Updated from its original publishing date August 15, 2014, to include ‘Additional Resources’ section and SIGECAPS.

It is becoming all too commonplace to turn on the news and see yet another celebrity has committed suicide. From comedians to food critics to religious leaders – no one is immune to experiencing mental illness. Despite one’s fame, fortune, and wealth, we are all susceptible to mental health issues like depression. There are an estimated 16.2 million American adults who suffer from this illness (nimh.nih.gov). Depression is no respecter of age, race, gender, income, marital status, nor faith beliefs. While it may impact individuals to varying degrees based on some of these demographics, it has the ability to negatively impact us all. Although there are some indicators that may put some at a higher risk for experiencing depression than others, such as having a lack of social support, you can be well loved, respected, valued and cared for and still struggle with Major Depressive Disorder.

[bctt tweet=”No one is immune to depression” username=”doctorsos”]

It’s important for you to know depression has many faces. Many of us find it difficult to even consider the notion of having a “mental illness”. The stigma about mental illness problems still exists despite the popularity of shows like Dr. Phil and the inclusion of characters dealing with mental health issues in our Thursday night sitcom lineup (This Is Us, Homeland, etc.). Mental illness is something that “other folks” have to deal with not me and you. Until one day it is “me and you”. Mental illness is just like any other kind of physical illness, there are biological, psychological, emotional, social, and spiritual components to it. Mental illnesses like depression can be debilitating and in some cases deadly. Most of the time, people don’t come to see someone like me until they just can’t take it anymore; their lives have become so unbearable or they are so unhappy that they just don’t want to “do this anymore”. That’s what I hear most often, “I just don’t want to do this anymore”.

When most people think about depression they imagine someone crying, feeling sad, and staying in bed all day. Many people probably think if someone is depressed, their mood is really down and they are withdrawn. For some people who experience depression, this is exactly what they feel, but depression does not always look this way. Sometimes, depression shows up as anger and irritability. Sometimes depression is loud and chaotic, instead of quiet and sad. Sometimes it is in your face, instead of withdrawn and subdued. Sometimes depression shows up in the form of “nitpicking”, or “pushing other people’s buttons”, or feeling like someone is intentionally trying to push your buttons.

Many people walk into my office describing these kinds of behaviors and are legitimately shocked when I say, “Sounds like you might be depressed”. Some folks get downright offended. You’d think I slapped them or cursed at them. “I’m not depressed”, one patient yelled at me. “I’m not crying all the time. I’m not staying at home. I get up and go to work every day, even though my boss is about to drive me crazy. I take care of my kids and my husband, even though they are getting on my last nerve. I am still doing everything for everybody just like I always have! So, I know I’m not depressed. I just want you to help me deal with these crazy people in my life because it’s something wrong with them, not me! If they would just leave me alone, I would be alright; I AM NOT DEPRESSED!” These are what I call the “mad not sad” depressed people. Many times their depression is overlooked or may even be misdiagnosed due to their seeming lack of supporting symptoms if you’re looking for the traditional way many of us think about depression.

they have mastered the art of masking their depression

Then there are those who, from the outside, appear to be doing quite fine. These are the “mask wearers” and they have mastered the art of masking their depression. They can be the life of the party when they are around others, but when they are alone they can experience feelings of hopelessness. They can be in a room full of other people and yet still feel like they are on an island all by themselves. Many people who experience this kind of depression may not even realize that they are depressed. They just know that they are feeling something that doesn’t feel right and they want it to stop.

Some people dealing with depression try taking things to make “it” stop on their own like drugs or alcohol. These substances only tend to make things worse, although for a short while they may seem like they make it better because they can numb some of the negative feelings or reduce some of the negative thoughts they might be experiencing. It’s not uncommon for there to be some kind of substance, be it alcohol, prescription or illicit drugs, involved in the death of someone who commits suicide.

While it remains sad and disturbing to read headline after headline of suicide deaths, in some ways I believe we may be growing desensitized to the ongoing impact and long-term implications these kinds of deaths have on our society. When someone commits suicide, the lives of their loved ones are forever changed and these changes can have a ripple effect on everyone connected to that person, which implies that in some way, we all are impacted by that loss of life. If only we were able to identify the suicidal patient when they were just the depressed patient and effectively treat them. While we may not be able to “catch” all of those who are suicidal before they reach that state, I believe we can all do a better job of identifying depression in ourselves and loved ones by educating ourselves on the signs and symptoms of the illness.

In my previous line of work as a Primary Care Psychologist, we used a helpful mnemonic to help us quickly identify some of the most common symptoms of depression. This screening tool remains commonly used by psychologists and family medicine physicians alike. It’s referred to as SIGECAPS (www.aafp.org).

Here are some symptoms and behaviors to look for when considering if you or a loved one might be dealing with a form of depression:

Sleep disorder (either increased or decreased sleep)*
Interest deficit (anhedonia)
Guilt (worthlessness,* hopelessness,* regret)
Energy deficit*
Concentration deficit*
Appetite disorder (either decreased or increased)*
Psychomotor retardation or agitation (slowing down of thought or physical movement; or a sense of restlessness and mental tension)

Experiencing several of these symptoms (4+) along with depressed mood and loss of interest for 2 weeks or more suggests that further assessment should be conducted by a medical or mental health provider. I’m not sharing this information with you so that you will be responsible for diagnosing yourself or your loved one, but rather to help you identify when additional help might be warranted so that you won’t dismiss or minimize someone’s expression of sadness in this way as a passing phase. It may very well be, but what if it isn’t? I think it’s better to ere on the side of caution and seek help early, even if only preventatively.

[bctt tweet=”You can’t fix, what you won’t admit.” username=”doctorsos”]

Depression is a multifaceted illness that can be treated. We can do something about it, but we have to be courageous enough to acknowledge it, because you can’t fix what you won’t admit. Then we need to find out what we can do to get help – which means we need to educate ourselves about the signs and symptoms and treatment options. Finally, we have to be willing to do whatever it takes to get better, whether it’s counseling, medication, exercise, meditation, or a combination of those things.

Depression doesn’t just come at the expense of the person who is dealing with it, it is a very selfish disease that takes a toll on everyone who cares about that person. It is a robber of relationships. Understand that you don’t have to suffer in silence and you don’t have to fight this battle alone. Don’t “white knuckle” it through life allowing depression to deal with you. Choose to get the help you need so you can have the quality of life God has purposed for you and those who love you.

“Life is about relationships.” – Doctor SOS

Additional resources about depression and suicide:

National Institute of Mental Health

Depression Basics


Web MD Depression Resources


Psych Central Depression Online Resources


American Academy of Child and Adolescent


Suicide Prevention Life Line


National Institute of Mental Health


American Association of Suicidality


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