can be so severe that you feel like harming yourself. First, you need to tell someone how you’re feeling. Then you need to see a doctor. You may worry that you’ll scare the person you tell. You may feel as though there’s nothing a doctor can do for you. But I’m telling you, help is available. Depression is very treatable. Don’t do something you can’t undo. Ask someone for help. Your safety is more important than anything else.
THIRTEEN SIGNS YOU MAY BE DEPRESSED
If you find you’ve been experiencing a number of the symptoms on this list for at least two weeks and they’ve been affecting your relationships and your day-to-day functioning, you could be depressed:
1. I feel sad a lot of the time.
2. I just don’t care about things anymore.
3. I’m overcome with feelings of guilt.
4. I feel worthless.
5. I can’t concentrate.
6. I’ve gained or lost weight (without dieting).
7. I’m having trouble sleeping, or I sleep all the time.
8. My performance at work or school is suffering.
9. Making decisions seems harder than it used to.
10. I’m experiencing physical symptoms that don’t have a physical cause.
11. I avoid seeing my friends.
12. I think about hurting myself.
13. I just can’t seem to see the positive side of anything.
Asking Why
It’s not common, but mood difficulties can have a physical cause, such as a vitamin deficiency, Addison’s disease, multiple sclerosis, pancreatic cancer, traumatic brain injury, or Lyme disease. Depression can even be a side effect of some medications. Ron is still embarrassed to admit that one of his clients, who had been working hard in therapy but wasn’t making any progress, ended up having hypothyroidism. As soon as her doctor started her on medication, all of the skills she’d been practicing with Ron worked like a charm. Visit your doctor to rule out any physical illness or condition that could be causing your depression.
Outside of a biological cause like a disease, deficiency, or medication side effect, no one knows exactly what causes depression. Is it a biochemical imbalance? Is it about serotonin levels? Genetics? Is it something we pick up from our parents growing up? Is it our personality? The reasons for depression are controversial and complex. This is one way depression differs from a broken leg — in most cases there’s no defining moment or single event we can point to as the cause of our emotional pain and malaise.
But that doesn’t stop us from asking why. Many people look at their lives — their family, their health, their partner, their job — and say, “I’ve got it so good. So why do I feel so bad?”
Ana, whom we met in the introduction, wonders why she isn’t over the moon when she has such a healthy, beautiful baby girl. So many couples struggle for years to conceive, with so much heartache and expense. So many babies are born with health challenges. “What’s wrong with me?” Ana wonders.
Kate, the second of the four individuals we’ll follow through this book, is shocked when her doctor suggests she might be depressed. “I know I’ve been feeling sad and low since my husband retired, but I’m so lucky that we can afford to live on one income,” she says. “It’s my friends who worry they’ll never be able to retire who should be depressed, not me.”
Becky, whose brother died of cancer, knows how fleeting life is. “I should be making every second count,” she thinks. “So why can’t I get out of bed?”
It’s also tempting to point a finger at the past. John, the fourth person we’ll regularly check in with on these pages, has spent his whole life feeling inadequate and incapable because of the way his parents and siblings treat him — so it makes sense to him that his depression is their fault.
Do you think your mood difficulties are linked to your childhood, your first romantic relationship, your choice to study one subject in college rather than another, the city you settled in, or your career path? Spending time in the past may help you to answer the question why, but it won’t give you the tools to feel better in the present.
The founders of interpersonal psychotherapy saw a pattern among the people they helped with mood difficulties. Their patients, they discovered, were all experiencing problems in at least one of four different areas in their lives at the time they became depressed: life transitions, complicated grief, social isolation, or interpersonal conflict. These four problem areas aren’t causes, but they are contributing factors to why people feel sad, blue, down, and depressed. At least one of them can almost always be linked to a recent depressive episode.
TRY THIS: We won’t spend too much time dwelling on the past to find answers. Instead, we’ll look at what’s going on in your life right now.
Your problem area (or areas) — whether it’s conflict with another person, grief that won’t go away, a life change, or lack of supportive relationships — may be connected to what happened years ago, but we’ll be keeping the focus on what you’re experiencing in the present and what you can do in the here and now to feel better. In Week 4, we’ll describe each of the problem areas in detail and help you pick one to work on. (To be true to interpersonal psychotherapy, which is a short-term approach that helps people feel better in eight to twelve weeks, we talk about “weeks” throughout the book. Ultimately, the pacing is up to you. Read as quickly or slowly as you like!)
You Deserve a Break Today
You may need to take a temporary break from some of your day-to-day responsibilities and commitments to work on feeling better.
It’s another good reason to think of your depression as if it were a broken leg. When we have a broken leg, our priorities have to shift. Recovery becomes our most important job, so we go to medical appointments, do the exercises the physical therapist prescribes, and put our feet up (literally) when we’re tired. We won’t be taking the kids to the park, hitting the dance club, spring-cleaning the house, or hosting the big family dinner. It’s obvious that we can’t do what we’d normally do, so we don’t try. And we might even accept the help that others offer us.
Depression is a medical illness as legitimate as that broken leg. We need to give ourselves permission to take the time we need to figure out what interpersonal problem is contributing to our unhappiness and learn new skills to cope. Taking time off isn’t forever. It’s just until we’re back on our feet.
Depression is hidden — often even to ourselves — so we think we have to power through it. We beat ourselves up for having a short fuse, not being able to concentrate, feeling tired, lacking drive, missing deadlines, or being indecisive.
The temptation to suck it up and keep going will be very powerful if you feel you’re the only one keeping your family’s boat afloat. You might be working three jobs and still struggling to make ends meet; have an ill parent, a child with a disability, a partner who can’t manage without you, a demanding job, or an unsympathetic boss; or there may be strong cultural expectations for your role.
Sometimes to take care of others, you have to put yourself first. Go for coffee with a friend instead of volunteering at the food bank. Sit down with your spouse to discuss how to divide up the household chores to lighten your load a little. Take your social media accounts down for a while. Ask your sister to take the kids for a weekend. Talk to your boss about next week’s deadline. You might discover that some of the things you thought others needed you to do for them are actually your own expectations of yourself. Think of taking care of yourself as a job. Make a list of self-care tasks and schedule them on your calendar.
PEP TALK: The world isn’t on your shoulders alone. Sometimes when you step back, it makes room for others to step forward.
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