depressive disorder must either have a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a two week period. This mood must represent a change from the person's normal mood; social, occupational, educational or other important functioning must also be negatively impaired by the change in mood. A depressed mood caused by substances (such as drugs, alcohol, medications) or which is part of a general medical condition is not considered to be major depressive disorder. Major depressive disorder cannot be diagnosed if a person has a history of manic, hypomanic, or mixed episodes (e.g., a bipolar disorder) or if the depressed mood is better accounted for by schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder or psychotic disorder. Further, the symptoms are not better accounted for by bereavement (i.e., after the loss of a loved one) and the symptoms persist for longer than two months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
This disorder is characterized by the presence of the majority of these symptoms:
Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). (In children and adolescents, this may be characterized as an irritable mood.)
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 of body weight in a month), or decrease or increase in appetite nearly every day.
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly every day
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt nearly every day
Diminished ability to think or concentrate, or indecisiveness, nearly every day
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.
According to the DSM-IV, dysthymia is characterized by an overwhelming yet chronic state of depression, exhibited by a depressed mood for most of the days, for more days than not, for at least 2 years. (In children and adolescents, mood can be irritable and duration must be at least 1 year.) The person who suffers from this disorder must not have gone for more than 2 months without experiencing two or more of the following symptoms:
poor appetite or overeating
insomnia or hypersomnia
low energy or fatigue
poor concentration or difficulty making decisions
feelings of hopelessness
In addition, no Major Depressive Episode has been present during the first two years (or one year in children and adolescents) and there has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder. Further, the symptoms cannot be due to the direct physiological effects of a the use or abuse of a substance such as alcohol, drugs or medication or a general medical condition. The symptoms must also cause significant distress or impairment in social, occupational, educational or other important areas of functioning.
What types of depression are there?
You may have heard or read various words labelling depression. Here are some:
"Clinical Depression" This is a lay term generally used to mean a depression that is really serious and potentially requires medical attention.
"Major Depression" This is a term used by professionals to refer to a severe form of depression that can be a one-time "major depressive episode" or can happen repeatedly and be labelled "major depressiv e disorder."
"Manic Depression" This is a lay term referring to "Bi-Polar Disorder." People who have Bi-Polar Disorder experience both severe depression and manic episodes.
"Agitated Depression" This is a major depression that includes restlessness, anxiety, often pacing--depression that manifests most obviously as intense, irrational, uncontrollable anxiety.
"Postpartum Depression" This is a mostly hormonally-induced depression that occurs in some women after giving birth. How the baby affects the woman's life, can also be a factor. It is usually short-lived (a few days to a few weeks), but sometimes can be very serious and dangerous for both mother and child.
"Pre-menstrual or Hormonal Depression" Some women get depressed due to hormonal changes shortly before having a menstrual period.
"Dysthymia" This is the clinical term for depression that is less intense than major depression and lasts for months, or years.
"Bi-Polar Disorder" This is the clinical term for someone who has had both depressive and manic episodes. Manic episodes are periods of extremely high energy, similar to the experience of using amphetamines, an uncontrollable need to talk, a lack of need for sleep, racing thoughts, grand ideas, and very poor judgement.
What treatments are there for depression and how successful are they?
There are numerous treatments for depression, and most people can get relief from depression either through talking, crying, their circumstances changing and/or time passing, without any professional treatment, or through one or more treatments. Psychotherapy can include a variety of methods and techniques that are helpful for depression. It appears as if each individual unpredictably responds to some treatments and not others.
Psychotherapy usually involves forming a warm, trusting connection with a non-judgemental, active-listening professional who can help you resolve the cause of the depression. Many times people feel better even after the first session. When the cause of the depression is not repeated childhood traumas, but something that is simple enough to resolve quickly, people continue to feel better over the next few weeks or months.
Sometimes learning how to think in a way that doesn't support depression helps (cognitive-behavioral work). If trauma caused the depression EMDR can often help, especially if a small number of distinct traumatic incidents are responsible for the depression. For many people, medication can help. When people have had repeated trauma when they were children, or parents who hurt, abandoned or neglected them, psychotherapy can take a much longer time, and medications are less likely to work.
For most people, psychotherapy is the best place to start. If other forms of treatment are needed, your psychotherapist can usually assess that and refer you to other professionals or books for additional support in healing. This may include medications, self-help, like exercise and healthy eating, herbs, accupunture, homeopathy and many other types of treatment.
How do I know if I have postpartum depression and how can I get relief?
Depression is a common problem during and after pregnancy. About 13 percent of pregnant women and new mothers have depression. Most new mothers experience the "baby blues" after delivery. About one out of every 10 of these women will develop a more severe and longer-lasting depression after delivery. One in 1,000 women develops a more serious condition called postpartum psychosis.
Postpartum Depression (PPD) is a complex mix of physical, emotional, and behavioral changes that happen in a woman after giving birth. PPD is a form of Major Depression that usually has its onset within four weeks after delivery. The diagnosis of postpartum depression is based not only on the length of time between delivery and onset, but also on the severity of the depression.
Symptoms of postpartum depression are similar to what happens normally following childbirth. They include lack of sleep, appetite changes, excessive fatigue, decreased libido, and frequent mood changes. However, these are also accompanied by the symptoms of major depression -- depressed mood; loss of pleasure; feelings of worthlessness, hopelessness, and helplessness; and thoughts of death or suicide.
There is no single cause. Rather, pregnancy and postpartum depression likely result from a combination of factors:
So hormonal changes may trigger symptoms of postpartum depression. When you are pregnant, levels of the female hormones estrogen and progesterone increases greatly. In the first 24 hours after childbirth, hormone levels quickly return to normal. Researchers think the big change in hormone levels may lead to depression. This is much like the way smaller hormone changes can affect a woman’s moods before she gets her period.
Levels of thyroid hormones may also drop after giving birth. The thyroid is a small gland in the neck that helps regulate how your body uses and stores energy from food. Low levels of thyroid hormones can cause symptoms of depression. A simple blood test can tell if this condition is causing your symptoms. If so, your doctor can prescribe thyroid medicine.
Other factors may play a role in postpartum depression. You may feel:
- tired after delivery
- tired from a lack of sleep or broken sleep
- overwhelmed with a new baby
- doubts about your ability to be a good mother
- stress from changes in work and home routines
- an unrealistic need to be perfect mom
- loss of who you were before having the baby
- less attractive
- a lack of free time
- stress between you and your spouse/partner family or co-parent
- intrusion or criticism from in-laws or others
- guilt about spending time with the baby if you have older children
- isolation from friends and co-workers
Certain factors may increase your risk of depression during and after pregnancy:
- a personal history of depression or another mental illness
- a family history of depression or another mental illness
- a lack of support from family and friends
- anxiety or negative feelings about the pregnancy
- problems with a previous pregnancy or birth
- marriage or money problems
- stressful life events
- young age
- substance abuse
Women who are depressed during pregnancy have a greater risk of depression after giving birth.
If you take medicine for depression, stopping your medicine when you become pregnant can cause your depression to come back. Do not stop any prescribed medicines without first talking to your doctor. Not using medicine that you need may be harmful to you or your baby.
The difference between “baby blues,” postpartum depression, and postpartum psychosis
The "baby blues," which occur in most women in the days right after childbirth and are considered more or less normal. A new mother has sudden mood swings, such as feeling very happy and then feeling very sad. She may cry for no reason and can feel impatient, irritable, restless, anxious, lonely, and sad. She may lose her appetite or have trouble sleeping. The baby blues may last only a few hours or as long as one to two weeks after delivery. The baby blues do not usually require treatment from a health care provider. Often, joining a support group of new moms or talking with other moms.
Postpartum depression (PPD) can happen a few days or even months after childbirth. PPD can happen after the birth of any child, not just the first child. A woman can have feelings similar to the baby blues -- sadness, despair, anxiety, irritability -- but she feels them much more strongly than she would with the baby blues. She can also have thoughts of hurting the baby or herself, feel no attachment to the baby, or have thoughts or images of the baby being in danger.
PPD often keeps a woman from doing the things she needs to do every day. When a woman's ability to function is affected, she needs to see her health care provider. If a woman does not get treatment for PPD, symptoms can get worse and last for as long as one year. While PPD is a serious condition, it can be treated with medication and counseling.
Postpartum psychosis is a very serious mental illness, though rare. It occurs in about 1 to 4 out of every 1,000 births. It usually begins in the first 2 weeks after childbirth. Women who have bipolar disorder or another mental health problem called schizoaffective disorder have a higher risk for postpartum psychosis. This illness can happen quickly, often within the first three months after childbirth. Women can lose touch with reality, having auditory hallucinations (hearing things that aren't actually happening, like a person talking) and delusions (strongly believing things that are clearly irrational). Visual hallucinations (seeing things that aren't there) are less common. Other symptoms include insomnia (not being able to sleep), feeling agitated (unsettled) and angry, and strange feelings and behaviors. Women who have postpartum psychosis need treatment right away and almost always need medication. Sometimes women are put into the hospital because they are at risk for hurting themselves or someone else.
The baby blues most often go away within a couple of weeks. If they don't, you may have postpartum depression. Seeing a psychotherapist (and possibly a medical doctor too) for an evaluation of what you need is important.
What to do if you have symptoms of depression during or after pregnancy
Call a psychotherapist who specializes in treating depression if:
- your baby blues don’t go away after 2 weeks
- symptoms of depression get more and more intense
- strong feelings of sadness or anger come on 1 or 2 months after delivery
- it is hard for you to performs tasks at work or at home
- you cannot care for yourself or your baby
- you have thoughts of harming yourself or your baby
- feeling extremely anxious, scared, and panicked most of the day.
Some women don’t tell anyone about their symptoms. They feel embarrassed, ashamed, or guilty about feeling depressed when they are supposed to be happy. They worry they will be viewed as unfit parents.
Any woman may become depressed during pregnancy or after having a baby. It doesn’t mean you are a bad or “not together” mom. You and your baby don’t have to suffer. There is help.
Here are some tips that have helped other mothers:
- Rest as much as you can. Sleep when the baby is sleeping.
- Ask your partner, family, and friends for help.
- Make time to go out, visit friends, or spend time alone with your partner.
- Discuss your feelings with your partner, family, and friends.
- Talk with other mothers so you can learn from their experiences.
- Join a support group. Ask your doctor about groups in your area.
- Don’t make any major life changes during pregnancy or right after giving birth. Major changes can cause unneeded stress. Sometimes big changes can’t be avoided. When that happens, try to arrange support and help in your new situation ahead of time.
- Eat plenty of protein at every meal and avoid sugar, especially eaten without protein. Also avoid artificial flavoring, coloring and preservatives.
- Drink a cup of water (no substitutes) every waking hour (if breastfeeding).
How depression is treated?
The good news is postpartum depression can be treated with counseling/psychotherapy to resolve the non-chemical sources of the depression, and sometimes medication, which can help relieve symptoms of depression.
If you are depressed, your depression can affect your baby. Getting treatment is important for you and your baby. If you want to consider taking medication, talk with your doctor about the benefits and risks of taking medicine to treat depression when you are pregnant or breastfeeding.
What can happen if depression is not treated
Untreated depression can hurt you and your baby. Some women with depression have a hard time caring for themselves during pregnancy. They may:
- eat poorly
- not gain enough weight
- have trouble sleeping
- miss prenatal visits
- not follow medical instructions
- use harmful substances, like tobacco, alcohol, or illegal drugs
Depression during pregnancy can raise the risk of:
- problems during pregnancy or delivery
- premature birth
- having a low-birth-weight baby
Untreated postpartum depression can affect your ability to parent. You may:
- lack energy
- have trouble focusing
- feel moody
- not be able to meet your child’s needs
As a result, you may feel guilty and lose confidence in yourself as a mother. These feelings can make your depression worse.
Researchers believe postpartum depression in a mother can affect her baby. It can cause the baby to have:
- delays in language development
- problems with mother-child bonding
- behavior problems
- increased crying
It helps if your partner or another caregiver can help meet the baby’s needs while you are depressed.
All children deserve the chance to have a healthy mom. And all moms deserve the chance to enjoy their life and their children. If you are feeling depressed during pregnancy or after having a baby, don’t suffer alone. Please tell a loved one and call your doctor or counselor/therapist right away.
If you are experiencing postpartum blues, or depression, please get support. You may need physical support to get more sleep and to take better care of yourself, and you may also need emotional support. You may be able to find a group of women going through what you are, and that might be the best choice for you. Postpartum depression is especially painful, and potentially dangerous, because it can include feelings of anger or numbness toward the baby. Since most women find these feelings to be unforgivable, they don’t want to admit to them, and then don’t get the help they need. Women who have a history of depression have a very good chance of getting postpartum depression. If this is you, please get help now! Ignoring these depressed thoughts and feelings can be dangerous to you, the baby, and your family.
If you want to speak to a therapist about this, call me or write to me so we can figure out together what will bring you relief as quickly as possible.
How is depression different for men?
Men and women respond to depression very differently. Statistics tell us that twice to ten times as many women as men fit the criteria for depression. This may not mean that more women are depressed than men. The medical definition of depression is based on how women generally express it. Men tend to express their depression differently, so statistics don't count most depressed men as depressed. Men feel more shame about being depressed, so are less likely to admit it, or get help for it. In men, some of the common signs of depression actually mask the depression. These include anger and blaming, alcohol and drug use, addiction to pornography, impotence, dependence on sex to improve mood, difficulty being friendly, trouble concentrating and making decisions.