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Depression is a complex disorder with many forms. Some people have a clearly sad,
depressed mood; others become irritable and short-tempered. One common factor is that
everything in life seems uninteresting, like looking at life through a dark filter. Some
people describe it as a loss of the "zest for life." Once a depressed or
irritable mood has been identified, health care professionals use a simple
strategy to assess depression called SIGECAPS, which looks at eight life
functional areas:
Sleep. Is there an inadequate amount of sleep (insomnia)? Is it difficult to
fall asleep, or is there a pattern of waking up early and not being able to fall back
asleep (maintenance insomnia). Maintenance insomnia is very common with depression. Is
there too much sleep (hypersomnia)? Sometimes depressed people sleep from 10 to 12 to 14
hours a day.
Interest. Has there been a loss of interest in activities or hobbies that were
once pleasurable? Does having fun or relaxing just seem too much of a bother? Have
projects and/or relationships been ignored?
Guilt. Is there a feeling of having let someone down, of being responsible for
failures and problems?
Energy. Is there a noticeable lack of energy compared with before?
Concentration. Is it difficult to pay attention to something or someone without
being distracted by other thoughts? Are problems with memory or work occurring? Are there
frequent requests for others to repeat information because of inattention?
Appetite. Has there been a significant loss of interest in eating? Any weight
loss? Alternatively, has there been random eating or weight gain?
Psychomotor agitation or retardation. Is there a sense of feeling
jittery or antsy; is it hard to sit still? Is there frequent shaking or pacing? Alternatively, is
there a sense of being slowed down, weighed down, or dragging around?
Suicide/Homicide. Have there been any thoughts of death, thoughts of self-harm,
harming others, suicide or homicide? Is there a concrete plan? Are the means to carry out
this plan (eg, weapons) available? Is there an alcohol or drug problem that might make
the person more impulsive or impair judgment? Have there been past attempts? Is there a
willingness to talk about this, to seek professional help?
If there is any indication of depression, please seek professional help. All mentions
of suicide or violence must be taken seriously. If there is a concrete plan, or an attempt
has been made, go to the emergency room for immediate treatment.
Some psychotherapy techniques for depression
- Cognitive restructuring: Reframing thoughts and actions to emphasize positive, effective
behavior.
- Identify and assign reinforcers: Assigning the person to engage in pleasurable
activities.
- Enlist social support: Depression makes people irritable and withdrawn, which naturally
drives others away. Special efforts are made to encourage and educate significant others.
- Concrete problem-solving: Depressed people often feel trapped in exploitative situations
or relationships. Assertiveness training allows them to express their needs and, if
necessary, separate from these situations.
- Challenge unrealistic beliefs: Depression often involves feelings of
hyper-responsibility ("It's all up to me.") or all-or-nothing thinking ("If
she doesn't say hello, she must hate me."). The depressed person needs to re-evaluate
these unrealistic beliefs.
- Analyze past losses and traumas: Grief over the death of a loved one, or guilt over
surviving, often evokes intense anger over abandonment. Situations similar to childhood
traumas may bring up unexpected hostility.
What to do with suicidal or homicidal thoughts
1. Take all such statements seriously. Violence against self or others results from
depression, anger, and hopelessness combined with impulsiveness, poor judgment, and/or
intoxication. Many so-called "cries for help" end up as completed suicides.
2. Contact a mental health professional. If there is a concrete plan or an actual
attempt, go to the hospital emergency department immediately.
3. Discuss the suicidal or homicidal thoughts. Depression narrows one's focus;
discussing options broadens it. Discussion allows for logical problem solving.
4. Hold the person accountable for threatened action. It is the depressed person's
plan; refuse responsibility for any suicide or violence.
5. Remove means of violence (usually weapons) and any alcohol and drugs from the home.
6. Be with the person, or at least be readily accessible. Accompany the person to
treatment so that you can provide history and background information, as well as social
support.
7. Be especially wary when the person's depression lifts. This is the most common time
for a completed suicide, perhaps because an increase in energy allows the person to carry
out the plan.
Living with a depressed person
Depression is a pervasive disorder that affects a person's body, thoughts,
emotions and interpersonal relationships. Often, well-meaning relatives and friends can
exacerbate the depression by either denying the depressed person's experience ("Cheer
up! Things aren't so bad!) or by taking over control ("Stop sulking and go to
work!"). Here are some suggestions for living with a depressed person that may make
things easier for you and more beneficial for the depressed person.
1. Recognize that depression is often expressed as hostility, rejection, and
irritability--especially in men. These are signs of a disease, not a personal rejection.
2. Understand that depression is a disorder with biological, psychological, and
interpersonal components; it is not a personal weakness or an admission of failure. Make
sure the depressed person knows that you understand this fact.
3. Adopt a "one-down" interaction style that leaves the depressed person in
charge, at least superficially. For example, instead of suggesting, "Let's go to the
movies tonight," you may want to suggest, "Hey, I'd really like to see a movie.
Which one of these would you like to see with me?"
4. Encourage the depressed person to seek professional help. Accompany and support the
depressed person, but make it clear that the responsibility for getting better lies with
him or her. Attempts to externalize responsibility ("You forgot to remind me."
"She wouldn't drive me to the session.") should be disputed and the
responsibility for getting better placed back on the depressed person.
5. Remember that treatment is very effective. About 70 to 85 percent of depressed people
improve within a few months after beginning treatment.
6. Support opportunities for the depressed person to be rewarded, such as visiting
friends or going out for activities. However, don't force these situations, as this would be
viewed as taking control.
7. Make sure to notice and praise any significant improvement. Be genuine. "I'm
glad you're taking care of the kids; I've always appreciated that" is better
than
"Well, it's about time you took care of the kids again."
8. Leave time for yourself and your own needs. Depression makes people lethargic,
irritable, and self-focused; this will wear on you. Take breaks from the depressed person
from time to time. It will help both of you.
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