Saturday, November 12, 2005

Identifying Depression: What To Do If A Loved One Is Suffering - By Michelle Rabin, Ph.D.

Depression can take on many faces depending upon the person, their age, and their gender. Overall, the best thing to be aware of is a significant change in activity or behavior.

Depression In Teens

Depression in teenagers can be difficult to identify, as their mood cycles are traditionally erratic. In general, females tend to suffer from depression more than males, but don’t overlook a young male whose behavior has changed. Again, the things to look out for are marked changes in behavior. If the teen tends to be social and there’s been a significant reduction in their social activities, than that might be an indication that he or she is depressed. Is the phone ringing a lot less? Have they become more withdrawn from the family? Are they sleeping excessively but still seeming to be tired a lot? It’s also not unusual for them to be especially irritable and cranky. Tearfulness is yet another sign. Grades in school often decline as the teen becomes more distracted and less attentive.

Drug use is also a concern for teens that are depressed—as it is for anyone suffering from this problem—because people often medicate their depression with alcohol and /or drugs to try to feel better.

Depression in Adults

Adults tend to hide their depression a little better than kids. They’ve learned how to put a mask on and act as if everything is fine, even when it is not. Appetite is often a strong indicator. The loss of appetite is most common, however there are those who sooth themselves with food so, in that case, you would expect to see a weight gain. Sexual appetite is another variable that is often identified. Depression puts a damper on sexual desire. Essentially when a person stops doing those activities that they used to enjoy, there’s a good chance that depression can be a factor.

Depression In The Elderly

The elderly suffer from depression a lot more than is reported. The older generation still feels a lot of shame and embarrassment about mental illnesses. The harsh reality of the elderly is that their friends are dying on a regular basis. These losses bring up many different feelings, ranging from loneliness and loss to the realization that their time is also limited. Withdrawal is a common sign, as well as weight loss, fatigue and irritability. It is critical to have the elderly evaluated by a competent gerontologist (a doctor who specializes in the older population) to rule out worrisome medical concerns.

Discussing Suicide

When a family member is discovered to be depressed, there is often a reluctance to be direct and straight forward with them. Often people think what if I ask the person if they feel like they want to end their life, and I’ve gotten them thinking about suicide when they hadn’t previously considered it? That will never happen. If a person is severely depressed, they will most likely have given some thought to ending their life. Vague, passing thoughts about suicide are normal for everyone at one time or another. What you need to be worried about is if a person has actually constructed a plan to end their life. Another phenomenon to watch out for is if someone who had been previously very depressed suddenly seems to be fine— happy even—and starts giving their possessions away. Do not be fooled into thinking that this person has made a spontaneous recovery.

So, if someone takes a sudden turn for the better and starts giving things away, or if someone talks to you about having a specific plan to end their life, you MUST take action. These are definitely cases of it being better to err on the side of caution. Let the person know that you are concerned about them, and ask that they speak with a mental health professional. You might offer to get an appointment for them and then take them to the appointment. If they refuse treatment, it is essential that you contact a mental health professional and seek their advice. You can search the internet, the phone book, or call information to get the number for your community mental health center. Most community mental health centers have an emergency clinician on call 24 hours a day to assist in such an emergency. Do not leave the person alone until they’ve been evaluated and it has been determined that they’re able to be left without supervision. People often feel concerned about upsetting the person by pushing for evaluation or treatment. The most important thing here is to prevent a suicide. Even if the person is initially angry, once their depression lifts they will be forever grateful that you intervened on their behalf. Depression is a life threatening illness. Suicide is a permanent solution to a temporary problem. Imagine this….a person feels so miserable that they decide they can’t take feeling this badly for another minute. But the good news is that the vast majority of people suffering from depression will recover and continue to have normal lives. I’ve occasionally had to make deals with my patients. I’ve suggested that they give me 3-6 months to help them feel good again. If I’m unable to help them change their perspective and feel better, then I’ll consider the possibility that suicide is the only remaining option for them. In all of my 25 years of seeing patients, it’s never come to that. Although not everyone has achieved perfect “normalcy” within that time period, the vast majority of people experience a considerable enough improvement to warrant wanting to continue their life.

Don’t be afraid to talk about depression. Don’t be afraid of tears. There is help available for everyone. Most community mental health centers receive state and federal funds so they have the opportunity to provide treatment and no or low cost. Everyone today can find some kind of treatment if they need it.

Dr. Michelle Rabin is a clinial psychologist with 25 years of experience treating depression. More information and depression resources can be found at

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