There is an antidepressant commercial that says “Depression can hurt…” and it is very true. Whether or not their medication works for the symptoms, or works for everyone, there is no denying that there is definite bodily hurt that goes along with the emotional hurt of depression. These physical depression symptoms are detailed below:

Headaches: These may feel simply like tension headaches, but tension and stress feel worse when depressed. The headaches may persist, or go away to come back frequently. If you have migraines, they may seem much worse.

Stomachaches: It may feel like you have to get yourself to eat because your stomach feels upset. It can also feel like the stomach fluttering you get when nervous, but it doesn’t seem to be linked to a particular incident, and it doesn’t go away easily.

Digestive problems: in addition to the stomachaches, you may have constipation or diarrhea. You may also have nausea or increased heartburn or other indigestion symptoms.

Appetite changes: You may lose your appetite, which goes along with the stomachaches and nausea. Alternatively, you may find your appetite increases, and you crave carbohydrates – sweets or salty and fried food. This is especially common in Seasonal Affective Disorder, one form of depression.

Backaches and other muscular aches: This may be because of the tendency to hunch up when upset. Our postures get stooped a bit, and we don’t sit up in our chairs. This can put undue stress on our backs, shoulders, and neck. This can also happen with prolonged time in front of the computer, but it may feel more severe when depressed.

Overall bodily aches: There may be an overall feeling of achiness, as if you are coming down with the flu. In fact, you may notice your bad mood because of the pain and attribute it to the pain instead of attributing the pain to the bad mood.

Other chronic pain.

Sleeping problems: Insomnia is common with depression. Trouble getting to sleep, trouble staying asleep goes with the insomnia. On the flip side, you may find you want to sleep all the time. You may sleep more than 10 hours a day and still not feel completely rested.

Loss of energy: You may feel tired all the time, whether or not your sleep is affected. You may notice a feeling of being slowed down, and that it takes extra effort to do things that you once found easy.

Sexual problems: Lack or arousal, or inability to orgasm can be signs of depression. These are also common side effects of antidepressants.

Restlessness: You may feel agitated like you need to move around or can’t sit still.

Dizziness or lightheadedness.

Sometimes chest pain can also be part of depression, or at least made worse when you have depression.

Behavioral Symptoms

These aren’t strictly physical, but they aren’t purely emotional either. They are also symptoms that can be recognized by others and prompt them to ask if you are ok.

Reckless behavior: driving too fast, making poor money decisions.

Escapist behavior: spending more time, which can be perceived by others as too much, at work, on sports, or absorbed in a hobby, while pushing others away.

Infidelity or promiscuity: This may be especially true in men.

Uncharacteristic displays of anger or aggressiveness.

Substance abuse, including alcohol, recreational drugs, or even prescription medications.

Difficulty concentrating and getting work done.

Relationship problems or trouble in school for teens and children.

photo credit: AmandaLouise

There are many other diseases that cause these symptoms. Some of those diseases, such as diabetes and chronic fatigue syndrome happen along with depression. It can be difficult to tease them apart at times. Also, chronic and/or severe health problems can not only cause physical symptoms, they can cause depression.

Only a doctor can listen and do tests to figure out where you symptoms come from. They will work to eliminate any other diseases that could be causing these symptoms. They will also be able to tell if you are suffering from more than one at the same time.

The diagnosis is just the first step. However, it is important because it steers treatment. And, there is treatment for depression, in many forms. The above symptoms, as well as the emotional symptoms of depression are serious and shouldn’t be dismissed. Help is available, seek it out if you need it.

If you have any questions, please leave me a comment below.

1. The essential feature of a Major Depressive Episode is a period of at least 2 weeks during which there is either depressed mood or the loss of interest or pleasure in nearly all activities. In children and adolescents, the mood may be irritable rather than sad.
2. There may be marital problems (e.g., divorce), occupational problems (e.g., loss of job), academic problems (e.g., truancy, school failure)…
3. The core symptoms of a Major Depressive Episode are the same for children and adolescents, although there are data that suggest that the prominence of characteristic symptoms may change with age.
4. In children and adolescents, an irritable or cranky mood may develop rather than a sad or dejected mood. This presentation should be differentiated from a “spoiled child” pattern of irritability when frustrated.
5. In adolescents, Major Depressive Episodes are frequently associated with Disruptive Behavior Disorders, Attention-Deficit Disorders, Anxiety Disorders, Substance-Related Disorders, and Eating Disorders.

So, where does that leave us? Not really much help in determining if a teen is depressed or simply going through the normal adjustments of growing up.

To parents: The best way to tell is to know your teen. Know who their friends are, know the symptoms of depression, and look for those symptoms in your teen. Not easy, I know, because teens can be pretty closed about their feelings.

However, take special note on: academic problems (e.g., truancy, school failure)…

Looking back at my teens, I know that I had a major depressive episode at the end of high school into my first semester of college.

I was an overachiever: almost 400 hours of volunteer work, tons of Girl Scout Badges, the two highest awards in Girl Scouts, Honor Society, class government, got into the college of my choice on early admission, honor roll every quarter…

…until I didn’t. Until I failed Physics one quarter. And didn’t do so well in Calculus either.

Now, let me stop and say that I don’t blame my parents at all for not noticing this and thinking only that my grades were an anomaly. Because, from their perspective, it was. They didn’t know the turmoil that was going on underneath.

Which is why the next part is for teens: If you find yourself feeling like everyone is smarter than you, people are picking on you, that all the achievements you’ve done don’t mean a thing – reach out for help. I’m not going to tell you to go to your guidance counselor, although you can. I remember that was dorky and no one went, even though that’s what they are there for.

Your friends may not be the best help either. They don’t know techniques to really help depression. And, if your experience was like mine, those friends can have a way of sticking up for you one minute, then cutting you down the next minute.

Your parents can help. But, that depends on how comfortable you feel with them.

A favorite teacher may be able to help. Tell them you’ve been feeling down lately and you’re not sure your parents would understand. Ask them if they have any suggestions.

If you are close to a religious leader, or the leader of a club or organization (such as the Girl or Boy Scouts), talk to them.

Don’t suffer alone.

To parents and teens: here’s a bit more of my story.

When crap happened at school, I kept it to myself. I didn’t talk to my parents about it. I remember many a night listening to sad songs and crying.

I wrote things like the following in my journal:

• “The wonderful feeling I had of being included and wanted is turning to a horrible one of dread.”
• “We then went on to Algebra where we took a test that I will be happy to get a C on. 70% will make me happy.”
• “I went for a walk after dark and I feel so empty.”
• “Why is my life the way it is? Is it me or others around me?…I need to talk to someone, but I don’t know who.”
• “I hardly have the will to put pen to paper, but I know I must…I hurt so much.”

Looking back, I see these as clear signs of the depression I now know I had. Although, I didn’t recognize it as depression until years later when, as an adult, I sought treatment for another major depressive episode.

Fortunately, I didn’t contemplate suicide, but unfortunately, many teens do. And often, parents and others don’t even realize the teen was depressed until they have ended their lives.

Checklist of things to look for as possible signs of depression in teens

1. A down mood. This may present as irritability not sadness. This could be passing, but if it persists for 2 weeks or more, it’s a cause for concern.
2. Changes in the usual behavior. This may not be just an irritability mood, but could also include lack of interest in things, or sudden problems in school. 
3. Withdraw from some people. They may still maintain a core group of friends, but not seem as outgoing as they used to.
4. Increased complaints of physical complaints such as aches and pains, headaches, or stomachaches. These could have other medical causes, but could also be a sign of depression.
5. Sensitivity to criticism. No one likes to be criticized, but depression makes you much more sensitive to these things. It can also make you feel like everyone is ganging up on you. Therefore, a teen that appears to get mad at a gentle joke or other comment that wouldn’t have upset them in the past may be hypersensitive due to depression.
6. Increased negative comments and criticism of others. True, puberty and “growing up” involve a period of differentiating yourself from others. However, if this behavior continues, with the teen putting down others regularly, calling them names, or refusing to hang around them when they did before, this could be a sign of depression. The could also manifest in the teen calling themselves names. Perhaps mentioning that they are stupid, or scoffing at once enjoyed activities.

The important thing to remember when it comes to recognizing teen depression is that these symptoms persist for more than two weeks. It may seem like a “phase” the teen is going through, but it very well may not be. Teens may also feel like it’s something they just have to endure, but it’s not.

Children and teens respect their parents, even if they don’t show it. If you think that something is amiss with your teen, let them know that you are there to help. Or, they don’t feel like talking with you, ask them if they would like an appointment with a doctor. Emphasize the physical problems over the emotional ones.

photo credit: studiostoer

Teens don’t want to let their parents in on their emotional life because they think they won’t understand. But, they may respond to an opportunity to see a doctor for the physical symptoms.

You can make a note to the nurse when the appointment is made that you suspect depression, but your teen isn’t talking about it with you.

Then, stay in the waiting room. Do not go into the examining room with your teen. They didn’t want to talk to you before, they won’t suddenly open up to the doctor if you are in the room. Respect that they are no longer your “little” boy or girl and give them the room to speak with the doctor confidentially.

If your teen isn’t willing to talk about the discussion with the doctor, you do have the right to ask the doctor if there is anything that you need to do to help your teen. Depending on where you live, the law may say that parents have the right to know exactly what was said, but don’t violate your teen’s trust.

And don’t put the doctor in the position of violating that trust either. What’s important is that you support your teen, not that you know every minute detail.

If you have suffered from depression as an adult, and that is quite possible since teens are more likely to get depression of they have family members who have suffered, then you know how horrible it can be. Try to imagine suffering from depression while also trying to get along in school, fit in with a bunch of people, and please your parents all at the same time. That is what depression during your teens feels like. And, if you suffered from depression in school yourself, then you know how difficult it is.

No one needs to suffer from depression. It is treatable and life is so much better without that dark cloud hanging over you. Look for the symptoms of depression in your teen, or teens you interact with regularly and help them get relief.

If you have any questions or comments, please leave me a comment below.

It’s important to remember that it is normal to feel down – to have off days. It’s normal to be sad when something ends, be it the life of a loved one, a job, a relationship. But feeling down and sad by themselves aren’t depression. It’s when those feelings are more lasting. And, if those feelings come up for no reason at all. Sometimes, it can be as simple as things feel off and you suspect that what you are feeling isn’t normal.

At that point, it’s important to consider that you may be suffering from depression. Read through the symptoms below and if you find yourself nodding your head with any of them, then see a doctor, therapist, or other trusted counselor. 

1. Depressed mood; persistent feeling of sadness, or even emotional numbness. There are always times when crying doesn’t seem out of place. But, when you are depressed, you may find yourself wanting to cry a lot, and cry over things that others don’t see as particularly sad. This can also manifest as an emptiness. It feels a little as if you are looking through a plate of glass at the rest of the world. You are there, but cut off from them. And, for the most part, you don’t care. It can be hard to feel happy for other people when you should, or even feel appropriate sadness. In an effort not to loose control, and cry in front of people, you let yourself go numb. Because numbness is easier to deal with than the oppressive feeling of sadness.

2. Feelings of worthlessness, hopelessness, and/or guilt. When the numbness lifts and you can feel some of your feelings, it feels as if the whole world is out to get you. Everything seems to go wrong. You are sure that everyone is looking at you and laughing about you behind your back. You take everything personally. And, you start thinking in always and never terms:

• I never get ahead at work.
• My partner never appreciates me.
• I’m always screwing up.
• Those times when I was “happy” were just a lie.

You feel broken, like you have a blackness inside of you that others don’t. You may even accept that everyone makes mistakes, but feel that others’ mistakes aren’t as bad as yours. You may feel like you have to be at 100% all the time, and resent that others can have a bad day without being criticized.

3. Loss of interest in doing things you used to like – including sex. Nothing seems to feel good anymore and it’s more trouble than it’s worth. You just don’t feel up to it. If you decide to do something you used to enjoy, it’s not enjoyable anymore. A night out with friends? Too loud, too many people, too hot, too stuffy, the jokes aren’t funny, the food tastes bad. Any number of things can put you off of feeling good, even if you felt a little better when you decided to go out. When you are depressed it’s very easy for your mood to drop. So, not only do things just not seem fun anymore, you avoid doing them because you don’t want that drop in mood to come when you least expect it.

4. Irritability or restlessness. The fog of depression makes everything get on your nerves. Your boss seems hyper critical and you can’t stand the sound of his voice. You get mad at yourself easily and may even find yourself being snarky with others. Little sounds, or uncomfortable temperatures make you want to scream. You get impatient with people and get tired of listening to their stories. You wonder why you even liked that person to begin with. The hyper critical lens you turn on yourself you can turn on others as well and see faults you hadn’t seen before – and every one feels like it’s aimed directly at all your buttons, constantly pushing them.

You may feel like you can’t sit still. This may be because you physically feel like you have to move, or because you want to get away from everyone. You may feel that if you were just a little bit faster you could get away from the feelings and start to feel like you accomplished something.

5. Difficulty concentrating. On the flip side of feeling restless, you find yourself forgetting things and your mind wanders from the task at hand. Often, it wanders to other thoughts that race through your mind, critical voices pointing out that you aren’t doing a good job as well as berating you for losing concentration.

6. Sleeping problems. You may feel tired all the time. This feeling of being tired is deeper than just not getting a good night’s sleep, though. It feels like you can never get enough sleep. You want to stay in bed all day because you feel so tired. You can sleep more than 10 hours a day and still feel tired.

On the flip side, the restlessness may mean that you can’t sleep very well. You may have a difficult time getting to sleep because your mind keeps racing. Then, once you get to sleep, you may not stay asleep long, or have bad dreams.  You may feel like you have to keep moving, even in the middle of the night.

7. Lack of energy. This comes not just from not being able to sleep. You feel like you are weighed down and moving slowly. It may feel like you are walking through water, with a lot of resistance to your every move. You may even feel drugged, like you are a little out of touch with reality.

8. Weight and appetite changes. Sugar and fat lead to changes in the brain that make us feel better. When you are depressed, you may continue to eat, because that higher feeling wears off so quickly. The thought of healthy food makes you want a cookie, or a cheeseburger. The lack of energy and increased eating of high sugar and high fat foods will often lead to weight gain.

On the flip side, you may feel so upset, that you don’t want to eat. Your stomach hurts like you ate something that didn’t agree with you. Even if you stomach growls, you feel like gagging at the thought of eating.  You have to force yourself to eat because you know your body needs some food. Yet, you look for food that is quick and easy – goodness knows you don’t have the energy or the desire to prepare something. This can lead to weight loss.

9. Suicidal thoughts, including attempts, and thoughts of death. In the lowest points of depression, you hurt so much, you don’t feel like you can continue. You hurt physically and mentally. It doesn’t feel like it’s going to get better, and ending your life can feel like the only answer. You may think about those you’ll leave behind and how they will cope. Yet, you figure that they might do better than if they had you dragging them down. The sense of worthlessness and guilt reaches a crescendo and you wonder why you should go on. And, even if you don’t feel like ending your life, you may feel like running away and hiding somewhere would help.

photo credit: dno1967b

When it comes to symptoms of depression in women, many of those above aren’t distinct. They blend together and the lines between them blur. You can’t sleep, so you have no energy. You feel bad so you sleep all the time. Things irritate you, so you lose interest in doing things.

Everyone has days when it feels like nothing is going your way. But depression feels like every day is that way. And, not only are things not going your way, but it can feel like people are deliberately out to get you.

Some days will be better than others, even with depression. If you feel that you may have the disease, seek help. There are treatments and support available. You aren’t alone, even though it feels like you are.

If you have any questions, please leave me a comment below.

That said, depression carries a lot of stigma in today’s modern society. While women may be more likely to be treated for depression, they can still be looked down upon. At one point I had to tell my boss that I would need to see a therapist on my lunch break every week and therefore would consistently be taking longer lunches. I didn’t want to, but it was the only way to attend therapy.

He remarked a few weeks later that I didn’t need to be so stressed and anxious at my job, indicating that he thought I was suffering from an anxiety disorder. While some of my symptoms were related to anxiety, the look on his face was one of shock when I said that I had been diagnosed with depression. Looking back, I wish I had not told him, after all, it was my business and not his. However, the thought of any of the men at that man dominated office admitting to the same gives me a headache. I just cannot see it at all.

Men in this society have many more privileges than women. Yet those privileges come at a price – that of not being able to show any “weakness” or perceived “weakness.” And, as my story above indicates, depression is certainly seen as weakness. Signs of emotion are the realm of women. Men need to be strong and supportive – the proverbial rock that others lean on.

Yet, even Vulcans from Star Trek, who were the masters at being emotionless, admitted to having emotions. Human men have emotions too. So, when those emotions are decidedly negative, they dismiss them, or work to hide them.

My husband is one of those men who are more likely to show their emotions. He will admit when something has gotten him down, or is stressing him out. But, even men who have “embraced their feminine side” don’t weep, or act from those emotions like women do. They, too, will put forth a tough exterior and work to be the rock.

So, when a man suffers from depression – what does he do? First, symptoms of depression in men are more likely to be physical ones. He may complain of being tired, or stressed out. He will probably deny that there is anything more wrong than just a hard day at work. The danger in this is that he may convince himself that this is true.

Yet, with men and depression, those feelings will persist even if the project is over, or things lighten up at work.

Depression brings with it a lowered sense of self worth. This may mean a man pushes himself to work harder, yet still feel like he is getting less done. He may show signs of irritation more frequently, or show increased signs of anger.

Men with depression are more likely to turn to drugs or alcohol to “drown their sorrows.” Even if that “helps” short term – say a few hours or less – it won’t stick long term. It will impact their job performance, compounding the effects of the depression.

Depression often leads to great difficulty doing those things that you used to have no problems with. This can frustrate men more than women and can therefore lead to a stronger feeling of worthlessness than in women. Men may feel that they don’t have anywhere to turn, that they can’t talk to anyone because that would show the weakness. Men are more likely to commit suicide than women.

Depression comes with a loss of pleasure in activities you used to like. This could be displayed in an expression of tiredness and “not feeling up to it.”

Men may also have sexual problems that can lead to tensions in their relationships, again, further enhancing the feeling of worthlessness.

On the flip side, they may turn to promiscuity, perhaps looking for the pleasure they are missing.

Because men tend to display their depression in physical ways, the depression could be missed as simply what he purports it to be – stress or lack of sleep.

This can be especially true if digestive problems, chronic pain, or even frequent headaches are the complaint. These can be signs of other illnesses, but they can also be signs of depression.

An important part of diagnosing depression is persistence of symptoms; officially 2 weeks or more. If these symptoms seem recent, they may simply be a sign of overwork or stress. Yet, if they continue for weeks, or even months, it is quite possible that depression could be the cause and help should be sought.

To recap, signs of depression in men:

• Complaints of feeling stressed
• Feeling tired and run down
• Escapist behavior such as spending more time at work, or on sports
• Reckless behavior such as driving too fast
• Lack of enjoyment in activities
• Sexual dysfunction or promiscuity and infidelity
• Increased irritability and uncharacteristic shows of anger or aggressiveness
• Digestive problems
• Chronic pain
• Increased substance abuse
• Restlessness and difficulty sleeping
• Difficulty concentrating or getting work done
• Increased feeling of worthlessness or irritation at ones self

Depression can be debilitating, for both men and women. While treatment is similar in both, perhaps including medication and psychotherapy, men are usually more reluctant to seek help.

photo credit: MarceloKristopher ✈

If you, or a man you love, has the above symptoms, I encourage you to get help.

It is important to realize that those closest to you won’t judge you for having a mental illness – because it is an illness. And, you don’t have to tell anyone else.

Medication doesn’t have to be taken in front of anyone, and therapists have after hours appointments. If anyone questions you, you can simply say that you’re fine – then deflect the conversation. It’s none of their business. There are lots of things in your life that people don’t need to know, put depression in with them.

I don’t mean to sound flip by any means. My goal is to highlight ways that men can seek treatment yet still keep face. With depression symptoms in men being easy to overlook, yet 75 to 80% of those who commit suicide being men, this is a serious matter.

No one should have to suffer with depression – men or women.

Only a doctor can officially diagnose someone with clinical depression, and help someone differentiate between depression and other illnesses. That being said, it is quite possible for someone to realize that their depressed feelings are out of the range of normal sadness and figure that is their diagnosis. But, when you go to the doctor, how exactly does he or she qualify you as having clinical depression?

In order for all doctors to arrive at the same diagnosis and understand an illness when it is named, they have a guidebook of symptoms. This is called the DSM IV; which stands for Diagnostic and Statistical Manual, Fourth Edition. This book lists symptoms and information for the doctor to fine tune their diagnosis.

Confusingly, the DSM IV first describes depressive episodes, then defines depressive disorders based on whether or not the patient has symptoms of a depressive episode. Seems like they could just define the episode and be done with it, but that’s not how they do it. To make it a bit less confusing, let’s break it down. Quotes from the DSM IV are in italics.

Mood Disorders

1. Depression is one of several mood disorders, that also include Bipolar Disorder and Depressive Disorders based on medical conditions or substance abuse.
2. Depression is referred to as “unipolar depression” to distinguish it from the depressive episodes of Bipolar Disorder.

Major Depressive Episode

The following symptoms are all indicative of a Major Depressive Episode; however, not all need to be present for a Major Depressive Episode to be declared. See below on Dysthymic Disorder for further explanation.

1. The essential feature of a Major Depressive Episode is a period of at least 2 weeks during which there is either depressed mood or the loss of interest or pleasure in nearly all activities.
   
2. Those 2 must be present, and at least 3 of the following as well:
1. significant weight loss when not dieting or weight gain
2. insomnia or hypersomnia nearly every day (sleep problems)
3. psychomotor agitation or retardation nearly every day (big words meaning feeling restless or agitated. Or, on the flip side, feeling slowed down.)
4. fatigue or loss of energy nearly every day
5. feelings of worthlessness or excessive or inappropriate guilt
6. diminished ability to think or concentrate, or indecisiveness, nearly every day
7. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation (thoughts of suicide) without a specific plan, or a suicide attempt or a specific plan for committing suicide
3. Notice that for most of these criteria, the symptoms must be present for nearly every day.
4. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. In other words, it’s messing up their life.

Now we get into the it’s not caused by parts:

1. The symptoms do not meet criteria for a Mixed Episode (a part of Bipolar Disorder)
   
2. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
3. The symptoms are not better accounted for by Bereavement. The DSM IV qualifies bereavement as only being for the loss of a loved on (not other circumstances) and lasting over 2 months (even though it may take longer to deal with the grief of losing someone).

Unipolar Depression Varieties

1. Unipolar depression comes in 3 forms:

1. Major Depressive Disorder: must have at least 1 major depressive episode
2. Dysthymic Disorder: in layman’s terms this is “mild depression” or “chronic depression” or “low level depression.” This is still depression, which means the person feels depressed more days than not, but it lasts for 2 years or more. It doesn’t meet enough criteria of a Major Depressive Episode to be considered under the Major Depressive Disorder diagnosis.
3. Depressive Disorder Not Otherwise Specified: Officially this is defined as:

…disorders with depressive features that do not meet criteria for Major Depressive Disorder, Dysthymic Disorder, Adjustment Disorder With Depressed Mood, or Adjustment Disorder With Mixed Anxiety and Depressed Mood (or depressive symptoms about which there is inadequate or contradictory information).

How’s that for a mouthful of doctor speak? What this basically means is that “we know it’s depression and not some other mood issue, but we don’t know exactly how to slot it into a diagnosis, since it doesn’t quite meet the criteria for other types of depression.”

 2. To further clarify, and pinpoint the type of depression, the following are also part of a diagnosis:

1. Major Depressive Disorder: in addition to the Major Depressive Episode, the symptoms can’t be caused by any Schizo-(type) disorder, and they don’t include a manic episode (in other words, they aren’t a depressive episode as part of Bipolar Disorder.) Didn’t I say it would have just been easier to define a Major Depressive Episode and be done with it?
2. Dysthymic Disorder: an official diagnosis adds a few more criteria. In addition to the depressed feelings, the person must also have at least 2 of the following symptoms:
1. poor appetite or overeating
2. insomnia or hypersomnia (sleeping problems)
3. low energy or fatigue
4. low self-esteem
5. poor concentration or difficulty making decisions
6. feelings of hopelessness
• Which, as you saw above, are some symptoms of a Major Depressive Episode
7. Has never been without the symptoms for more than 2 months. Yes, I know, that should go without saying, since the first part says it has to be 2 years.
8. This isn’t accounted for by any other of the following:
1. Schizo-(type) Disorder
2. No major Depressive Episode (could be before the 2 years began, but not during it)
3. No manic episodes (again, no Bipolar)
4. Not caused by a substance (whether illegal or medication) or by a medical condition
5. The symptoms mess with your life enough to be a problem

So, yeah – Dysthymic Disorder is a low level depression that isn’t Major Depression. (But, the DSM IV needs several pages to describe this.)

The Take-Away

photo credit: Eric The Fish (2011)

In conclusion, a doctor diagnoses depression by:

1. The description of symptoms
2. How many of the symptoms are present
3. How long the symptoms have been present
4. Ruling out the symptoms being caused by any other problem

The good news is that if you feel any of the symptoms mentioned above, a doctor will be able to diagnosis your type of depression. This is useful because it helps the doctor decide on which treatment to use, and it also gives them a specific code for insurance companies for reimbursement.

The bad news is that diagnosing depression involves an element of art, and not just science. That’s one of the reasons it’s important to trust your doctor and have a good working relationship with him or her. This article isn’t the place to go into all the other mood disorders and their symptoms. However, some of them include similar symptoms so it’s important to mention all the things you are feeling for the correct diagnosis.

If you have any questions, please leave me a comment below.

According to the DSM IV, the official manual of psychiatry, depression has the following general symptoms:

1. A depressed mood most of the time. This means almost the whole day and for days at a time.
2. Lack of interest in daily activities. This is a general lack of interest and loss of pleasure in things you generally like to do. This may be recognized by the person with depression or by others around them.
3. A great loss of weight that isn’t accounted for by any weight loss efforts.
4. On the flip side, there could be an increase in weight.
5. Significant change in appetite – either loss of appetite or an increase, which can lead to the weight gain mentioned above.
6. Problems sleeping – sleeping too much, not sleeping enough, insomnia, troubles getting to sleep, etc.
7. Feeling agitated and restless, and/or feeling slowed down that can be sensed by others.
8. Consistently being tired, or having a loss of energy.
9. Feelings of worthlessness, or increased guilt, hopelessness.
10. Loss of ability to concentrate or make decisions.
11. Thinking about death or suicide, perhaps even making plans for suicide.
12. These symptoms are enough to disrupt your normal life and interfere with normal activities. They may be so bad you can’t do normal activities at all, or barely at all. Or, they may be less severe, but require significantly more effort.

photo credit: stofiska

These symptoms can be caused by other things than depression, including some medications or medical problems such as hypothyroidism. They can also be caused by grief, although if they go on longer than two months after someone has died, they can warrant a diagnosis of depression.

Depending on the degree of the depression symptom, its duration, and how many of them you have, there are various types of depression that may be applicable. A doctor will ask you about these symptoms, as well as some other mood symptoms, to make sure that there isn’t another cause for your down feelings, including a form of anxiety or Bipolar Disorder.

For information on specifics relating to the symptoms of depression, please see:

• What Is Clinical Depression? The How Of A Doctor’s Diagnosis 
• Depression In Men: It’s Not Just Stress, It’s Serious 
• Signs Of Depression In Women: Pay Attention To That Feeling That Things Just Aren’t Right
• Teen Depression: Negative Behavior May Not Just Be “Typical Teen”

There are many basic ways to maintaining relationships whether they are with your lover, family or friends; but the most important of them is communication. A lot of relationship fails because of the lack of communication. Sometimes, we just forget to let people know that we love and care for them. We can get very busy at times that we don’t get to stop and appreciate what we have.

In relationships, conflicts are unavoidable and are in fact, inevitable. We just won’t agree with each other all the time. Nevertheless, this doesn’t make our relationship is flawed. Actually, sometimes conflicts can be good since they bring issues into the open so that they can be dealt with and solved. We can always work things out by communicating with each other to find out what is wrong and how it can be fixed. Many times compromise is necessary from both sides, but this can be hard, especially during an intense argument. So, instead of participating in a shout-fest, try to talk things over first. After all, you cannot douse fire with fire. When you feel offended or hurt, let the other person know instead of keeping them and letting all of them pile up. This can be unhealthy and toxic for you since you would be bringing this baggage all the time and it would result to unresolved conflict that would always come up in every argument. So speak and let the other know what you are feeling and experiencing, then work out a solution that would work best for both of you.

If we just learn to communicate better and take time to listen to what the other says, our relationships might actually last longer and become happier. This would result in less conflict and more understanding of what we want and need.

Written by Steve who, besides offering his insight into relationships, is the online expert on refrigerators and freezers.

However, this is a difficult disease to live with, and can affect those around the person with it. Therefore, it is important to get help if these, or similar symptoms are experienced.

The Manic Episodes

What sets Bipolar Depression apart from Unipolar Depression, or a disease that only shows depression symptoms, is the experience of mania as well. This mania can be very pronounced, or more subtle, known as hypomania.

Mania is an increased mood, beyond what would be recognized as normal happiness. The person may even appear so happy as to be euphoric. This would be recognizable to someone else as abnormal, or over the top.

Mania can show increased energy, that also comes with a decreased need for sleep. People experiencing a manic episode will sleep much less than others, sometimes as little as 3 or 4 hours a night, yet not seem to suffer for it. In extreme cases, they may not sleep for days at a time.

The person may have grandiose ideas or even feel that they are chosen for a special mission. They are delusional and show obvious signs of racing thoughts. Their attention span may very limited and they can be easily distracted.

Some may also be extremely anxious and irritable, and may strike out with increased rage.

Those having a manic episode may indulge in other abnormal, seemingly over the top, behavior. They may go on lavish spending sprees, make unwise business decisions, or have an increased sex drive and seek out multiple partners. They may engage in substance abuse from alcohol and sleeping pills, or harder drugs such as cocaine and methamphetamine. In fact, those suffering from a manic episode may be mistaken for being on drugs, even if they have not taken any substances.

The farther into a manic episode the person is, the less likely they are to want treatment and may neglect to take prescribed medication. They may greatly enjoy the feeling of mania and feel that those around them want to stifle them or bring them down. Especially if they have progressed to the point of psychosis where they have hallucinations or delusions of grandeur, they will be especially hard to get into treatment.

They may be more talkative than usual and feel that they need to keep talking; what is known as pressured speech.

They may also have what is known as psychomotor agitation, or an increase in action of movement that appears erratic and unnecessary. It may be pacing, wringing the hands, or taking clothes on and off. In severe cases, it may extend to self harming actions such as chewing or tearing at the cuticles to the point of bleeding. This arises from the anxiety symptoms a person may feel and again, can look like the person is reacting to substance abuse.

Some know that they are having a manic episode and can control it, but enjoy the feeling of happiness and creativity. This may be especially true for those with hypomania.

Hypomania

Hypomania is “below mania”, showing symptoms higher than what would be considered normal, but not severe as is the case with full mania. It may only appear as normal happiness, but upon closer look would be seen as a more elevated mood than is really normal, or mild euphoria.

Like full mania, hypomania can result in a decreased need for sleep with an increase in energy.

Mania can contribute to creativity. However, unlike with someone having a full manic episode, the creativity can be channeled and doesn’t result in impairment of functioning. In fact, they can find themselves much more productive than usual. Many with creative talents recognize they have hypomanic episodes and attribute their successful works to these episodes.

Hypomania doesn’t have the delusions of grandeur, or the psychosis, that may be associated with full mania. In hypomania, these symptoms appear as a drive to succeed, and increased competitiveness. They may have a flood of ideas, which will fall short of obsessive racing thoughts.

Hypomania may be easy to miss, whereas full mania is generally unmistakable. As with Unipolar depression, Bipolar disorder can start as early as the teen years, when it may not be recognized as Bipolar, or thought to just be the normal mood fluctuations of teenagehood.

However, almost always, mania or hypomania occur after a long depressive episode, so if depression is suspected, a sudden change in mood may not actually indicate a reversal of depression symptoms.

Those suffering from Bipolar disorder also sometimes have what are called mixed episodes.

The Mixed Episodes

In the case of a mixed episode, the person experiences symptoms of both depression and mania. Rather than a separate disorder, these episodes occur as part of the mood changes of depression and mania in Bipolar disorder.

During a mixed episode, the person may feel like a failure at the same time they have grandiose ideas. They may have fits of crying and have increased irriatibilty.

Mixed episodes are especially dangerous as a person with high energy but decreased mood is more likely to turn to substance abuse or suicide.

The Depressive Episodes

While many times the depression of Bipolar disorder is seen as the same type of depression as Unipolar depression, there are differences. Although the DSM IV, the bible of mental disease, doesn’t distinguish between the two, those with Bipolar depression are more likely to suffer severe depression than those with Unipolar depression.

Bipolar depression also differs from Unipolar depression in the self reported difficulty functioning. Those with Bipolar depression reported more difficulty functioning, had more problems with doing work well and finding it interesting. They have more problems with relationships and have more arguments and feel upset more of the time. They are more likely to be ashamed of themselves and more likely to commit suicide. They also report feeling depression symptoms on more days than those with Unipolar depression.

Bipolar depression may also cause the person to want to sleep, or to overeat more often than those with Unipolar depression. While those with Unipolar depression may feel sluggish and slowed down, with slower speech, this can be more pronounced or more likely in Bipolar depression. This can lead to impairment in typical activities, especially ones that involve thinking, such as making decisions or making a list.

Those with Bipolar depression may not cry as much as those with Unipolar depression, but they may have stronger feelings of guilt and low self worth. These feelings cause those with Bipolar depression to feel pleasure less often than those with Unipolar depression.

While Bipolar depression hasn’t be studied as extensively as separate from Unipolar depression, there is good reason to feel that they are distinct manifestations.

photo credit: sydney g

Often, the treatments for Unipolar depression, such as anti-depressants, don’t work with Bipolar depression, and may make it worse. In some instances, anti-depressants may bring on a manic episode in someone with Bipolar depression.

Given the differences in Unipolar Depression versus Bipolar Depression, it is important for doctors to accurately diagnose and treat the disease. Especially in those with hypomanic episodes that may not be recognized as an instance of mania, and therefore part of Bipolar disorder.

If you feel that you have any symptoms that could be indicative of manic or hypomanic episodes in addition to depression, you should bring that to the attention of your doctor. They aren’t with you all the time and they need to know everything that could help you with your treatment. Even if it seems unimportant, it may be a vital clue to your doctor.

Mental illness is not fun by any means, but it is treatable, and there are other people suffering with mental illness, even if you feel alone. And for those on the ouside of the illness, family, friends, and others, it can be very hard to understand and help. But, if you hang in there and keep looking until you find the right doctor, you life will change and you will most likely feel dramatically different – but in a good way.

If you have any questions or comments, please leave me a comment below.

The term manic depression is an older term that has been replaced by Bipolar disorder or simply Bipolar. It refers to the cycling between periods of depression and periods of high mood, known as mania.

On TV and in the movies, Bipolar disorder is shown as extreme, with those suffering from a manic episode going out and doing life endangering activities, leaving their families for weeks, and living in a total dreamworld, out of touch with reality.

While the basic concepts are the same, the reality of Bipolar isn’t so clear cut. Bipolar is diagnosed when an individual does have periods of an elevated mood, higher than you would see in normal happiness. The other side of Bipolar is depression. The cycling is random and can be very sudden. However, there are some individuals who won’t seem to be acting manic except to those around them who know their mood is exceptionally elevated. There are also some manifestations of depression that are believed to actually be a milder form of Bipolar, not simply depression.

The idea of a disorder referred to first as manic depression, and then later as Bipolar, has been around for at least a century, dating back to the beginning of psychiatry. However, it’s only been since the 1970s or so that the idea of a Bipolar spectrum has been gaining widespread approval. Although not all psychiatrists believe that a Bipolar spectrum is needed, there are distinct reasons to have one.

The Bipolar spectrum is a way of defining the range of severity of Bipolar symptoms that patients experience. Those with clear manic episodes that cycle with depression, those closest to what you see in the movies and on TV, would be at one end of the spectrum. Those who have mild periods of mania, which may be mistaken for times of normal happiness, would fall on the other end of the spectrum.

The bipolar spectrum is divided into four segments:

Bipolar I is the new name for what was typically thought of as manic depression. Those with Bipolar I have a manic episode that lasts for at least one week, alternating with periods of depression. The cycles are random and can’t be anticipated. The periods of depression occur more often than the mania, at about 3 to 1.

Bipolar II is used to describe those with Bipolar who don’t show symptoms as severe. The periods of mania are much milder, and can last several days, though not necessarily as long as those with Bipolar I. The periods of mania are referred to as hypomania and can often be mistaken for periods of normal happiness. Also, because the episodes of depression outnumber the periods of hypomania, usually at least 30 to 1, many patients are thought to simply be depressed, and the cycling that comes with Bipolar II can be missed.

The other two categories of Bipolar aren’t typically thought of when someone thinks of depression or manic depression.

Bipolar III refers to those who may have seemed to be simply depressed, yet end up with hypomanic episodes when they are put on antidepressant medications. In these cases, the antidepressant medications have made symptoms worse, but a good psychiatrist will be watching for these reactions and carefully working with the patient to find the best treatment for them.

Bipolar IV is used for those who have a rapid cycling between the extremes of mania and depression. This type of bipolar disorder is described as at least 4 episodes of either mania or depression in a year. In rare cases, the cycling may be even more rapid, up to those severe cases where the cycling occurs throughout a single day.

The DSM-IV, the “bible” of mental disorders, refers to part of the Bipolar spectrum called Cyclothymia. This is alternative Bipolar III, characterized by a history of episodes of hypomania and depression. The depression can certainly be recognized, but may not be as severe as other depressive episodes. Remember that because hypomania can be seen as normal happiness, depending on the diagnosing physician, they may be seen as having recurrent depression.

Although, if the return of the depression appears to have a distinct cycle, the diagnosis may be changed from depression to part of the Bipolar spectrum. A doctor may also treat recurrent depression as if it is on the Bipolar spectrum, even if he doesn’t suspect episodes of hypomania; mood stabilizers in combination with anti depressants are helpful for some people.

Cyclothymia also describes those whose hypomania or depressive episodes appear as a personality trait. Since the cycling may be gradual and the symptoms very mild, others may not recognize the individual as having a mental illness. None the less, these patients can also be helped, and their mood stabilized so that their life is not affected.

One of the reasons this spectrum of bipolar isn’t widely accepted is because there are some who feel many different manifestations of mental illness are really subsets of bipolar disorder. Diseases such as substance abuse, eating disorders, or personality disorders have been proposed to fit on the scale, sometimes in between the categories stated above, as fractions, like Bipolar I 1/2.

If you hear of someone who has been diagnosed, or have been diagnosed yourself, with manic depression, or Bipolar disorder, it is unlikely to be as dramatic as depicted in fiction. Although symptoms of the disease are along the same lines as those seen in the movies, they are usually not as severe.

photo credit: Sander van der Wel

Also remember that Bipolar may refer to a much milder form of cycling that mostly involves depression, rather than distinct periods of mania. And, as hypomania may seem, even to the person experiencing them, as what normal feels like, a diagnosis of Bipolar may seem much scarier than it really is.

It’s important for anyone who suspects they may have depression or Bipolar disorder to see a trained professional to help distinguish exactly what is going on. This will ensure a method of treatment that is best suited to each individual. If they don’t feel comfortable with their physician, they should see someone else.

Since mental illness can be very slippery, unlike an infection, treatment will probably need to be adjusted as some medications may not work as well, or even as the seasons change. A good relationship with a doctor allows the doctor to sense changes in mood that may indicate the need for a change in medication.

Whether a diagnosis of Bipolar I, or Bipolar II, or even a diagnosis of only depression, sometimes called unipolar depression, there is help available. A balanced mood helps people live a normal life without ruining relationships, turning to substance abuse, or engaging in even more extreme behaviors – including suicide. Mental illness is an illness, and a good doctor will treat it as such.

If you have any questions, please leave me a comment below.

Seeing a good psychiatrist to get medication can be a big help. In some situations, so is therapy. You may choose not to go this route, or even if you do, there are a lot of things you can do to help yourself with depression. The following tips will all help.

And, unlike other articles online that give simple directions, and feel good platitudes, I understand what it’s like to be depressed and give tips on the least you can do to help yourself.

When you feel depressed, the best thing to help yourself is to do the exact opposite of what you really want to do. Your brain’s wires are crossed and sending you faulty messages. What seems like the best course of action is a brain trying to figure out what will help. But, depression makes it very hard to see things clearly, so what you want to do really isn’t the best thing for you.

I understand that these may be very difficult to do, especially on those days where’s a struggle just to get out of bed to use the restroom. However, if you can drag yourself out of bed for just one of these things, I promise it will help you feel a little bit better.

1. You feel alone and isolated, like no one understands what you are going through.

For instance, it helps to know that being tired goes along with feeling irritable, as well as not being hungry, or being overly hungry. You may feel sluggish, or on the flip side, restless. And, you may switch back and forth between the two. One day you’ll feel like you can’t sit still because you feel like you have to get away. Then, the next day, you could feel like you need a crane to lift you out of your seat. Things happen around you that you can’t makes sense of, or that you don’t want to make sense of.

Seek out forums if you can, or at least stories of others who are dealing with depression. Trust me, you are not alone, and there are others who have beat this disease – you can too. The internet is a great place to look for others, and even in the middle of the night it’s very possible that you will find someone on a forum that is also unable to sleep and needs someone to talk to.

2. You feel like all you want to do is curl up in a ball and pull the covers over you head. You want the world to leave you alone, and you want things as dark as possible to shut everything out.

So, force yourself to get out of bed, or get out of the dark room and get into the light. Taking a walk in the sunshine will go a long way to helping you feel better.

However, I know this may be way more than you are ready for. In that case, try sitting on your front porch, deck, patio, or even the front steps of your apartment. If you have to, sit in a chair with a blanket pulled up to your shoulders and a pair of huge sunglasses on.

Either way, getting outside will help. Even on a rainy day, the change in air will help. And, if it’s not storming, the rain can be very soothing. Or, if you are someone like me who likes storms, then enjoy the thunder and lightening.

If you really don’t feel like going outside, try a therapy lamp. These are very bright, but they do help to lift your mood. They won’t have the added effect of raising your vitamin D levels, which has been shown to boost mood. However, they do have the right wavelength that your eyes sense and send messages to your brain to make hormones that work against the crossed, destructive messages your brain is sending you.

3. You want everyone to just go away and leave you alone.

Try to watch comedies if possible. Eddie Izzard is great. I was having a bad day one day and all I wanted to do was come home and crawl into bed. But, when I got there, my brother was over and I wanted to snap. However, feeling like I had to be a good hostess, I sat down to watch the show with him. Within a few minutes I was laughing. I’ve asked around and found that Mr. Izzard has a similar effect on many people.

If you feel up to it, talk to your friend about how you feel. Maybe ask for advice, or help with something that seems overwhelming at the moment. Many people are happy to help, if you tell them exactly what you need help with.

4. You don’t want to move from your bed or from you couch. You may feel aches and pains and an overall yuckiness.

First, tackle the yuckiness. Try taking a shower and just enjoy the water washing over you. Wash off, taking time to make sure you hit every square inch of skin. Run your fingers between your toes. The point is to:

• Make sure that you feel super clean which emotionally feels like you have washed away the yuckiness.
• To pay attention to something other than your mood. By taking the time to think about hitting every square inch, you must focus on something else.
• Get you to move. Even the small movements of turning on the water and washing get you out of the fetal position and give you a small boost.

The water doesn’t have to be warm. In fact, it may help to make it on the cool side to get a sensation you don’t usually get. And, cool water makes you feel more refreshed, further getting rid of the yucky feeling.

5. You feel like getting up will take more energy than you have. You think that only one of those huge cranes has the strength to lift you.

Of course it’s not true that you can’t move, you just don’t want to. I’m sure that you move to go to the bathroom, so moving is possible. Focus on small things at first, and then true exercise – if you can.

Load the dishwasher, vacuum the floor. If you have cats, scoop the litter box. None of these things are particularly fun, but they do get you to move. And, when you are done them, you will feel a sense of accomplishment, which also boosts mood.

Exercise is probably the best thing you can do. But, I know that this isn’t realistic when you feel the deepest in depression.

So, on those days when you feel better, even if you still don’t really feel good, do some exercise. It’s very easy to take a walk. Especially in the sun, as noted above, but even in the evening a walk will help.

If you are up to it, do something a little more vigorous. Try power walking, or lifting weights. The more consistently you exercise, the better you will feel.

Exercise is always easier with a friend. Even if you aren’t depressed, it’s easier to keep to a regular schedule if you do it with a friend. But when you are depressed, doing it with a friend helps even more. Combining this, number 5, with friends, number 3, intensifies the mood boost. So, if you can, exercise with a friend.

There are other self help for depression techniques. You may find that Vitamin D supplements help. You may also find that other herbs help. As part of the research you are doing in number 1, look for supplements you can take to help you out. This is especially helpful if you don’t, or can’t, get to a doctor for medication, or if you don’t want to take artificial substances.

Remember, when you are depressed, you brain is confused and sending the wrong message. Find out all you can about depression, and then tell yourself that doing the opposite of what you really want to do will do the most good. If you have any questions, please leave me a comment below.