Adolescent Depression Depression (also known as melancholia) is the state of sadness, decreased initiative, and introversion. It s known as being blue, or just being down. Depression can be caused by anything that s disturbing to the individual, or can be caused by massive amounts of stress. Anything that gives you a feeling of guilt can lead to depression. Adolescence is a time where there are great amounts of stress due to mental, physical, and chemical changes in the body. This is the time where many people feel down or depressed. It sometimes goes unnoticed because it s felt that these are just things kids have to go through, but speaking from personal experience not everything is written in plain black and white. Adolescent depression is a big problem, and if nothing s done about it, it can lead to an emotional breakdown. Sometimes resulting in attempted suicides. Adolescence is what scientists label a problem period. This is the time where children, become young adults. They are being prepared for adulthood. To prepare for this the body must go through a certain amount of changes. These changes are both physical and mental: Adolescence comes from the Latin verb adolescere, which means to grow, or to grow to maturity. Maturing involves not only physical but also mental growth. On the physical side, it means the attainment of mature stature...mentally a mature individual is one who has reached their maximum intelligence level. During this time, weird things begin to happen to the mind and body that are scary but exciting at the same time. But this time also brings huge amounts of pressure and stress. Some of which the child may not be able to handle, causing them to feel weighed down by life. The teen doesn t have to be troubled to feel depressed, all it takes is something negative that makes them feel insecure and you have the beginnings of adolescent depression. During this period the youth is worried about their new role in life. They are unsure of their abilities and this confuses them, adding stress to an already stressful period: A person is an adult when he can take his place and play his role in adult affairs, physically, socially, and economically. A person is regarded as an adolescent until he operates as an adult. During this period of the youths life, it causes them to be confused, uncertain, and anxious. This is a transition period for the youth, and it may be too much for one to handle causing emotional unstability: Like all transitions, adolescence is marked by shiftings backward and forward from old to new behavior, from old to new attitudes. Instability and inconsistency are indications of immaturity. This shows that the youth is unsure of themselves and they re second-guessing their abilities, and they are trying to adjust themselves to the new status that they must now assume in their new social group. There are easy to read signs of transition (the beginning stages of depression). Because he feels unsure of himself and insecure of his status, the adolescent tends to be aggressive, self-conscious, and withdrawn. This causes them to shelter themselves and become more reserved. They won t talk much, and they ll begin to feel less social, unwanted, and misunderstood. This is from my personal experience. The teen years is when the depression usually goes unnoticed because people feel this is just a phase and eventually they ll grow out of it. Sometimes you do, and sometimes you don t. It s like a time bomb ticking away that could go off at any minute. moods are linked to physical functions. But when they last for several days and weeks, these are when the sirens are going off. These are warning signs that there are severe disturbances of personality or undesirable conduct. Although these are symptoms that all teens go through, they differ depending on sex. As adolescents boys and girls worry about different problems, but they all lead to the same thing. Girls are more concerned with school problems, relating to their parents, family adjustments, social adjustments, personal attractiveness, and etiquette. Boys worry about money and problems relating to their future. Being a teen is stressful enough but when you add all of these pressures, it leads to mental and physical breakdown. Within themselves the adolescent years are already a problem. This is a confusing time for youngsters because they have many changes and adjustments to make. Society also helps add to the turmoil of the adolescent years. Society has a lot to do with the failure of some adolescents in life. When you have something to prove it makes you tentative. Here are some of the main reasons for failure: Overemotional repression, oversuppresion of unsatisfied desires, the undue multiplicity of wishes, failure to be properly introduced, when young, to the world of reality, which is followed subsequently by the uncontrollable desire to flee from reality... Too often, adolescents are judged by adult standards, thus putting massive amounts of pressure on them. This is the time when adolescents usually get very unhappy. That s because of the demands placed on them by society. This is all on top of the demand placed on the youth by their social group. This could be too much for a still developing mind to cope with. Peer group membership is the essential feature of this phase of development. Other causes of pressure leading to depression can come from home as well. I know when I became depressed at the beginning of the year it started at home. Parents put lots of pressure on their kids. Yes, they want their kids to do well, but by drilling that you must succeed in life into their heads, it makes the kid anxious, and nervous. And when the child does fail at something, they think it s the end of the world and that they ve failed themselves and their parents. Another thing that puts a lot of pressure on kids is school. School has always played a big role in adolescent depression. This is where a lot of depression actually begins. When a student feels like they are not understanding something, instead of going to get help they ll just forget about it. They ll pretend nothing s wrong and that they don t really need school to succeed in life. They won t ask for help because they re afraid of what will be thought of them. Adolescents always worry about what others think, this is what gets them down. Treating depression can be very difficult, because before you can treat someone for depression, they have to acknowledge the fact they have a problem. This is the hardest part of trying to treat depression. Before anything can be done, the person has to want help. After the person acknowledge that they have a problem, counseling is the first stage of recovering. Talking to a counselor about all of their problems will help relieve some of the pressure they feel. Counseling can help adolescents adjust to their new roles in society. But this is not always the best way to go. Counselors are just there to talk, if the person is really depressed, other treatments are going to be needed. Counselors are there for talking. For reassurance, to let the youth know that they can get through any of their problems. Depending on the type of problem, treatments are different.Kinds of Problems Everyday Problems FriendshipsFamilySchool, etc. ExperienceEducation(Guidance) Special Problems EducationalVocationalPremaritalPersonal, etc. Guidance(Counseling) Adjustment Problems EmotionalSexualSocialReligiousMoral Counseling(Psychotherapy) Mental health and personality problems NeurosesHomosexualityAlcoholismDrug AddictionPsychosisPsychopathy, etc. Psychotherapy(Medical Treatment)Medical problems InjuryDisease, etc. Medical Treatment A person must first be diagnosed with having a problem before any type of psychotherapy or medical treatment. They must be diagnosed by a professional MD. For the other types of problems, the youth may come to an adult telling you what s wrong with them. All treatments should be done by professionals, but if the youth just wants to talk, it s okay for you to listen to their problems, but do not under any circumstances try and perform your own personal counseling session. These are serious problems and they need to be treated that way. DysthymiaDysthymia is a mild or moderate form depression. Is has been observed as form of depression since 1980 . Dysthymic disorder is characterized by an overwhelming yet chronic state of depression, exhibited by a depressed mood for most of the days, for more days than not, for at least 2 years. (In children and adolescents, mood can be irritable and duration must be at least 1 year.) The person who suffers from this disorder must not have gone for more than 2 months without experiencing two or more of the following symptoms: + poor appetite or overeating + insomnia or hypersomnia + low energy or fatigue + low self-esteem + poor concentration or difficulty making decisions + feelings of hopelessness No Major Depressive Episode has been present during the first two years (or one year in children and adolescents) and there has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder. The symptoms are not due to the direct physiological effects of the use or abuse of a substance (alcohol, drugs, and medications) or a general medical condition. The symptoms must also cause significant distress or impairment in social, occupational, educational or other important areas of functioning. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms for more than 2 months at a time . Dysthymic disorder can begin in childhood and in adulthood. Like most for the depression, Dysthymia is more common in women then in men. Most people who suffer from this disorder cannot remember when they first became depressed. Up to 3 percent when people suffer from Dysthymic disorder. 5-15 percent of people in a local doctor's office has the disorder . If someone is the criteria for Dysthymia they should go discuss the matter with a physician. The physician will then determine whether the symptoms are because of depression the outside factors such as thyroid disorders. Also a full diagnostic interview is held. When possible collaborative information from family and friends is utilized. Information on the causes of Dysthymia remains largely incomplete. There are several series on the matter. It has been observed that Dysthymia runs in families. This would suggest that Dysthymia may be hereditary but the family environment may also play a role. There's also a theory that Dysthymia may be the result of a change in the brain involving the chemical Serotonin, which would hinder the ability of the affected person to maintain social or interpersonal relationships .Since the calls the Dysthymia is not known there seems to be no exact way to prevent it. According to Dr. Martin Keller, executive psychiatrists-in-chief at Brown affiliated hospitals in Providence RI, the best way to deal with Dysthymia early detection. Since most people who suffer from Dysthymic disorder at some point in their lives experience chronic major depression the diagnosis of Dysthymia can be used to help prevent these cases . Treatment for Dysthymic disorder is also very broad topic. According to Dr. Phillip Long medication is usually not an issue for someone who suffers from this disorder. Most patients show no additional improvement with the addition of an antidepressant medication, Long-term treatment of this disorder with medication should be avoided; medication should be prescribed only for acute symptom relief. Additionally, prescription of medication may interfere with the effectiveness of certain psychotherapeutic approaches. Consideration of this effect should be taken into account when arriving at a treatment recommendation . When appropriate to treat a concurrent major depressive episode, Tricyclic antidepressants are effective and inexpensive. Phillip W. Long, M.D. suggests that, "a patient should not be considered a failure until the equivalent of 200 mg to 300 mg of Imipramine has been evaluated for at least 6 weeks." Selective Serotonin reuptake inhibitors may also be appropriate for prescription. Phillip W. Long, M.D. also states, "A number of drugs are not of value for long-term treatment. Those drugs include the amphetamines, the barbiturates, and the benzodiazepines. Those drugs are often prescribed for patients with chronic symptoms of insomnia, fatigue, or tension. However, clinical experience and systematic research indicate that they are little better than a placebo and are at times worse." As with many chronic disorders psychotherapy is the recommended treatment of choice. Is important for the initial physician to conduct a complete diagnostic evaluation to assess the patient's ability to function, suicidal tendencies, etc. a cycle therapeutic approach seems to work best because the therapist can provide us to produce change oriented personalized environment for treatment. Therapy should be generally conducted with respect to the client's pace and level of functioning. Attempts to focus on change too early in therapy could lead to early termination of therapy. This likely occurs because the patient feels the therapist didn't respect or care enough about him or her to move at their rate. Psychotherapy approaches for this disorder vary widely. Short-term approaches are preferred, however, because they emphasize realistic, attainable goals in the individual's life, which can usually bring them back to their normal level of functioning. This level, however, may be markedly less than what is expected in the average person. A person who suffers from Dysthymic disorder has generally learned to live with a fair amount of chronic unhappiness in their lives. Realistic goals should be established early on and the focus of therapy, instead of focusing on the person's mood state. Group therapy has been shown to be an effective modality for individuals suffering from this disorder. A group can be more supportive to an individual than any one therapist can and help point out inconsistencies in the patient's thinking and behavior. It should be considered, if not initially, then later on in treatment as the client regains his or her own self-confidence and can interact in a social context. Issues of self-esteem often accompany individuals who have Dysthymic disorder, so care must be employed not to place the person into a group situation (where failure may be imminent) too soon. Family therapy may also be helpful for some individuals. Couples therapy can bring the individual's spouse or significant other into the therapeutic relationship to create a therapeutic (and more powerful) triad. Goals will vary according to type of therapy. Cognitive therapy emphasizes changes in one's faulty or distorted way of thinking and perceiving the world. Interpersonal therapy focuses on an individual's relationships with others and how to improve and strengthen existing relationships while finding new ones. Solution-focused therapy looks at specific problems plaguing an individual's life in the present and examines how to best go about changing the person's behavior to solve these difficulties. Social skills training focuses on teaching the client new skills on how to become more effective in social and work relationships. Usually, psychoanalytic and other insight-oriented approaches will be less effective because of their focus on the past and emphasis on lengthy therapy. While incorporation of therapy into a person's chronic condition might be quite financially lucrative for the therapist, it is not the most change-effective and timely approach to help the individual overcome his or her difficulties. Because the clinician must move at the client's pace, progress with any type of therapy can be slow. Therapists should resist the temptation to try and "speed up" the process or force the client in a direction he or she is not yet ready to try. Closely related to this issue of the pace of therapy is being aware of the clinician's frustration with lack of progress or boredom within the therapy session. It can be an emotionally draining experience for some therapists. Additionally, Phillip W. Long, M.D. adds, "The patient's unrealistic and idealistic expectations of himself or herself may, for example, be transmitted to the therapist and give rise to overlying optimistic expectations of progress in therapy. If the patient shows no subjective improvement over time, the therapist may inadvertently respond somewhat in the way significant individuals in the patient's life have responded. Interpretation of such personal experiences by the therapist can, in the proper context, be therapeutic." Seasonal Affective Disorder I just feel a little bit under the weather, that s all is a phrase some may use to explain a slight feeling of depression that they feel. However, the weather and the change of seasons may cause a harsher form of depression, known as seasonal affective disorder. Seasonal affective disorder is the feeling some get, every year at the same time of year, that makes them feel depressed for extended periods of time. This period of time is usually between the months of September and the following May, and so this form of depression is also commonly known as the winter blues or winter depression. However, during the rest of the year, the patient feels perfectly normal and mentally healthy. Hence the disease is named the seasonal affective disorder, because though the majority of the cases occur during the September to May period, there are the few occurrences of the depression during the spring or summer. The existence of the term seasonal affective disorder has had a short life span. The term seasonal affective disorder was coined in 1982 by Norman Rosenthal after he had researched what they perceived as regular patterns of depression in Rosenthal and one of his colleagues, Herb Kern. In the mid 1970 s, Kern, a research technician at the National Institute of Mental Health, noticed some regular changes that occurred every year. He noticed that every winter, he would become unhappy, slow, and lazy, while in the summer and spring and fall, he would behave normally, more quickly and more productively. Rosenthal theorized that these changes were due to the change in the amount of sunlight one received throughout the year, and theorized that daily doses of bright light would be able to cure the condition during the winter. The research team settled for two doses of three hours each of bright sunlight-like light exposure everyday. After just three days of treatment, Kern felt better, more lively, and his colleagues also noticed that he was more energetic and generally more friendly. These studies led to the conclusion that although the symptoms pertaining to seasonal affective disorder could be triggered by anything, such as stress, most cases of seasonal affective disorder were caused by lack of bright light due to a lack of time spend outdoors during elongated periods of time. Stress, however, is still a major factor. If a painful or stressful time in a person s life is associated closely with a specific season or time, the person is susceptible to seasonal affective disorder during that set amount of time. Further studies were conducted, and the results conducted showed early on what seasonal affective disorder was about. During certain seasons, most likely winter, some people will try to stay inside more, and not go out as much as they would normally. This kind of behavior is likely to cause slothfulness in a person, as well as certain extents of depression, weight change, and lack of energy. This is somewhat natural, but when the change of season affects a person to the point of what is referred to as clinical seasonal affective disorder, one may not be able to leave the house and may feel a greater sense of depression. If one notices a set pattern during several years in which there is a repetition of feelings of depression during a certain season, one can easily seek help, and this is a treatable disorder, with almost a 90 percent treatment effective rate. There has been, since the creation of the clinical term seasonal affective disorder , many revelations made by various scientists and their research groups. One is that a vast percentage of the world suffers from any range of degrees of the types of seasonal affective disorder from clinical seasonal affective disorder to a degree in which one just feels a little sad during the winter. In his original study, Dr. Rosenthal suggested that almost one of twenty five adults in America suffered from a change in season, especially the transition between fall and winter, the time in which the most light hours were lost. He also conjectured that another 14 percent, roughly one in eight adults, had a milder form of the disorder, known as winter blues or winter depression, which is the label for cases strictly in winter and less severe than the clinical versions of the disorder. Another 30 percent of the population was shown to suffer from Sub-syndromal seasonal affective disorder, a condition or state in between the states of full-blown seasonal affective disorder and the more common winter blues. Another factor that may be favorable for getting seasonal affective disorder may be one that a person cannot immediately control. That factor is his/her location. According to various studies conducted in the twenty-year history of seasonal affective disorder, it has been found that people living in certain zones are more susceptible to the adverse effects of seasonal affective disorder. For example, 10 percent of Alaska residents have been reported to have clinical-level seasonal affective disorder, while the rest of the population only suffers from milder levels. Also, in Britain, almost one in three adults between the ages of 20 and 40 are shown to have some level of the disorder. On the contrary, those who lived in Florida only showed a total of one percent suffering from any stage of seasonal affective disorder. Thus it is generalized that the closer one is to the equator, since there are periods of sunshine, the lesser chance of one getting the disorder, while on the other hand, the closer one finds oneself to the polar caps, the chance of getting seasonal affective disorder grows exponentially. Whatever the cause, seasonal affective disorder usually causes one or several problems in a patient. These symptoms have tolls on both the mind and body. For the mind, the disease may cause such symptoms as: depression, guilt, low self-esteem, loss of confidence, hopelessness, apathy, loss of feelings, irritability, avoidance of human , despair, suicidal feelings, anxiety, inability to tolerate stress, paranoid thoughts, poor memory, poor concentration, difficulty thinking straight , difficulty concentrating or making decisions, panic attacks, abusive behavior, weeping, seasonal alcohol and drug abuse, and seasonal bulimia. For the body, symptoms may include: fatigue, lethargy, debility, too much sleep or trouble staying awake/waking up, insomnia, carbohydrate craving, weight gain, decreased libido, and low body temperature. Many of the symptoms are inter-related, if not all. The main symptoms root out from a disruption in the biological clock. The lack of exposure to sunlight has the effect of increasing the amounts of melatonin released by the pineal glands. This, in turn, makes a person more apt to sleep earlier and awaken later in the morning. This may lead to lethargy and lack of energy, fatigue, and weight gain. These physical symptoms, in turn can cause mental symptoms such as depression, guilt, low self-esteem and hopelessness. Those may in turn cause an inclination to avoid human , as well as despair and suicidal feelings.Depression is the most noticeable symptom of seasonal affective disorder. People may become depressed for a multitude of reasons. Among them is the fact that they may be saddened by their realization of their sad condition (no pun intended), or that they may see themselves as less physically fit due to the lack of physical exertion during the time. I also notice that people tend to be happier when they are basking in the bright rays of the sun. Another cause of depression may be the cause of the disorder itself, unnecessary stress that is encountered or associated with a certain period of time. For instance, if there were to be a death in one s family in mid-January, one might feel more anxiety, or even depressed during the period of time around that of the death. There can be many different causes of depression, and multitudes of different possibilities for these causes.Another major symptom of the disorder is a lack of self-esteem. This symptom can occur during any time of the year, but during winter, those who are more conscious of their physical image may suffer greatly. If one is conscious about one s figure, it is downgrading to gain weight or a few layers of fat due to the celebrations that usually accompany the various holidays of the wintertime. This symptom goes hand in hand with another, the loss of confidence. When one loses one s self-esteem, and finds oneself unable to uphold their high image of themselves, it is hard to venture forth into the world to attempt new things, or even things that they are comfortable with. These two often lead to another, hopelessness, when they take their toll for long amounts of time. As depression is the most outstanding mental symptom, sleep disorders are the most outstanding physical symptom associated with seasonal affective disorder. Why some people sleep too much and why some suffer from insomnia is unclear, as is the situation with many semi-mental/semi-physical ailments. People who suffer from seasonal affective disorder have the tendency to stay inside, trying to avoid human or just naturally wanting to stay out of the cold, harsh weather associated with winter. This type of activity is conducive to falling into an irregular sleep patterns. When one stays inside for hours on end, there is found not much to do besides eat, watch t.v. or listen to the radio, and to do things such as go on the internet or play computer games for hours on end. Another activity available is sleeping, but is usually dispersed between the other activities. And so an irregular pattern of sleeping between meals and sleeping between watching t.v. or playing computer games is established, leading to fitful sleeps at night or hours on end of sleeping due to a lack of sleep in days before. A scientific perspective has lent itself to the sleep disorder caused by seasonal affective disorder as well. Scientists theorize that people have the natural desire to hibernate like other mammals during the winter months. Although most people would reject the idea that we are on the same level as bears, others may feel an innate urge to rest themselves throughout the winter months. This theory tends to support the idea that there is a genetic inclination born into some people to get seasonal affective disorder, perhaps indicating a slightly lower level of evolution, say some. Another physical symptom that may be caused by seasonal affective disorder is the atrophying of muscles. Although there is a natural tendency to lose lean mass over the winter, there are certain cases in which there is great deterioration of muscular tissue due to inactivity in cases of clinical seasonal affective disorder. This is just another part of the unending cycle of cause and effect created by the system of symptoms of seasonal affective disorder.Perhaps the easiest way of treating all these unwanted symptoms is to not get them at all. Prevention is key in both physical and mental health when dealing with diseases, and seasonal affective disorder is no exception. To avoid the winter blues, one can do many things. For example, instead of staying cooped up in one s house, one can go out for walks or participate in winter sports such as ice skating, skiing or snowboarding. One can also help in prevention of seasonal affective disorder by preparing oneself for the possibility of this disorder, if one has experienced such symptoms before. Another method of prevention is to seek health if one notices anything out of the ordinary occurring over and over again during similar times of year.However, it is inevitable that many people suffer from seasonal affective disorder. To those who are affected by the disorder, the most common treatment is the light box treatment. This apparatus approaches the angle that most people suffer from the disorder because of a lack of natural sunlight. The light box is a small, perhaps television sized (or smaller) box providing bright light that usual house lights cannot provide. They give the full spectrum of light, thus emulating the light given off by the sun. Light boxes were soon utilized, even before the actual name of the disorder was coined, and were able to yield visible results within short spans of time. However, it was found that UV radiation, which some of the light boxes gave off, were unnecessary, and this aspect of the boxes were taken out. Despite this, a light box will still provide more than 10 times the normal amount of light in a small indoor room, and now come with such conveniences as desktop models, wall mounting models, stand supported models, and come in a variety of sizes and shapes. However, there are certain side effects created by light boxes. People who suffer from eye disorders should use caution, and should discontinue use if pain is felt. Also, for those who do not suffer from severe cases of seasonal affective disorder, there are other options.For those who simply have the winter blues, there is the dawn alarm clock, which simulates a sunrise by gradually increasing the amount of light given off by the alarm. This will not have such a hard effect on the eyes, and provides the little amount of help required by those who are not in need of serious attention. Another, somewhat impractical solution is to move within 30 degrees of the equator. The effects created by seasonal affective disorder are somewhat inevitable to some, but as long as one stays healthy and exercises regularly, regardless of weather, one should be able to deal well with the disorder that strikes one of every three Britons.Suicide Caused by Depression Suicide is the eighth leading cause of death in America. It is more common among adolescents and the third leading cause for those between the ages of 15-24. One out of two Americans has considered, threatened, or attempted suicide at one point in their life, but this does not account for the number of people who have though of suicide as a possibility but did not tell anyone. It is estimated that 30,000 people a year successfully commit suicide, but the actual statistics are higher than those documented. This is because there have also been countless deaths misinterpreted as accidental instead of suicidal. People sometimes try to cover up the fact that their loved ones committed suicide, and pass it off as accidental death to avoid the shame involved with suicide. Every forty-five seconds, someone attempts suicide, and every 16.9 minutes, someone succeeds it. Many people who are considering suicide wish to live if their physical and/or emotional suffering would diminish. They wish their depressive episodes would stop recurring, and would live if they truly believed that their lives would get better, and become more tolerable. Depression limits their thought process, and it restricts their ability to see all the possibilities. It leaves the person in a hopeless state, and therefor they see suicide as their only option. They usually cannot make clear-headed decisions; instead, they are shrouded in a cloud of confusion and disintegration of their self and social status. People with suicidal feelings have pathological and narcissistic ideals, and if they cannot achieve these ideals (and they are usually unreachable), they feel that they have no choice except to die. Hopelessness is a major factor that distinguishes people with suicidal feelings from those who are without.
Seriously depressed people see the world as an unattractive place. They believe, as a result of their hopelessness, that nothing will get better for them and there are very few things worth living for. To some, death may mean a joyful afterlife. But what usually happens is, suicidal people do not give much thought to death, but rather just to the thought of not living anymore. Instead of wishing to die, they wish to escape the stress of living. Suicidal people have an impairment that results from a serious distortion in their capacity to recognize reality. Their perceptions become distorted. As poet A. Alvarez wrote in 1970 after his suicide attempt (using alcohol and barbiturates): I thought death would be like that: a synoptic vision of life, crisis by crisis, all suddenly explained, justified, redeemed, last judgment in the coils and circuits of the brain. Instead all I got was nothing. I d been swindled. Karl Menninger, in 1938, assessed that people who successfully committed suicide manifested the wish to kill (symbolizing hatred), the wish to be killed (symbolizing guilt), and the wish to die (symbolizing hopelessness). Walter Bonime stated that the depressive can not escape suffering because of the way he lives. He noticed also that the depressive responds to any ordinary enhancement as though it were a five dollar payment on a million dollar debt. Instead of reciprocity and relative self-sufficiency, the depressed person often expresses irresponsible dependence upon others and can be involved in exploitation and manipulation on occasion. This excessive dependency (existing in narcissistic ideals) may actually provoke one s anxiety and guilt, which is followed by a need of alleviation. Thus, it results in lowered self-esteem and unsure feelings towards relationships with others. All this leads to an eventual recession and further losses, completing an excruciating depressive cycle for the individual. Soon, one may become hopeless and sees no means of escape except through suicide. II. There are no definite symptoms that can rightfully determine if someone is suicidal. But there are clear characteristics that can be used as warning signs by loved ones. A persistent sad or empty mood A tendency towards isolation Anger or increased anger Anticipates the worst Claiming to feel dead Considerable weight gain or loss Decline in quality of work Decrease in mental productivity and drive Decreased ability to express gratification or love Decreased or loss of self-esteem Decreased physical, social, or role functioning Depersonalization Difficulty concentrating, remembering, or making decisions Disintegration of ego Dissatisfaction Dwells persistently on negative and unhappy thoughts Eating disturbances (increased appetite or loss of appetite) Exaggerated excitement (trying to seem pleased or happy) Fatigue Feeling excessively critical towards oneself or others Feeling that they don t deserve to have fun or be happy Feelings of hopelessness, helplessness, worthless, pessimism, or guilt Gloominess or joylessness Hypochondriacal preoccupations Inability to accept responsibility Increased crying, anxiety or panic attacks Irritability or increased irritability Loss of interest in ordinary activities and/or sex Loss of interest in things one cares about Making arrangements and setting one s affairs in order Moodiness Not tolerating praise or reward Obsessive-compulsive behavior Overly serious Painful dejection Pathological and narcissistic aspirations or ideals Persistent boredom Persistent physical pains that don t respond to treatment (headaches, backaches, etc.) Personality changes or odd behavior Preoccupation with death Pride themselves on being realistic Quiet, introverted, passive, or unassertive Retardation or excitation of motor responses Self-accusations Self-blame Self-contempt Self-destructive behavior Self-disgust Self-hatred Sleeping disturbances (insomnia, sleeping too much, or getting too little sleep) Statements about hopelessness, helplessness, or worthlessness Substance abuse or increased substance abuse Suicidal threats Talking about suicide or making statements revealing a desire to die Tendency to brood and worry Thoughts of suicide, suicide plans or attempts Throwing out or giving personal things away Unexplained tearing or weeping Unrealistic or paranoid delusions Unusual neglect of personal appearance Unusual visitation or with people one cares about Violent actions, rebellious behavior, or sudden absences (running away) Wanting punishment Withdrawal or apathy Appearance of happiness and calmness after a period of some or all of the aforementioned characteristics Although the list of symptoms is a lengthy one, there aren t any definite criteria to determine the existence of suicidal feelings in a person, unless that person tells someone straightforwardly. Sadness is often considered the most common characteristic of depression. Edward Bibring states that the main characteristics of melancholic depression are loss of self-esteem and the subsequent development of self-hatred and self-accusations due to feelings of guilt and inferiority. It has also been noted that women traditionally find it more appropriate to express their sadness by crying and are supposedly more concerned with their appearance as opposed to men. No one knows the one true cause of depression, but most tend to regard depression as the sole pathological principle for suicide. Suicidal urges can be caused by endogenous factors, which are, factors that are caused by a biological deficiency, or reactive factors, which usually brought on by an upsetting or even devastating circumstance. Recent research studies show that, despite the common notion that depression is caused by purely psychological factors, endogenous factors may take part. Chemicals in the brain may get out of balance, changing the brain chemistry, causing the person to be depressed. Depression can hit people with no reason to be depressed, although problems in their life are a factor. Tests have shown marked variations in the absorption of Serotonin and norepinephrine, neurotransmitters that anti-depressants act on to make more available at the synapses. This Serotonin deficiency is possibly the biochemical cause for depression. These studies, testing the urine, blood, cerebrospinal fluid, and brain tissue of suicidal patients confirm that the dysfunction of serotonergic pathways is critical and serotonin is the neurotransmitter implicated in the biochemical etymology of depression. It has also been noted that anti-depressants exert their effects through interactions with brain catecholamines and that abnormalities in brain catecholamines may be responsible for drug-induced depression. Depression does not seek out a specific class of society, although it has been observed that women tend to attempt suicide more often than men, but men complete suicide more often than women do. Furthermore, using the Beck Depression Inventory (by Aaron Beck) to test the degree and severity of one s depression, it has been noted that males who attempted suicide were less depressed than females who attempted suicide. Dealing with the psychological factors that cause depression is more understandable. Dr. Sigmund Freud stipulated three preconditions of depression: the loss of a love object, ambivalence (love and hate) towards the lost object, and regression of the libido into the ego. He believes that depression has its roots in an early object loss, such as loss of security and love. This can lead to hopelessness for the person, and thus suicide. Furthermore, the feeling of self-contempt in a suicidal person can be related to an early trauma, such as a problematic family and childhood, and/or the absence of a parent (especially the father) during childhood. However, there is no doubt that depression can be brought on by endings, separations, losses, divorce, moving to a new community, graduations, breakup of a relationship, loss of friends, completion of a major project, or the death of a loved one. These are factors to reactive depression. Suicide or suicide attempts, oddly enough, rarely occur in the heavy depths of a depressive episode; it is more likely to occur as the depressive episode reduces. It is said that this may be due to the fact that it is only when the depression reduces that people have enough energy to act on their decision of choosing life over death. Also, for psychiatric patients, the risk of suicide is greatest around three months after their release from the hospital, when their depression has decreased but they must again encounter the same stresses in their life that contributed to the development of the suicidal wishes in the first place. It is said that depression is anger turned inward towards the self. That there is a heavy feeling of failure envelops the mind. That a depressed person, when angered, instead of becoming angry with the person that has provoked them, their angry is turned inward so that they become angry with themselves, blaming themselves. Their condition exacerbates with their (depressive) reactions to empathic failures on the parts of others. For example, if people important to them fail to understand, recognize, acknowledge, appreciate, and/or respond in a way that the depressed person had hoped they would; this failure delivers the message that the depressed person isn t good enough. They feel as if they are not worthwhile or important. Usually, the person that has failed them, along with general observers, feel that their failure is not of a serious or noticeable proportion, therefore stirring an unnecessary and uncalled for reaction on the part of the depressed person. However, to the depressed person, it is a serious blow to their self-esteem. An interesting argument made by Larry Morton Gernsbacher, Ph.D., states that depression serves as a suicide substitute. He believes that as long as the individual remains depressed, he or she is in little danger of successfully committing suicide. This argument does correspond with the observation that only when the depression begins to decrease, does the depressed become dangerously suicidal. There is obviously no way to treat someone who has successfully committed suicide but there are ways to prevent suicide attempts and people with severe depression from attempting suicide again. Friends and family can suicide prevention centers, crisis intervention centers, mental health clinics, hospitals, or family physicians. Talking to others about it usually cannot alleviate severe depression. People who do not have severe depression are usually treated with psychotherapy, where they talk about their problems. Severe depression can be treated with therapy, such as cognitive, changing the depressed person s negative thought processes, and interpersonal, improving the depressed person s interaction with others. Further advances in pharmacotherapy have lead to anti-depressants, such as fluoxetine (prozac) and setraline (zoloft) which have been proven to be extremely helpful for depressives as it returns their brain chemicals to normal. However, there needs to be careful administration of these anti-depressants, because they may intensify the anxiety and distress of the patient and increase his suicidal tendency as it can also be used by the patient as a means of killing himself. Along with those advances is the emergence of electroconvulsive therapy (ECT). It is well known that most people, especially the young, usually recover completely from depression and that most depressives go into spontaneous remission without treatment. Even with treatment, most patients show a high percentage of spontaneous recovery. Appendix Adolescent DepressionCase Study: There recently came to me a young man of 22 who had failed in all his final freshman college examinations, had returned home and secured a job, but had lost it within 3 months through tardiness because he so dearly loved to lie in bed and daydream even after a good night s sleep; he lost position after position, got into debt, was hounded by his creditors, and was constantly quarreling with his father because he came home so late at night, and further because he contributed so little to the family exchequer. He said: I am willing to admit I am licked. I don t know what to do. I need help, but is there any help for a fellow in a fix like mine? Analysis: Now, this young man has already done his part by admitting that he had a problem and he needed help. It is now up to the others around him, and himself to get him that help. This is a man who at 22 has already flunked out of college (one of the most stressful places in the world), lost numerous jobs, lives with his parents, is in debt, is being hassled by creditors, and is arguing with his father. Sure he s not quite an adolescent but he is fresh out of adolescents, and part of him is still an adolescent (my mom says you re not an adult until you re living on your own), but he is clearly depressed. Him laying in his bed daydreaming is a sign of depression. His body is telling me that he doesn t want to get out of the bed ad start his day, he would rather lay there all day than to go out and face his problems.Case Study: There is help for this young man if he really wants it, but I seriously doubt whether he will want it sincerely enough to make the necessary effort if his parents permit him to remain at home where he has food and lodging, unless he wakes up to the fact that he has failed to master the art of concentrated and controlled singleness of purpose. He has allowed his mind and energies to be foolishly dissipated over a wide range of activities; in brief, he has failed to make good---and all because he has no definite goal; he lacks a life motive. Analysis: The doctor makes some good points here and I actually agree with a few of them. This man knowing that no matter what he has a free food, free home, free heat, electricity, and running water, is not going to try too hard to fix his life. I have a few people like that in my family only they re not depressed, they re just lazy. What my grandmother did to them was make them leave. Now, I m not saying that s what his parents should do because that wouldn t help him at all, but what hey should do is make him pay a certain amount a month to live there if he doesn t want to get help. Throwing him out would do no good and it will only make him feel worse about himself and then cause him to do something stupid. Just charge him a little bit every know and then for his living expenses and then once he s able to handle these responsibilities then he can move on to greater things. But he must first get the help that he needs. He needs to be able to set goals for himself and the doctor can help him with that during their counseling sessions. But he has to make the decision, it s his, no one else s. He has to want to be able to get better. It s not going to come naturally, it ll take work. Case Study 2: Chester is a young man, 21, and a junior in college. As a child, he was sickly and underweight, and prior to coming to college had undergone psychiatric treatment for a period of one year. He is an only child who resides at home with his father and mother. Presently, Chester is doing well in school, has put on considerable weight, has improved his health a great deal through proper diet and exercise, and has benefited considerably from psychiatric treatment. However, Chester still has a serious problem in his relationship with his mother. Periodically, they get into conflict with each other in which the mother berates him with foul language and name calling, and sometimes pummels him with her fists. Chetser states that at such times he hates his mother, and that this feeling of hatred continues for weeks after the encounter. This is a typical instance of adolescent identification with the aggressive mother, in which there is a great deal of frustration, hostility, and aggression. Typically, Chester feels very depressed and guilty after each such encounter although the hostility continues underneath. Treatment would have to be directed toward resolving the basic Oedipal relationship between the boy and his mother. Analysis: This is a situation where the son was having problems as a child. He went out and got help. He had the psychiatric treatment for one year and he turned his life around. So the treatments do work. But if you have a mother like Chester s then, all that treatment could have been for nothing. The only way to stay healthy is by living in a healthy environment. Negativity no matter where it s coming from is good for no one. Chester needs more help, but this time he needs to go with his mother because that s the only way thier relationship will ever survive. Appendix Suicide The first case is that of Jimmy Gobstalt, a thirty-three-year-old white Protestant male who poisoned himself with carbon monoxide in his car. He had a very intrusive mother who was extremely critical and deprecating of him. His father had almost no with Gobstalt. His relationship with hi smother was often negative and resulted in ambivalent feelings of Gobstalt s part. His wife claimed that Gobstalt hated her and his mother, a feeling that she shared of the latter. Gobstalt married in 1957, at the age of twenty-four, shortly after graduating with a degree in electrical engineering. His wife was from a Catholic family and he was from a middle class Protestant family. Gobstalt s mother objected strongly to the wedding and was reported to have said that his wife was not good enough for him. It seemed as though nothing satisfied Gobstalt s mother. However, Gobstalt seemed dependent on his mother. Throughout college and after his marriage, Gobstalt continued to live with his mother even though he had a high-paying job where he managed around three hundred employees. Gobstalt could be characterized as a dependent-dissatisfied individual. Gobstalt had three children with his wife. Many of the feelings Gobstalt had towards his mother were transferred to his wife. Gobstalt s wife thought that his mother dominated him. The conflicts between his wife and mother forced Gobstalt to take refuge in his work. Gobstalt and his wife saw each other infrequently and had sexual intercourse once a month on the average. Gobstalt began drinking. He was quiet and rarely communicated with anyone. He worried about bizarre, remote natural catastrophes like the polar ice caps suddenly melting. Gobstalt stated that he felt like a failure. He had low self-esteem and claimed that no one liked him. He talked openly about wanting to commit suicide. In June of 1967, when he was thirty-three, Gobstalt made four suicide attempts in six days. On June 14th, Gobstalt tried to shoot himself but the police took the gun away. On June 16th, Gobstalt tried to gas himself but it didn t work. On June 18th, he took fifty aspirin but just go sick. On June 20th, he succeeded with his fourth attempt by attaching a vacuum cleaner to his car exhaust and running the hose into the car. His wife described the last days as follows: Well, he tried to kill himself three times. I called the police the time he had the gun and they took it away. He kept threatening to kill himself and I was pretty disgusted with him. He told me he had a girlfriend in Washington and she wrote to me. I told him to go ahead and kill himself good riddance. Of course, I thought he was just trying to get attention. The night before he did it we went out (he had about ten beers), came home, and I made soup for him. We seemed to be getting along okay, went up and made love which was unusual. I went to sleep and didn t wake up until about 7:30 in the morning when the children came and told me daddy was out in the car and he was all blue. I didn t look; just called the police. I was pregnant. I got an abortion. I didn t want that baby. He burned all his books and fishing equipment in the fireplace while I was sleeping. He called the Suicide Prevention Center sometime during the night and I don t know what they said. Obviously it didn t work. Gobstalt was obviously depressed, desperate, and hopeless within an entire life pattern of contributing self-destructive forces. Then there s the push-pull of Gobstalt s aggressive, ambitious mother and his resultant punitive superego. This damaged his ego and led him to believe that nothing was good enough for him to achieve lasting gratification. He had negative interaction with his wife and mother including social isolation from others who might have been able to offer crucial support. The next case is of Michael Langheim who was a white Catholic male who successfully committed suicide on his second attempt by overdosing on barbiturates two weeks before his divorce was to be finalized. He was forty-eight. Langheim had been married to his wife for 27 years. Langheim s physician had prescribed him barbiturates when he reported that he had trouble sleeping. His wife stated that he d wake up during the night for about the last ten years [of our marriage.] Michael Langheim was born in 1917; he was the eldest of three children. When he was about five months old, his mother made a nonfatal suicide attempt. When he was seven years old, his parents were divorced and he lived with his father. When he was ten, his stepmother started to drink heavily and he began living with his biological mother and his stepfather. His mother remarried five times and Langheim was often physically punished by his stepfathers. On one such occasion, he was pushed down the basement stairs following an argument when he was still ten. During his teenage years, Langheim frequently acted out aggressively. He was arrested for car theft at fourteen and for armed robbery at sixteen. Langheim was convicted of the latter offense and jailed for three years. Shortly after his release (he was twenty-two), Langheim eloped with his first and only wife. In the first four years of their marriage, two sons were born. Even though the marriage appeared stable, Langheim started having affairs within six months of his marriage. At the birth of his first son, Langheim visited his wife in the hospital with one of his mistresses. More severe problems began later. In 1944, when Langheim volunteered for the Army, he was rejected as a psychoneurotic. At the age of forty-one, his biological father died of a heart attack. The following year, Langheim had surgery for a back injury. When he was forty-five, he held a gun to his wife s head and threatened to kill her; then he went outside the house and fired the gun into the ground several times. Two years later, Langheim and his wife were legally separated and he began drinking heavily. He had a notable income drop and he lived alone. He made frequent statements that he wanted to die. In October of 1965, when he was forty-seven, Langheim took a nonfatal dose of barbiturates. Two weeks before his divorce was to be official, Langheim took a fatal overdose. His wife described the last days of his life as follows: We were two weeks away from getting a divorce. He had said you ll never be a divorcee, you ll be a widow. We had been married twenty-seven years. He had tried to kill me held a gun to my head. In 1964 he said many times I ll never make it to fifty years of age. He had wanted me to go back to him. I said no. I had had it. We had been separated before and I d go back and it would be the same. For a week or two he would be all right. Then I d never know what went wrong. He d get mad at me for no reason. He said many times that he d kill himself. I got so disgusted with his actions and threats I told him do it or shut up about it! Langheim experienced trauma, object loss and object inconsistency, the suicidal behavior of his mother, physical abuse, and the alcohol problems of his stepmother in his childhood. It is possible that, from this, he learned to deal with stress through alcohol abuse, suicide attempts, and violent, aggressive behavior. It is likely that he had highly ambivalent feelings toward his mother and, and his wife later stated, towards women in general. She also believed that Langheim was trying to punish women. Towards the end, Langheim was suffering form an impending loss of a major love object, a wife upon whom he was dependent but with whom he was also dissatisfied. Appendix Seasonal Affective Disorder TERRY GROSS, HOST: The short days and long nights of winter leave a lot of people feeling depressed. My guest, Doctor Norman Rosenthal, has spent the past 20 years studying the effects of the seasons on mood. He's a senior researcher at the National Institute of Mental Health, and he led the first team that investigated what is now called "seasonal Affective Disorder," known by the acronym SAD. In fact, Doctor Rosenthal coined the name. He's convinced that exposure to certain types of artificial light can help reverse certain forms of winter depression. He's just revised his book "Winter Blues." I asked him to describe the typical symptoms of SAD, Seasonal Affective Disorder. DOCTOR NORMAN ROSENTHAL, EXPERT ON SEASONAL AFFECTIVE DISORDER; AUTHOR, "WINTER BLUES": People with SAD have a typical cluster of symptoms year after year. As the days begin to get short and dark; they have difficulty waking up in the morning, they tend to oversleep, they feel slowed down, it's harder to think, to concentrate, they tend to eat sweets and starches, and as a consequence, to gain weight. And after a while they begin to feel sad and down, and anxious, and withdraw from friends and family. And this happens year after year in the winter, and as the spring comes, these symptoms all tend to get better again. GROSS: Now, I always thought that was just a normal reaction to the season changes. ROSENTHAL: Well, I think that's an indication of how common the problem is. We figure that about one in five people have some difficulty with the winter, and how you classify that really depends on how severe it is. For example, people who simply are a little under the whether or have some difficulty with creativity or productivity, and just don't enjoy themselves as munch; we say they are suffering from the winter blues. But that group of people which is about six percent of the population; who really feel somewhat disabled, somewhat impaired by the winter would suffer from SAD or Seasonal Affective Disorder. And how you' d know that is that there are problems with their bodily functions, they really oversleep, they really can't get up in the morning, they' re having real difficulty concentrating to such a degree that their job suffers or they're so withdrawn that their relationship suffer. Once it's beginning to impact on function to that degree, then we say you've got SAD. GROSS: How does Seasonal Affective Disorder compare to regular depression? ROSENTHAL: Well, it is a kind of a depression, but the first clue is its timing. Regular depressions can pop up at any old time, whereas with SAD it's this very regular occurrence. The second thing is that it seems very reactive to the environmental light. So, if for any reason, people aren't getting enough light, even if it's in the middle of the summer and it's a spell of two or three cloudy weeks people could experience the symptoms of SAD. That's not so characteristic of ordinary depression, and then this very exquisite response, which we will presumably talk about, to light therapy -- is another hallmark of Seasonal Affective Disorder. And then regular depressants often times don't really want to eat; they lose weight, they can't sleep enough, they have a different clinical picture, and they're more likely to commit suicide. Somehow the problem of suicide in depression occurs when a person is energized and activated which some depressed people are, but people with SAD are usually the opposite. They're slowed down, they're sluggish, and the one advantage of that is that they're less likely to harm themselves. GROSS: What are some of the theories about why light should affect mood? ROSENTHAL: Well, we know that the body takes in light in various ways. Firstly, it comes in through the eyes; secondly, it comes in through the skin, and we've known for years, for example, that ultraviolet light causes vitamin D synthesis in the skin that's very important for calcium absorption. What's really quite new is this recognition that coming in through the eyes, light has many signals that it gives to the brain via connections between the retinas of the eyes and a special part of the brain called the hypothalamus. And we have got theories as to how the light may actually modified brain functioning; one involving a very common nerve chemical -- a neuro transmitter called serotonin. One involving a hormone that is secreted at night called melatonin, and other such explanations. And, of course, when there are so many explanations you can bet nobody knows for sure which won is correct. GROSS: Now, I know one of the remedies that you've been experimenting with for many years is light -- artificial light -- through the use of light boxes that can be used in the home or the office. What does a typical light box look like? ROSENTHAL: A light box varies in size, but a typical box would be maybe one and a half foot by two foot -- a rectangle -- and it sits upon a desk or tabletop; it's got a metal or wooden frame; it's got several fluorescent tubes in it, and a plastic diffusing screen in the front. And it sits upright or at a slight angle towards the eyes, and the user sits maybe a foot, two foot away from the light fixture depending on the exact nature of it, and remains there in that position for a half an hour to even two hours per day. GROSS: How bright are the lights that you have worked with in your studies compared to, say, the typical brightness in a kitchen or an office? ROSENTHAL: These lights are between 5 and 20 times as bright as ordinary indoor light lighting. In fact, light is measured in a measurement called "lux" -- "L"-"U"-"X." And the typical light fixtures are between 2500 and 10,000 lux; whereas an ordinary indoor room will only be about 300 to 500 lux. GROSS: Are you likely to get eye strain from this intense light? ROSENTHAL: Some people can, and if they do I recommend that they just back off a little and then they can often ratchet it up again. GROSS: What are some of the other side effects? ROSENTHAL: Headaches can similarly occur, or if you use it late at night, you can keep people up and cause a little insomnia. So, you may want to do the light therapy a little earlier during the da