Depression
Clinical depression is a condition that affects one's thoughts, moods, feelings, behavior and physical health. We now know that depression is not a weakness but a medical condition with a biological or chemical basis.

Depression is more common in women (one in six will seek help for depression at some time in their lives) than in men (one in nine) and is four times more likely to affect the elderly than the young.

Is depression "triggered" by life events?
Although depression can be exacerbated by holiday stress, it is also important to remember that depression can be triggered by certain illnesses, hormonal disorders/imbalances such as those caused by birth control pills and by hormone replacement therapy, disturbing and/or traumatic events or changes in life, tension or stress, chemical imbalances in the brain, thyroid disorders, poor diet and lack of exercise, allergies, and premenstrual and postpartum chemical shifts.

Other times depression seems to occur spontaneously, with no identifiable specific cause. Whatever the cause, depression is much more than grieving or a bout of the blues.

Depression may occur only once in a person's life. Often however, it occurs as repeated episodes over a lifetime with periods free of depression in between. It may also be a chronic condition requiring ongoing treatment over a lifetime. In the United States, depression affects more than 18 million people of all ages and races.

Can depression be treated successfully?
Psychotherapy alone or often in combination with medication has proven successful in treating depression. The medications available are generally safe, have few side effects and are effective, even for the most severe depression. With proper treatment, most people with serious depression improve, often within weeks, and can return to normal daily activities.

How does one know if someone is really depressed, not just feeling sad or gloomy?
Depression is not the same as being sad or discouraged. These feelings are a normal part of life and usually pass. True depression is severe sadness and hopelessness that does not go away over time and makes normal activities impossible. The American Psychiatric Association bases its definition of clinical depression or major depression on the following eight primary criteria:

1. Sleep disturbances. Sleeping too much or having problems sleeping can be a sign you are depressed. Waking in the middle of the night or early in the morning and not being able to get back to sleep is typical.
2. Confused thinking ability or concentration, trouble concentrating or making decisions and having problems with memory.
3. Significant weight loss or gain. An increased or reduced appetite and an unexplained weight gain or loss of more than five percent of normal weight can indicate depression.
4. Agitation or slowing of body movements. One may seem restless, agitated, irritable and easily annoyed, or may seem to do everything in slow motion and answer questions slowly in a monotonous tone of voice.
5. Fatigue, weariness and lack of energy nearly every day—feeling as tired in the morning as when going to bed the night before.
6. Low self-esteem, feelings of worthless and excessive guilt.
7. Less interest in sex. One can experience a dramatic decrease of interest in having sexual relations.
8. People who are depressed may have generalized thoughts of death, a persistent negative view of oneself, one's situation and the future. People who are severely depressed may have thoughts of their own death, dying or suicide.

While any individual evaluated by a health care professional would be assessed on history as well as symptoms, someone exhibiting at least five of these eight symptoms will likely be diagnosed with clinical depression. A person exhibiting four out of the eight symptoms may be considered "borderline" depressive.

For diagnosis, most of the above signs and symptoms must also be present most of the day, nearly every day for at least two weeks.

Depression can also cause a wide variety of physical symptoms and complaints, such as generalized itching, blurred vision, excessive sweating, dry mouth, gastrointestinal problems (indigestion, constipation and diarrhea), headache and backache. Children, teens and older adults may react differently to depression. In these groups, symptoms may take a different form or may be masked by other conditions.

Individuals stabilized on medication as part of their treatment for depression may experience an acute episode of depression. Some may have discontinued medication because of a pervasive sense of hopelessness, a feeling the medication is no longer working. Others may feel they are fine and no longer need medication. One should not stop using medication without consulting a physician.

How Congregations Can Be Supportive
If you as an individual or a group from your congregation want to help someone through the winter blues, general thoughtfulness is wonderful.

You might:
Reach out, genuinely. If you see someone you know looking atypically glum or gloomy, pause, smile and begin a conversation. A complement can go a long way toward lifting someone's spirits. You will know pretty quickly if the person would rather not engage in conversation.

Call. People in the doldrums often avoid social events and contact—the very thing that might improve their outlook. If someone you are accustomed to seeing frequently at meetings and services is suddenly among the missing, call and let him/her know that she/he is missed. When you call, begin with an open-ended non-questioning statement like, "I was thinking about you." or "You have been on my mind." or "We have been missing you at ______ ." If you are uncomfortable or hesitate to call, send a note or small gift.

Visit. It is particularly important to visit people who may be limited in their ability to drive or travel to social events. Remember that holidays tend to be a time when many people visit. The times in between holidays are not nearly so full of cheery visitors.

Isolation can be a major causal factor in depression. Remember that those who are family caregivers are often limited by their responsibilities and cannot participate in church and social events. Many caregivers become depressed as they deal with isolation, grief and guilt.

If you are planning to visit someone who is in a hospital or other health care facility, be certain you know and follow the new privacy regulations. Visitors are not given free access as they once were. Please remember that it is not advisable to visit someone if you are ill or might be "coming down" with something.

Focus on food. Taking a dish (healthily prepared, of course), offering to pick up groceries, setting up a lunch or dinner can be thoughtful ways to show a person that he or she is important.

Invite. Extending an invitation to attend an activity, view a movie or participate in an event at your church is another way to help draw people out of the blahs and blues. Offer to drive if they are not comfortable driving at night or in bad weather. Arrange a walk or other exercise session to help motivate someone who might benefit from the fresh air and sunlight. [Remember that wheelchair users also like to take walks.]

As you decide to be helpful, keep in mind that there are differences between people and in being supportive. One must use an approach in keeping with the style of the person you are trying to reach. Sometimes the difference between helpfulness and nagging is only in the eyes of the beholder.

The diagnosis of depression carries the stigma unfortunately still attached to any form of mental illness. This stigma can make it difficult to ask for help. It can also cause discomfort on the part of anyone who is trying to be supportive. The more awareness we have in congregations, the easier it will be to both ask for and give support.

IMPORTANT NOTE:
This article is not written as a diagnostic tool. While it outlines indicators for depression, it should not replace the evaluation and therapeutic intervention of a trained health professional. If a person you know appears to be mildly depressed, encourage and support them in getting help.

If someone appears severely depressed, immediately let someone in a position to make care decisions know what you have observed!

A person who is severely depressed often markedly changes his or her behavior . Someone might:

• stop taking showers or baths or wearing make-up
• not change clothing or get dressed without prodding
• miss work or school
• no longer appear to take responsibility for family and children
• articulate suicidal thoughts or a preoccupation with death
• purchase a deadly weapon
• refuse to make plans for the future
• indicate that he/she might not be "around" much longer
• begin giving away personal belongings because he/she no longer needs them

If someone shares suicidal thoughts or life threatening information never, never, never promise confidentiality.

If there are no care decision makers available and you feel the person is in imminent danger, contact his or her therapist (if one is being seen) or get him/her to an emergency room. It is always better to err on the side of the living!