Depression. One of the most misunderstood conditions by both those who live with it and more so, those who don’t. The unfortunate suicide of two celebrities in recent days has garnered a lot of attention in the news about depression and suicide. The number of suicides in the United States is staggering, but sadly it has taken the celebrity status of these two deaths, amplified by them happening within days of each other, to get the attention of the media.

Sunday morning, a speaker who is one of the most vivacious, outgoing, talented people I know told his story of being suicidal for almost twenty- one years of his life. This man, a friend of mine, travels all over the world motivating people. His revelation was a wake-up call to many. I knew then that I had to write to you about depression, more specifically women and depression. There’s a reason for addressing women.

As a registered nurse, I’ve not only studied depression, but I’ve had the opportunity to work with some remarkable people who suffer from it, people who would surprise you. Great achievers who, unbeknownst to anyone who knows them, fight these demons every day. The question is why.

Mental health is a closet subject. It has a stigma attached to it that makes it an unmentionable taboo subject. Nobody wants to openly admit that they, or someone in their family, has a mental health issue for fear they might be branded as crazy or even be “locked up.” And rightfully so. In general, the public for the most part is ignorant about depression. In fact, they’re ignorant about mental illness. Because of the lack of knowledge and fear of the unknown, even in this day and age, the stigma lives on.

 

So why women? It may shock you to know that the suicide death rate for women aged 60-64 has increased 60 percent since 1999. Why? The cause is unclear but getting older and dealing with life changes is hard.

Your kids grow up and they don’t need you like they did before. Your whole life was about being the greatest mom in the world and you were always there for them. It was who you were.

Suddenly that changes. You tell yourself how great it is that they’ve grown up to be successful and independent, and can function beautifully on their own. You did your job well. But the truth is, it’s difficult to no longer be needed. It hurts. They don’t want your advice or to be told what to do. When they actually ask for your opinion, your mood level rises 100%.

You no longer turn heads when you walk into a room like you used to, no matter how much you diet and exercise. The beautifully straight eyeliner you used to put on in one easy stroke takes you half a day and still looks like a road with potholes.

Your kids look at you like you have three heads when you show up in that really cool new outfit you just bought.

These darling kids are calling you Grandma, which you love and are proud of, but still makes you cringe a bit. Grandma?

You’re desperately looking for something new to fill your days and make you feel productive, like you’re contributing something somewhere.

You see your life moving past you like a freight train. You say things your mother used to say like time flies.

Hormones, or lack thereof, are raging and contributing to the “nobody likes me” syndrome.

And some days you feel so useless and unwanted you think it would be better for everyone, especially yourself, to just end it all. Nobody would care anyway, right? Maybe a little bit of that’ll show ‘em kicking in.

Sound familiar?

The fact is, you’re not alone. Most women your age feel the same way. Your mother and grandmother went through it. And just like little kids don’t know what it’s like to be an adult because they’ve never been one, your adult kids haven’t been where you are. They will never understand until they get there. But you were them once upon a time, so it’s up to you to remember that you didn’t understand how your mother felt then either. What if you would have?

Dealing with these changes as we age, it’s normal to go through the grieving process.  Part of that grieving process is depression. For women who may be vulnerable to depression, this time in their life can be particularly difficult and even spur some into a clinical depression. Knowing the difference in being in an acute depression and slipping into clinical depression is extremely important. There’s no specific moment or symptom that differentiates the two except that it’s not getting better over time. Nobody wants to admit to themselves, much less anyone else that they may need help.

Awareness is critical.

WHY NOT TALK ABOUT IT?

So why don’t people who fight depression or have thoughts of suicide talk about it. They don’t want people to think they’re crazy. They don’t want to lose their credibility. They don’t want others to avoid them. They don’t want to have their loved ones put them into a facility. They feel damaged and don’t feel worthy. They don’t want the stigma. They don’t want people to think they’re just trying to get attention. They feel so sad they don’t care. They don’t want anyone to stop them. The list goes on. There are a lot of reasons. Everyone has different reasons and they’re all valid.

It would surprise you if you knew how many people around you have suicidal thoughts. They’re often the most outgoing, happy, successful, creative people you know. Got everything going for them, it seems. Got the world by the proverbial tail. I know. Because I’m one of them.

My four precious granddaughters who have lived four blocks away and been our life since the first one was born twelve years ago, are moving to Tennessee shortly. That’s fourteen hours away by car. We attend every school event, dance competition, go to the same church and are always on call to pick them up from school or keep them when needed. Our house is their house. We are extremely close. Since my son told us several months ago that they were moving, I’ve been hurting so badly I’ve thought about taking my own life many times, through my tears. When you go through that kind of pain, you understand how it could happen to someone. Awareness is essential. I recognize it as acute. It will pass. Ending my pain now would mean not only missing out on all of the wonderful things in their future, but passing my pain on to them, and that’s not fair. I have to put on my big girl pants and go to plan B.

Another is example is Robin Williams, one of the funniest people ever born. Who knew his pain? Watching him, knowing his success, who would have ever known about the demons he fought. But think of the stigma he would have had to deal with if he would have openly talked about his mental illness? It’s unfortunate that people are not more informed about this illness.

People need to understand that It’s not contagious. It’s not a weakness. Quite the opposite. It takes a lot of courage and strength to live with it.

WHAT’S SO HARD TO UNDERSTAND ABOUT DEPRESSION?

Why don’t people understand depression?

It’s subjective. You can see a broken leg. You can measure blood sugar levels. Those are objective. You can’t see pain. And that’s what clinical or chronic depression is. It’s unbelievable, ongoing, never-ending, unbearable pain. It’s a sadness that won’t go away.

The depression that most of us can identify with is acute. Everyone has experienced it. Something has brought it on like losing a loved one, a job or your house from a financial downfall. Anyone can name hundreds of reasons. This kind of depression gets better and goes away over time or when the situation gets better. Anyone who has experienced it, which is most of us, understands the excruciating indescribably pain it can cause. Fortunately for most, it’s temporary.

Imagine living with this pain continuously day and night. Pain that nothing good happening in your life can take away. This is clinical depression which is chronic versus acute like I discussed before.  It’s an illness, a mental illness. It’s a disease that those who do not have it cannot truly understand.

 But everyone needs to understand clinical depression, for themselves and those around them. People normally don’t want to be around a person with clinical depression because they don’t know what to do.  They try to make them “cheer up” and feel happier but when it doesn’t work, they feel helpless. They don’t understand why they can’t just “snap out of it!” I’ve heard that from many people who simply don’t understand it. Trying to get a person with clinical depression to snap out of it by being cheerful around them only makes things worse. They see a cheerful person and it makes them more depressed, wondering why they can’t be happy as well.

WHAT ARE THE KINDS OF DEPRESSION AND THEIR SYMPTOMS?

Like a lot of diseases, clinical depression can exist at different levels of severity. You’ve heard people remark that someone is a bad diabetic for example. Depression is the same. There are mild, more transient mood states to more severe, chronic forms. Typically, the more severe states are the ones referred to as clinical depression.

There are also two primary types of clinical depression.

Major Depression, also referred to as Major Depressive Disorder (MDD) or Unipolar Depression, is what most people think of as depression. The symptoms of this type of depression are more than just feeling sad. Here’s a list of common symptoms to be aware of:

• Feelings of sadness or emptiness
• Loss of interest in previously enjoyed activities
• Weight and appetite changes
• Sleeping problems
• Tired and lack of energy
• Feelings of worthlessness or guilt
• Problems concentrating or making decisions
• Feeling slowed down or extremely agitated
• Thoughts of suicide

The second kind of clinical depression is what most people know as Bipolar Disorder. With this disorder, clinical depression pairs with a manic phase and the person experiences extreme mood swings of highs and lows. The symptoms of the depressive phase are the same as Major Depression, but during the manic phase, a person may experience symptoms at the opposite end of the scale, such as:

• Increased energy
• Sleeplessness
• Irritability
• Rapid speech
• Hypersexual behavior
• Racing thoughts
• Grandiose ideas
• Greatly increased activity
• Impulsive behavior
• Poor judgement

WHAT CAUSES CLINICAL DEPRESSION

Sadly, the causes of depression are somewhat of a mystery. Studies have shown that multiple factors may work together to cause a person to develop depression. Some studies show it could be inherited  neurotransmitters in the brain, mood-regulating chemicals, that do not work properly. Environmental factors may be responsible for triggering depression in people who are already genetically vulnerable.

WHAT TO DO ABOUT DEPRESSION

Talk to your doctor about your symptoms. Depression is a disease that is treatable and not to be ashamed of.

Medications

The standard first choice for treating depression is antidepressant medications. These can be life-saving medications for those clinically depressed. There are several different types available, but SSRIs which are a class called selective serotonin reuptake inhibitors, are most likely the most often prescribed. They are the most popular choice of both doctors and patients because they have less side effects. Some of the more common ones are Prozac, Zoloft, Paxil and Lexapro.

Another group of antidepressants belong to a group called SNRI’s or serotonin and norepinephrine reuptake inhibitors. Cymbalta and Wellbutrin are two common medications in this category.

Be sure to ask your doctor which of these would be most appropriate for you and discuss their side effects.

Psychotherapy

Psychotherapy is another popular treatment for depression. Depending on the situation, it can be effective on its own or with medication.

Psychotherapy involves working with a professionally trained and licensed therapist. It could be alone or in a group setting. It is beneficial for those with depression to help them better understand problems that may be contributing to their depression and how to manage it.

Studies show that the combination of medication and psychotherapy which attacks the depression from two different angles may have the best results. The medication treats any chemical imbalances while the psychotherapy addresses the psychological factors involved.

I’M NOT A PROFESSIONAL THERAPIST WHAT CAN I DO

Whether you or someone you know are suffering from the symptoms of depression the question is what to do about it.

1. Awareness is number one. Know the symptoms. Feeling sad all of the time is not normal. If you recognize yourself when you read this list of symptoms don’t be afraid to talk to your doctor about it. Get professional help. Depression is nothing to be ashamed about.
2. If you have a friend or loved one who exhibits several of these symptoms, don’t be afraid to talk about it with them in private, in a non-invasive non-accusing way. Don’t use the words mental illness or mental health, which may offend them or make them think you are accusing them of being unbalanced. Ask them if they’re ok or simply how they are. Perhaps say something like you’ve noticed they seem a little down lately. Ask them if there’s something they’d like to talk about. Some people need someone to reach out to them in a caring, concerned way. You could be throwing them a lifeline.

How many people have said after the suicide of someone they know, if only I had known.

3. When talking to someone, be patient. Listen. Let them do the talking. Ask occasional gently probing questions if necessary. Then wait. Unless you a trained mental health therapist the only advice you should offer is a suggestion that they talk to their doctor. Do not say psychologist or psychiatrist. 

       Most therapists just listen, sometimes for very long periods of time. Allow them to start the       conversation once you’ve initiated it. Most people will talk about what’s on their mind.

4. Don’t get frustrated. People suffering from depression are most likely used to people around them getting frustrated with them being sad. Most people don’t understand they can’t just snap their fingers and snap out of it. They will easily pick up on it if you are uncomfortable or frustrated. Often they are often feeling guilty or unworthy. This is common. Make them understand that you care. Be sincere.
5. It is normal for people to try to cheer up a depressed person by acting cheery and happy when they talk to them. This is the worst thing you can do. It makes them more depressed to see how happy you are, emphasizing how unhappy they are. Be yourself and don’t put on an act. Just be there and allow them to talk. Listen. If they won’t talk, stay there beside them. Hold their hand if they will allow it but don’t force it. Let them know you sincerely care and you’re not going anywhere.

 

THINGS TO REMEMBER

It may seem like the end of the world. You may not want to live today, but you will tomorrow. Wait one more day.

Be cautious about using words like “shrink” when talking to people, or making jokes or comments about mental health. You never know when someone is listening who may be silently suffering from one of these diseases or have a loved one who is.

A HUG OR A SMILE CAN SAVE A LIFE