Appendix I: Depression

What is Depression?  
Depression is a complicated disturbance in our mood characterized by many kinds of changes in our normal experience and functioning.   These can include:
• Changes in the way we feel - more hopeless, helpless, pessimistic.
• Changes in sleep - We may sleep too little or too much, awaken in the middle of the night or early morning and feel unable to get back to sleep.
• Changes in eating patterns - We are not hungry or eat a lot more than usual.
• Changes in our view of ourselves -We may feel guilty, worthless and incompetent.
• Changes in energy level - We feel chronic fatigue and low energy.
• Changes in our sense of pleasure - Things that used to seem fun do not interest us.
• Changes in our sense of time - Time can seem to stretch out monotonously and endlessly, different from our usual perception of it.
• Changes in our ability to concentrate - We may try to read and feel unable to focus or remember what we read.
• Changes in our bodies - We may experience more headaches or hard-to-account-for pain or gastric upsets such as constipation or diarrhea.
• Changes in our thinking - Unconsciously we begin looking more and more at the dark side of things. Our glasses are seen as “half empty,” not “half full.”
• Changes in our view of our ability to solve problems - We may begin excessive worrying.
• We may experience self-destructive or even suicidal thoughts. 

What causes depression?
• Bio-chemical malfunction - You may have heard of the expression “chemical depression.” Problems in the complex neurotransmitter systems of the body may play a role in the depression. Anti-depressant medicines act to mediate these biochemical problems. Anti-depressant medications are powerful sources of help for many depressed people but are usually not the only answer to resolving depression.
• Long-standing negative or unrealistic thinking patterns - We may have unconsciously learned from living in a depressive family or social environment to a) focus on the negative b) to blame ourselves for negative outcomes and never take credit for positive ones c) to underestimate the amount of control we have over things d) to have more of a focus on our internal state rather than a focus on actions we might take. Thoughtful people have long realized we need to find a balance between contemplation and activity.
• Reaction to grief or trauma - Facing the death of someone we love or a trauma can elicit depressive feelings in all of us. These are normal human reactions and usually pass with time.
• Long-standing feelings of being out of control, of having no mastery over the events in our lives - Researchers have shown that people who continuously feel very little control over their lives can develop feelings of depression.
• Long-standing feelings of isolation and alienation - This relates to a tendency to focus exclusively on internal state, not action. 

Ten Ways to Relieve Depression:
• TRY to distinguish between “the blues” and a more serious depression. Periods of sadness and feeling blue are a normal part of human experience. So is grieving, following a loss or trauma.
• If the down mood does not lift after several days, and you, in a sustained way, experience many of the changes discussed earlier (i.e., changes in mood, sleep, eating, concentration, feelings about self, activities, sense of pleasure, sense of control), then you may want to CONSULT a therapist and/or physician.
• If medication is prescribed, FOLLOW the doctor's instructions carefully. Anti-depression medicine, properly used, is a powerful tool in the treatment of depression.
• TRY to examine your thinking patterns. These are very automatic for all of us. Yet we can learn to disrupt self-negating, self-destructive patterns.
• DON'T FORGET healthy nutrition, exercise patterns and sleep. Bodies that are well taken care of physically may be less prone to depression.
• REMEMBER alcohol and many other drugs are central nervous system depressants and may be contributing to your depression. If you use alcohol, think about its effect on you.
• TRY to find ways of feeling more in control of your situation. Talk things over with a friend to try to map out solutions to problems. Try to avoid automatically assuming “there is nothing I can do.”
• If you tend to be very introspective and focused on yourself, TRY to find a good balance among activity, outer focus and inner-contemplation. Too much obsessing and ruminating about ourselves can be depressing for any of us. It leads to exaggerated feelings of guilt and responsibility for the negative.
• LOOK OUT for the emotions of anger and rage. Are you a person who tends to swallow anger, repress it, never act on it appropriately? Too much “stuffing” of strong feelings such as anger can make us feel out of control and contribute to depression.
• FIND physical activities you enjoy doing. It is difficult to be engaged in vigorous physical activity that enhances our competence and still be depressed! 

Does depression come and go or is it a constant state?  
There seems to be more than one kind of depression. Some people experience chronic, long-lasting depressive feelings of the kind we have been looking at. Professionals use the term “dysthymia” for this kind of depression.  

Other people experience serious depression symptoms which may last from a matter of a few weeks to several months. This is termed “major depression.”  

Depression is complicated and there is usually not one single cause.  

Is depression “my fault?”  
NO. Depression is a most uncomfortable state no one chooses to be in. People do not get depressed on purpose.    

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