TW: This article contains content that some readers may find disturbing, such as depression, suicide and suicidal ideation.
Depression is a mood disorder that may involve intense, drastic mood changes or overbearing feelings of worthlessness that cause one to feel trapped, helpless or suicidal. Major depression is a mental health condition that often involves anhedonia, the loss of pleasure or interest in daily activities (including sex or personal relationships), which may be experienced as lethargy (excessive tiredness) and reported as a sudden deprivation of energy. This medical condition is most often defined by persistent, intense feelings of sadness over an extended period of time.
It is possible to feel depression in your body. Physical effects of depression may turn somatic, so depressed individuals may report suffering from chronic pain or fatigue, backaches and headaches, as well as changes in eating or sleeping habits, memory and concentration. People experiencing depression often complain of insomnia or hypersomnia, which means sleeping too little or too much. It may also cause weight gain or weight loss, in addition to anxiety (an impending sense of doom or danger).
Psychological symptoms of major depression may include decreased self-worth or low self-esteem. Other symptoms include restlessness. Major depression can result from situational life stressors, changes in brain chemistry, traumatic experiences, a crisis, low life satisfaction (discontent), lack of personal happiness or positive relationships, a feeling of having no control and low serotonin, a brain chemical responsible for improving mood that can also regulate sleep patterns and curtail not just sleep disturbances, but sleepiness.
Major depression may cause recurrent suicidal thoughts to arise. Before this happens, individuals may become withdrawn and isolate themselves from those closest to them. They might experience extreme mood swings and display other warning signs that indicate they pose a danger to themselves. They can express agitation, frustration, irritability and other impulsive moods in very concerning ways. They can also engage in risky or reckless behavior that is worrisome to others, such as heavy drinking or drug use. At this stage, depressed individuals might actively plan suicide attempts instead of just entertaining thoughts of taking their own life, which indicates that their condition is escalating.
Depression is more than a blueness, although blue days are common when depressed. It involves an overwhelming sense of hopelessness or emptiness. It is often characterized by a blanketing sensation of powerlessness or marked by overpowering moods that cause a sense of futility among individuals who feel defenseless to pain and therefore desire to end their suffering. An individual struggling with depression may feel as though he has no reason to live. He may also experience angry outbursts.
Symptoms of depression can be mild in duration but still severe in trajectory. For instance, a person may oscillate between feeling melancholy and self-destructive versus feeling numb or a sense of nothingness for a period of two weeks, but if these feelings are so strong that it causes her to actively lose interest in her own life, forfeit day-to-day activities, suffer a nervous breakdown and consider self-harm, or otherwise prevent her from coping to the extent that she enters a near-comatose or catatonic state of being and is hospitalized for depression — then the severity of her unhappiness is proof of severe depression.
She should be monitored closely to reduce the risks of suicide and seek treatment to help manage her symptoms. Treatment may include medication, such as antidepressants, or forms of psychotherapy, such as dialectical behavioral therapy (DBT) or the most common treatment for depression, cognitive behavioral therapy (CBT).
Depression is not always easy to pin down, which is why it’s important to recognize its signals, even if it’s impossible to predict its onset or pinpoint the causes of depression since they are not always identifiable — depression needs no cause.
Here’s how to identify when you or someone else in your life is experiencing major depression.
You Can’t Stop Saying Goodbye
You can’t help but notice that when speaking to friends and family members, a certain individual in your life codes her speech with messages of farewell. You are invited to attend a small luncheon with pals, organized by your longtime friend, but you find her actions during the small gathering unusual and worrying. Throughout the lunch, she throws oddballs in conversations that disquiet you, jumping from congratulating herself on unexpectedly quitting her job of 12 years to discussing how she has just revised her will, before drifting to talk about purchasing a gun (she’s been anti-gun for as long as you have known her). She complains of being unusually tired yet makes no effort to slow down her aggressive planning.
If you aren’t weirded out enough yet, she suddenly starts talking about checking items off of her bucket list, including flying on a helicopter, going to Jamaica and taking a trip to the Bahamas after purchasing a last-minute cruise through the Florida Keys for six weeks before hiking Lake Tahoe. Next, she tells you she’s just bought spontaneous plane tickets to Rwanda for a safari trip. You’re not sure how to respond to her — her actions are so strange and unlike her. Everything is wrong with this equation — she loves her job, she’s too young to write a will, she hates guns and Jamaica, she’s scared of heights and water, she gets nauseated riding boats, she’s not a fan of warm climates and she’s never liked the outdoors — what business does she have traveling the globe? Plus, she’s the least spontaneous person you know; she’s had her life mapped out since she was 15 and it certainly doesn’t include a trip to Jamaica or a wildlife excursion. Why is she suddenly expressing a lack of interest in her work and regular life?
But she sounds happier than you’ve ever heard her, and she’s certainly not yet old enough to be having a mid-life crisis, so what do you do? You think she must be joking, or she’s desperately in need of some excitement in her life. You begin to think that perhaps, a change of pace would be good for her.
Then, before she leaves, she offers some of her favorite belongings as a parting gift, delivering to each person at the table a beloved possession that you never could have imagined her separating with, saying to each pal, “I want you to have this, to remember me when I’m gone.” The last part sends a whirl of alarm through you — what is she talking about? What does she mean, “When I’m gone?” Is she referring to suicide?
You sit her down to have a serious talk with her just as she’s about to stand and depart from the restaurant, but she writes off all of your concerns and says it’s nothing to worry about. She grabs her purse and flees before you can inquire about her state of mind.
You know in your heart that she’s not okay, and begin to talk with the rest of your friends about holding an intervention the next time you see her. It’s apparent she’s struggling with clinical depression.
You Wish You Had Never Been Born
You can’t shake the feeling that you’d be better off dead, and seeing how happy everyone else is and how miserable you are makes you wish your parents had never birthed you. Being alive seems more trouble than not being at all. Signs of suicidality appear in your behavior.
One day, when looking at your large stack of pills, you think about intentionally overdosing. You fantasize about swallowing an entire bottle of capsules and waking up in a different world, in a different body or dimension, or not waking up at all. You tell yourself it’s just a fantasy, but the urge becomes stronger as the days go by, incentivizing you to act upon that thought.
You dream about drowning in the bathtub — waterboarding yourself — and devise plans to go through with it, if you can only wrack up enough nerve. Sometimes, before your mom gets home from work, you make extensive Google searches about ending your life. Your personal favorite search? “Easiest way to end your life,” followed only by “Most painless way to die.” You quickly learn the quickest ways to die, and the most foolproof. You become an expert in the science of suicide.
You Engage in Suspicious Behavior or Self-Harm
You begin actively engaging in self-destructive or ruinous behavior. You might begin cutting, gradually using a razor before escalating to a full-on knife. Perhaps you don’t have the strength to self-mutilate yourself, but you begin sleeping with a knife under your pillow, for your own safety or protection, or perhaps just to comfort yourself, to remind yourself that you have control over whether your life begins or ends and no one can take it away from you. You decide whether you will live or die; you are your own judge, jury, and executioner.
You begin studying the local bridge, not due to an interest in sight-seeing or out of a desire to take a local nature walk, but to understand the ins and outs of the place. You seek to gain intimate knowledge of the destination to best control your navigation of the bridge. You wish to know: When is there the most traffic? When are police most likely to patrol? When is it the easiest to get in and out? When is it the safest to visit without the threat of being detected or seen? What part of the bridge offers the best vantage point? Who is most likely to prevent you from jumping if you wanted to, if anyone? What is the height of the bridge, and are there any mechanisms in place to prevent you from getting seriously hurt if you jumped? What time offers the least amount of visibility?
You show all the symptoms of depression. You develop backup plans, in case your original plan doesn’t work out. You google “garage asphyxiation” and “how to tie a noose.” You get a thrill out of actively devising an exit plan. Searching for new ways to die no longer becomes a last resort. It becomes a hobby and a challenge. You seek to out-do yourself. How to go out quietly, unnoticed, or how to go out with a bang. Death will be your greatest achievement. You see your life as a pursuit of death, and dying (not living) is the miracle.
Here are some common symptoms of depression.
You are emotionally stable one minute, then emotionally volatile and aggressive in the next.
You have trouble getting through the day without bursting into tears, hysterically, or getting angry and lashing out at the person nearest to you. Your crying spells come out for no apparent reason, but you can’t shake the feeling of being upset. Your emotional unrest and imbalance cause you to be incessantly critical of yourself — you feel like you cannot do anything right.
You shift between emotional apathy (having an unfeeling or uncaring attitude toward the events of your life) and emotional over-identification with everything — you take the slightest misgiving personally and accuse people of accosting you on purpose. The slightest indiscretion gets blown out of proportion and you overreact because you find it impossible to control your emotions. You feel unsteady, as if you could drift away with the smallest breeze. You feel winded by life; you can’t keep up and you feel like your life hangs in the balance.
You feel totally detached from the people in your life. On one hand, you feel cut off from the rest of the world, not sheltered but insulated from the crowd. On the other hand, you know that you are responsible for actively pushing people away and shutting out those who would help you if you would let them. You can’t help it; you don’t feel like talking to other people — what’s the point? You don’t have the energy to do so. You can’t pretend to care anymore.
You feel totally alone in the world, which makes you want to compartmentalize the thoughts that confirm this reality by behaving accordingly and exiling yourself. But doing so only enables you to drown in the feeling of aloneness, until you realize your solitude is causing you more harm than good. By refusing to call back or text your friends and ignoring every phone call ring from your worried, anxious mother and concerned boss, you are actually ensuring your lonesomeness. Your seclusion only exacerbates your sense of numbness and joylessness. You begin to think there is nothing that could make you feel hopeful or alive, or make you want to feel and live. Your emotional withdrawal from the world and physical retreat/non-interaction makes you feel fated to die alone. You want to escape yourself and your thinking. You want to escape your life.
Depression can seriously impair one’s quality of life. The condition can plague one, as it isn’t usually a short-lived episode. For this reason, it’s important to treat signs and symptoms of depression uniquely and seriously, rather than seeing it as something that can be willed away or easily overcome. Depression doesn’t disappear on its own; it’s a persistent ailment that takes work and the dedication of a lifetime. Don’t be afraid to seek help.
If these symptoms sound familiar to your own life, and/or if you have had suicidal thoughts, reach out to someone you trust or call this number: 800-273-8255.