Depression: What It Is and What to Do about It (Part I)

This is the first of a two-part series on depression. In this issue, I will explore what depression is and what causes it. In the next issue, I will describe how depression is treated and prevented. If you or someone close to you suffers from depression, it is important to educate yourself about it and seek treatment from qualified mental health professionals.

Depression is a serious illness, not a harmless part of life. It is a complex disorder with a variety of causes. It is never caused by just one thing. It may be the result of a mix of factors, including genetic, chemical, physical, and sociological. It is also influenced by behavior patterns learned in the family and by cognitive distortions.

Depression affects millions of people in this country. It is always troubling, and for some people it can be disabling. Depression is more than just sadness or "the blues." It can have an impact on nearly every aspect of a person's life. People who suffer from depression may experience despair and worthlessness, and this can have an enormous impact on both personal and professional relationships. In this newsletter, I will describe many of the factors that may cause depression, and I will explore strategies for preventing it.

Depression Is Pervasive

When a person suffers from depression, it can affect every part of his or her life, including one's physical body, one's behavior, thought processes, mood, ability to relate to others, and general lifestyle.

Symptoms of Depression

People who are diagnosed with clinical depression have a combination of symptoms from the following list:

·    Feelings of hopelessness, even when there is reason to be hopeful

·    Fatigue or low energy

·    Much less interest or pleasure in most regular activities

·    Low self-esteem

·    Feeling worthless

·    Excessive or inappropriate guilt

·    Lessened ability to think or concentrate

·    Indecisiveness

·    Thinking distorted thoughts; having an unrealistic view of life

·    Weight loss or gain without dieting

·    Change in appetite

·    Change in sleeping patterns

·    Recurrent thoughts of death

·    Suicidal thoughts

·    A specific plan for committing suicide

·    A suicide attempt

·    Feelings of restlessness or being slowed down

When a person is suffering from depression, these symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. This means that the person's family and social relationships, as well as work life, are impaired.

When a person is suffering from depression, symptoms such as these are not the result of a chronic psychotic disorder, substance abuse, general medical condition, or bereavement.

Grief, Sadness, and Depression

Depression may include feelings of sadness, but it is not the same as sadness. Depression lasts much longer than sadness. While depression involves a loss of self-esteem, grief, disappointment and sadness do not. People who are depressed function less productively. People who are sad or disappointed continue to function.

Depression and Socioeconomic Factors

Depression does not seem to be related to ethnicity, education, income, or marital status. It strikes slightly more women than men. Some researchers believe that depression strikes more often in women who have a history of emotional and sexual abuse, economic deprivation, or are dependent on others. There seems to be a genetic link; depression is more common among parents, children, and siblings of people who are diagnosed with depression. The average age at the onset of a depressive episode is the mid-20s. People born more recently are being diagnosed at a younger age.

Physical Causes

Many physicians believe that depression results from a chemical imbalance in the brain. They often prescribe antidepressant medication, and many people find relief as a result. However, there is no reliable test to identify such a chemical imbalance. It is unknown whether life experiences cause mood changes, which create changes in brain chemistry, or whether it works in reverse.

Depression may be associated with physical events such as other diseases, physical trauma, and hormonal changes. A person who is depressed should always have a physical examination as part of the assessment process to determine the role of physical causes.

Signs That Professional Treatment Is Needed

If you or someone you know is depressed and exhibits any of the following signs, it is extremely important to seek the assistance of a medical or mental health professional.

1.    Thinking about death or suicide. This is always dangerous and you should see a professional therapist immediately.

2.    When symptoms of depression continue for a long time, you may need professional help. Acute responses to events are normal, but they should not last beyond a reasonable time.

3.    Your ability to function is impaired by your depression. Seek help before your life situation deteriorates to a serious level.

4.    You have become so isolated that you have no one with whom to check reality. Seek out someone to share your thoughts and feelings with.

5.    Depressive symptoms have become severe.

In my next newsletter, I will discuss the treatment and prevention of depression.

Dealing With Midlife Issues

I would like to help explore the challenges and opportunities that come at midlife. Let’s take the opportunity to look at issues that are specific to the Baby Boomer generation and Generation X. We also have a chance to begin the process of your own midlife assessment with a list of questions presented at the end of this article. I call this assessment the Midlife Checkup.

Benefits of the Midlife Checkup

Taking the time to assess how your life is going at this point can result in benefits such as these:

·    It can help you identify and intensify your inner strengths.

·    You can find your own voice and express it your own way.

·    You can accept your changing physical self.

·    It is an opportunity to forgive those with whom you've been angry.

·    It can help you find ways to reduce stress.

·    You can learn to simplify your life.

·    You can reenergize yourself in preparation for the second half of your life.

Generation X or Gen X 

Generation X is the demographic cohort following the baby boomers and preceding the Millennials. There are no precise dates for when Generation X starts or ends. Demographers and researchers typically use birth years ranging from the early-to-mid 1960s to the early 1980s.

Members of Generation X were children during a time of shifting societal values and as children were sometimes called the "latchkey generation", due to reduced adult supervision as children compared to previous generations, a result of increasing divorce rates and increased maternal participation in the workforce, prior to widespread availability of childcare options outside the home. As adolescents and young adults, they were dubbed the "MTV Generation" (a reference to the music video channel of the same name). In the 1990s they were sometimes characterized as slackers, cynical and disaffected. Some of the cultural influences on Gen X youth were the musical genres of punk music, heavy metal music, grunge and hip hop music, and indie films. In midlife, research describes them as active, happy, and achieving a work–life balance. The cohort has been credited with entrepreneurial tendencies.

As young adults

In the 1990s, media pundits and advertisers struggled to define the cohort, typically portraying them as "unfocused twentysomethings". A MetLife report noted: "media would portray them as the Friends generation: rather self-involved and perhaps aimless...but fun." In France, Gen Xers were sometimes referred to as 'Génération Bof' because of their tendency to use the word 'bof', which translated into English means 'whatever". Gen Xers were often portrayed as apathetic or as "slackers", a stereotype which was initially tied to Richard Linklater's comedic and essentially plotless 1991 film Slacker. After the film was released, "journalists and critics thought they put a finger on what was different about these young adults in that 'they were reluctant to grow up' and 'disdainful of earnest action'."

Stereotypes of Gen X young adults also included that they were "bleak, cynical, and disaffected". Such stereotypes prompted sociological research at Stanford University to study the accuracy of the characterization of Gen X young adults as cynical and disaffected. Using the national General Social Survey, the researchers compared answers to identical survey questions asked of 18–29-year-olds in three different time periods. Additionally, they compared how older adults answered the same survey questions over time. The surveys showed 18–29-year-old Gen Xers did exhibit higher levels of cynicism and disaffection than previous cohorts of 18–29-year-olds surveyed; however, they also found that cynicism and disaffection had increased among all age groups surveyed over time, not just young adults, making this a period effect, not a cohort effect. In other words, adults of all ages were more cynical and disaffected in the 1990s, not just Generation X.

In 1990, Time magazine published an article titled "Living: Proceeding with Caution", which described those in their 20s as aimless and unfocused; however, in 1997, they published an article titled "Generation X Reconsidered", which retracted the previously reported negative stereotypes and reported positive accomplishments, citing Gen Xers' tendency to found technology start-ups and small businesses as well as Gen Xers' ambition, which research showed was higher among Gen X young adults than older generations. As the 1990s and 2000s progressed, Gen X gained a reputation for entrepreneurship. In 1999, The New York Times dubbed them "Generation 1099", describing them as the "once pitied but now envied group of self-employed workers whose income is reported to the Internal Revenue Service not on a W-2 form, but on Form 1099". In 2002, Time magazine published an article titled Gen Xers Aren't Slackers After All, reporting four out of five new businesses were the work of Gen Xers.

In 2001, sociologist Mike Males reported confidence and optimism common among the cohort saying "surveys consistently find 80% to 90% of Gen Xers self-confident and optimistic. In August 2001, Males wrote "these young Americans should finally get the recognition they deserve", praising the cohort and stating that "the permissively raised, universally deplored Generation X is the true 'great generation,' for it has braved a hostile social climate to reverse abysmal trends", describing them as the hardest-working group since the World War II generation, which was dubbed by Tom Brokaw as "The Greatest Generation". He reported Gen Xers' entrepreneurial tendencies helped create the high-tech industry that fueled the 1990s economic recovery.

In the US, Gen Xers were described as the major heroes of the September 11 terrorist attacks by demographer William Strauss. The firefighters and police responding to the attacks were predominantly Generation Xers. Additionally, the leaders of the passenger revolt on United Airlines Flight 93 were predominantly Gen Xers. Demographer Neil Howe reported survey data showed Gen Xers were cohabitating and getting married in increasing numbers following the terrorists attacks, with Gen X survey respondents reporting they no longer wanted to live alone. In October 2001, Seattle Post-Intelligencer wrote of Generation Xers: "now they could be facing the most formative events of their lives and their generation". The Greensboro News & Record reported Gen Xers "felt a surge of patriotism since terrorists struck" reporting many were responding to the crisis of the terrorist attacks by giving blood, working for charities, donating to charities, and by joining the military to fight The War on Terror. The Jury Expert, a publication of The American Society of Trial Consultants, reported: "Gen X members responded to the terrorist attacks with bursts of patriotism and national fervor that surprised even themselves".

In midlife

Google co-founder Sergey Brin, speaking at a Web 2.0conference

Guides regarding managing multiple generations in the workforce describe Gen Xers as: independent, resourceful, self-managing, adaptable, cynical, pragmatic, skeptical of authority, and as seeking a work life balance. In a 2007 article published in the Harvard Business Review, demographers Strauss & Howe wrote of Generation X; "They are already the greatest entrepreneurial generation in U.S. history; their high-tech savvy and marketplace resilience have helped America prosper in the era of globalization.” In the 2008 book, X Saves the World: How Generation X Got the Shaft but Can Still Keep Everything from Sucking, author Jeff Gordinier describes Generation X as a "dark horse demographic" which "doesn't seek the limelight". Gordiner cited examples of Gen Xers' contributions to society such as: Google, Wikipedia, Amazon.com and YouTube, arguing if Boomers had created them, "we'd never hear the end of it". In the book, Gordinier contrasts Gen Xers to Baby Boomers, saying Boomers tend to trumpet their accomplishments more than Gen Xers do, creating what he describes as "elaborate mythologies" around their achievements. Gordiner cites Steve Jobs as an example, while Gen Xers, he argues, are more likely to "just quietly do their thing".

In 2011, survey analysis from the Longitudinal Study of American Youth found Gen Xers to be "balanced, active, and happy" in midlife (between ages of 30 and 50) and as achieving a work-life balance. The Longitudinal Study of Youth is an NIH-NIA funded study by the University of Michigan which has been studying Generation X since 1987. The study asked questions such as "Thinking about all aspects of your life, how happy are you? If zero means that you are very unhappy and 10 means that you are very happy, please rate your happiness." LSA reported that "mean level of happiness was 7.5 and the median (middle score) was 8. Only four percent of Generation X adults indicated a great deal of unhappiness (a score of three or lower). Twenty-nine percent of Generation X adults were very happy with a score of 9 or 10 on the scale."

The Baby Boomers

The Baby Boomer generation is passing midlife (Give or take a few years) right now. This generation includes almost 78 million Americans born between 1946 and 1964.

The Boomers are the largest generation in U.S. history. They have had a major impact on American society as they have passed through every life stage. They are passing through midlife in their own unique way, differently from their parents and differently from Generation X, the group born in the years after 1964.

The first Boomer turned 50 at the beginning of 1996, and the remaining 78 million will observe this anniversary sometime between now and 2014.

Typical Feelings

According to Rocking the Ages authors J. Walker Smith and Ann Clurman (researchers at Yankelovich Partners) and authors like Gail Sheehy, people passing through middle age typically experience the following kinds of feelings.

Great expectations: Most Boomers are beginning to recognize their own limitations. Growing up in the comfortable 1950's, the Boomers learned to expect unlimited growth and endless possibilities. They believed their good luck would never end. Now that they are turning 50, many are shocked to discover that there are limits to life's possibilities.

Regret: As people reach midlife, they must face up to the loss of some of their dreams and regret the mistakes they have made. It is not easy for anyone to face the person one will never be.

Loss: At midlife, everyone has to face the loss of youth, valued by our society. In her book New Passages, author Gail Sheehy calls this experience "The Body Blues" or "The Vanity Crisis."

Meaning: According to Sheehy, the "universal preoccupation" of the middle years is "the search for meaning in whatever we do." As they face the fact that time is limited, the Baby Boomers typically become even more intent on this need to analyze and search for significance.

Change: The midlife years can be a time of radical change for many people. This is the result of endless questioning and evaluation of how one has lived life thus far. Many midlife crises become mid-life meltdowns, says Sheehy, because some people react to feelings of emptiness or disillusionment by destroying everything they have built.

The Boomers developed a value system that is based on a sense of entitlement and which values individuality. Because they hold these values, Boomers respond differently to each life stage than do other generations. You can see these values reflected in scenes like those from television shows from the 1950s and early 60s.

According to Smith and Clurman, four important characteristics of the Baby Boomer value system are:

Self-absorption: The Boomers (once called the "Me" Generation) have the reputation of being more narcissistic than other generations. Because of the times they grew up in, they have always been fascinated with themselves. The indulgence they experienced at home in the 1950s and the world's seemingly limitless possibilities created a fascination with self and a feeling of specialness.

Sense of entitlement: As a generation, the Boomers see themselves as superior to others. They have always assumed that they could have life their way and that the rules were meant for others, but not for them. They feel entitled to rewards and view themselves as winners. They expect success and cannot accept failure.

Need for control: The Boomers need to feel certain and to sense that they are in control of life. They have a difficult time dealing with uncertainty.

Reflection: Baby Boomers have always valued introspection and take pleasure in asking questions.

For most people, life at age 45 or 50 doesn't match the dreams they had at age 20 or 30. When people reach age 45 or 50 and are even slightly disappointed by their achievements and experiences, their feelings are likely to be compounded by these factors of self-absorption, sense of entitlement, and a need for control. But there is also a positive side to this. The tendency to reflect and explore can help one look for new possibilities instead of being stuck with feelings of disappointment.

Keep all of this in mind as you complete the Midlife Checkup. It is a list of 29 unfinished sentences that will help you assess your life to date. The items on this list provide a framework for conducting your own assessment. Please add your own ideas that you think will help you reflect on your life's direction.

The Midlife Checkup

    1.    My most important accomplishments are...

    2.    I am disappointed about...

    3.    I would describe the person I turned out to be as...

    4.    I want to change the following things about my self and my life...

    5.    Things I want to do before I die...

    6.    If I knew I couldn't fail, I would...

    7.    Things I have mastered...

    8.    Things I want to keep...

    9.    I want to keep these relationships...

    10.    I want to let go of these relationships...

    11.    I want to keep these possessions...

    12.    I want to let go of these possessions...

    13.    I want to have these experiences...

    14.    I want to clean up these messes...

    15.    I want to celebrate...

    16.    I don't ever again want to...

    17.    My body is...

    18.    My children are...

    19.    My parents are...

    20.    My spouse is...

    21.    I want to remember...

    22.    I want to forget...

    23.    I must apologize to...

    24.    I must seek an apology from...

    25.    I am most proud of...

    26.    I wish I could forget about...

    27.    I wish I could do over...

    28.    I wish I had never...

    29.    I wish I had...

    30.    Add your own items:

How People Change

What Is Happiness?

If you are thinking about changing your life for the better, one way to start is by identifying your goals. You are probably hoping to find some version of happiness or emotional well-being. That might look like any combination of the following:

·    A sense of freedom

·    Self-esteem

·    Self-confidence

·    Happy to get up in the morning

·    Working toward goals

·    A sense of purpose in life

·    Satisfying relationships

What Is Unhappiness?

If you are thinking about changing your life, you may be experiencing some combination of the following elements:

·    Feeling sad, lethargic or depressed

·    Feeling afraid

·    Abusing or being addicted to alcohol or drugs

·    Feeling lonely

·    Anxiety

·    Problems with relationships

·    Not getting what you want in life; feeling frustrated in working toward goals

·    Not caring enough to have goals

How Will You Change?

When you decide to change your life, try the following ideas.

1.    Explore your feelings. Keep a journal, talk to a trusted friend, work with a professional counselor.

2.    Envision your future. Write in a journal, make a collage, do a guided visualization, talk to a friend or counselor, research the possibilities.

3.    Explore wishes and dreams. Keep a journal, talk to a trusted friend, work with a professional counselor.

4.    Be open to new ideas. Take a class, travel, say yes to things you may have avoided in the past.

5.    Look for kindred spirits. Avoid people who make you feel bad about yourself, seek out those who make you blossom, reach out to those with similar interests and dreams.

6.    Try something different. Deliberately buy new items, try different brands, shop at different stores, do the opposite of what you usually do, see different movies, read different kinds of books and magazines.

7.    Set goals and targets. Learn how to set useful goals, follow through, evaluate progress regularly, reward yourself for achievement.

8.    Take one step at a time. Divide your goals into tiny pieces and do one small new thing each day, starting now.

9.    Look for lessons. Remind yourself that experiences are not good or bad; they are simply lessons.

How to Overcome Your Resistance to Change

Have you ever noticed that when you think about changing your life, you feel resistant? Many people say that they not only feel resistant, but they actually do things to keep their lives familiar. They do things like start a diet and then eat a candy bar on the first day, or quit smoking and then sneak a puff.

There are some things you can do to make yourself less resistant. Here are six effective strategies:

1.    Eliminate clutter. Clutter can be viewed as a sign of uncertainty. Accumulating "stuff" might be stopping you from committing to an important thing. If you keep a lot of half-started projects around, it makes it difficult to zero in on the really important things.

2.    Start small. Thinking of your overall goal can be overwhelming. So manage your resistance by choosing one small part of it and attacking it today. Let's say your goal is to lose 20 pounds. That can certainly seem like an impossible thing to accomplish. It will seem more doable if you tell yourself, I'm going to lose five pounds by (date).

3.    Disprove your disempowering beliefs. In Reinventing Your Life, authors Young and Klosko suggest that you identify the beliefs that keep you from succeeding. They offer a way to dispute those beliefs by asking, "Is there really an evidence today that this belief is true?" They suggest making a list of the evidence.

4.    Remind yourself of all of your available options. You always have alternatives and the power to choose among them.

5.    Take responsibility for what you want. Look for signs that you are blaming

your situation on others or not admitting past mistakes. Acknowledge them and move on.

6.    Visualize the future. Author Barbara Sher suggests one way to do this: Write an imaginary press release about yourself. The date is today's date, two years in the future. The press release is announcing the most extraordinary event you can think of. It doesn't matter whether this event seems only vaguely possible to you. The important thing is that it is exciting to imagine.

When to Seek Professional Help

Sometimes it makes sense to find a professional counselor to work with as you work through the change process. Here are some ways to know when that would be appropriate:

1.    You've tried several things but you still have the problem.

2.    You want to find a solution sooner rather than later.

3.    You have thoughts of harming yourself or others.

4.    You have symptoms of depression, anxiety, or another disorder that are significantly interfering with your daily functioning and the quality of your life. For example, you have lost time from work, your relationships have been harmed, your health is suffering. These are signs that you may need the help of a trained, licensed professional.