   Pastor Ralph: Depression is very often found with accompanying
Anxiety Disorders and it's important to be aware of these
possibilities, so you can explain and present them for treatment.

   I've Listed Below Clusters of Experiences and Feelings in
Our Everyday Language that You My Be Able to Relate to,
followed by a clinical description from Wikepedia.
*************************************************************

PART 1. Depression: Issues, Feelings...

* For those Days of Profound Sadness, Loneliness.

* Feeling Like No One Really Understands or Cares,
       A Hopelessness, Moments of Low Confidence,
       Self-Esteem Lapses, Never Not Good Enough.

* Personal Fears and Concerns Out of Proportion.

* Fatigue, Energy Drained, Withdrawal, Irritability,
       Super Sensitivity, Guilt and Defensiveness...

* For Major Depression ~ Recurrent & Single Episodes.
      Except For Bipolar Disorder or Manic Depression.

* For Dysthymia ~ A Chronic, More Subtle Depression.

* Adjustments and Reactions to Severe Personal Losses
       and Trauma from: Mistreatment, Degradation, Major Changes
       through Divorce, Terminal Disease, Grief, Job, Locale,
       Status Shifts, Marital, Parenting & Familial Difficulties.

* For The Serious and Debilitating Attack of The Blues...

* A Childhood History of Victimization, Mistreatment,
       Sexual Molestation, Degradation, Humiliation,
       Physical, Verbal and Mental Abuse and the Daily
       Guilt and Fear of Being A Victim or An Innocent.

* Marital and Parenting Concerns,
       Direction, Coaching and Counseling.

* Adults with Controlling, Critical, Negative,
       "Never Good Enough" and Guilt Maker Parents.

* Help for Your Children and Teens Who Are
       Growing Up, Suffer from Depression & Anxiety & The
       Many Adjustments to Life's Changes, Fears, Trauma and Reactions.

   Feeling Sadness, Loneliness and Hopelessness:

*   For Those Days of Sadness, Loneliness, Feeling Like No One
Really Understands or Cares, A Hopelessness, Moments of Low
Confidence or Self-Esteem, Never Good Enough...

* I'm grateful for my life but I feel somehow isolated.

* Even in a crowd or with friends I feel like I'm alone.

* I'm kind of lost and don't know where to turn.

* It's easy to cry or hard not to.

* There's a cloud of sadness around me.

* Yes I'm well off. It seems people believe that therefore:
       I don't suffer & I should stop complaining & get grateful.

* I'd really like to talk to someone about this...

* It seems no one really cares or understands.

* For a long time now, I have felt never good enough!

* I feel walled off. No one's listening anymore.

* I'm really frustrated. I just can't seem to get through.

* I'm not heard, valued, appreciated or understood.

* I'm always wrong. It seems everything's my fault.

* There have been so many broken dreams and promises.

* Discouraged - Despair - Hopelessness.

* I'm so very tired of all of this.

* It sounds childish & ridiculous but I just feel like running away.

   Feeling Tired - Can't Get Moving

* There's no energy. I can't get motivated.

* It's as if I'm in slow motion or in a fog far away.

* I don't feel very much like having fun anymore.

* I've been withdrawing from friends and family.

* I'm spending more and more time quietly alone.

   Grief and Severe Personal Losses Can Cause Depression.

* The are so many things that hurt badly when we lose them.

* There's the loss of our plans, dreams and an entire way of life.

* The loss of a life's work in retirement and simply getting older require serious adjustment.

* Whether it's temporary or long term, the loss of our
physical freedom and imposed limitations is very hard.

* Being forced to stay at home, from disability or illness can go from being boring to becoming severely depressive and disheartening; from quiet to severely loneliness and hopeless.

* The most severe pain is when we lose someone we dearly love.

* Sickness, disease accident and death are harsh realities.

* Suddenly we are shoved, roughly into another unpleasant world.

* There's nothing you can do to make things the way they were.

* There's the sickening feeling of emptiness and loneliness...

* You never know when something will trigger a memory,
and then the tears...

* Will today be a good day or a sad day or an anxious day.

* There are the frustrations, limitations, changes, adjustments
and overwhelming changes and responsibilities.

* And there is also the anger, rage and guilt.
Why God? Why God me? Why God now?

* Will it ever get better? Do I really want it to get better?

* I'm so tired. I want to give up. No, I must go on. Why?

   Past Hurts and Abuses.

Still haunt me and my today relationships

A parent who is controlling and a guilt-maker.

A partner who is critical and devaluative.

It's never good enough! They're unpleasable!

I'm afraid to trust, then I do, and get hurt again.

I seem to have a knack for picking the wrong mate.

How do I stop the cycle and get off this merry-go-round?

How do I say no or take care of myself without feeling guilty?

   Guilty - Low Self Esteem in Some Areas.

* How do I say no to people or take care of myself without feeling guilty?

* I feel wrong sometimes without a reason.

* I shouldn't feel this way. God has blessed me
and I have so very much to be grateful for.

* I sometimes feel worthless, useless or like a failure.

* Apologizing or saying "I'm sorry" too much.

* Excessive blaming or criticism of yourself.
Really when I think about it, I'm my own worst enemy.

* I don't think I really like myself very much.

* I sure don't like being alone with myself.

* I've lost some of my confidence. I know I lost my edge.

* Afraid to take a chance and try much that's new.

* I didn't do anything wrong. Why do I feel guilty?

   Despair - Hopelessness.

* I just feel like giving it all up.

* I'm so very tired of all of this.

* I'd like to run away or move.

* I can't hang on much longer.

* It seems nobody cares anyway.

   Sleep, Appetite & Weight Difficulties.

* Too much - Too little - Changes - Problems.

   It's Hard to Concentrate or Decide.

* Feeling overwhelmed or stressed out.

* Preoccupied or confused sometimes.

* Forgetting things and embarrassed about it.

* I'm a little concerned - Am I losing my grip?

   Irritable - Impatient - Can't Relax.

* Sudden mood swings and overreactions.

* People seem to take forever to do things.

* Becoming more critical, picky and negative.

* Feeling restless, antsy, I have to keep busy.

* Super sensitive - My feelings are easily hurt.

* Over Defensive - Unnecessary counterattacking.

   Basically We first need to Talk, Discuss and Get to Know and Understand the Kind of Depression You're Suffering from and then We Can Begin a Program of Relief.
   If you can relate to, or feel comfortable with, some of the feelings, thoughts and treatment options listed above, and you'd like to make some changes and get relief, You can contact me through our * Home Page. or * Contact Page.

   Answers: To Learn How God Sees You and to Really Get
in Touch with Who You are and What You have to Offer.
YES, both the Negative and the Positive. Yes Your Personal
Gifts and Talents to This World and To Help Others and NO, Not just
the Down Side Anymore. AN HONEST LOOK AT YOURSELF!!!

   Answers: To Sensibly Talk through, Understand and Finally
Obtain the Complete Depth and Healing Available from
Accepting God's Love and Realizing The Power of Applied
Forgiveness in All Areas of Our Lives.

Answers: Find A Comforting and Powerful Relationship with
God, Who is Always Present, and Finding An Acceptable and
Realistic Means to Receive the Benefits of This Relationship and
Then Learning How to Access Him ANYTIME and ANYWHERE!

PART 2.
A Clinical Listing of
Types of Depression & Symptomology,
Taken from Wikipedia.orgClick Here for Wikipedia's Descriptions & Information on Depression.

Types of psychological depression

Depression is a term that can refer to a wide variety of abnormal variations in an individual's mood. If changes in an individual's mood are persistent and cause distress or impairment in functioning, then a mood disorder may be present. Individuals with mood disorders experience extremes of emotions, for example sadness, that are higher in intensity and longer in duration than normal.

Mood disorders are generally classified as either a type of unipolar depression or bipolar depression. Unipolar depression is characterized by periods of depressed mood, profound sadness, or loss of interest in activities. Bipolar depression is characterized by periods of depressed mood that alternate with periods of extremely elevated mood, increased energy, and euphoria. These periods of elevated mood are referred to as mania. Within both unipolar and bipolar categories, specific sets of symptoms are characteristic of particular disorders, each of which has its own diagnostic profile, treatments, and prognosis. The Diagnostic and Statistical Manual of Mental Disorders (DSM), now in its fourth revised edition, describes the diagnostic criteria for each disorder.

Depressive disorders are very common medical conditions. Unipolar depression will affect 20% of individuals at some point during their life span while bipolar depression will affect 4% of individuals. Unipolar depression is twice as common in females than males, but bipolar depression is equally common in both sexes. The etiology of depressive disorders is most likely multifactorial with both complex genetic factors and environmental stressors (for example, emotional stress, substance abuse, psychological, physical, or sexual abuse) likely contributing to the neuronal changes seen in affected individuals. In an individual who has a high genetic predisposition to a depressive disorder, little or even no environmental stress may provoke a depressive illness. In an individual with a low genetic predisposition to depressive disorders, a major stressor may or may not provoke a depressive illness. Individuals with first degree relatives (i.e., parents, siblings, children) with a depressive disorders are more likely to be a risk for experiencing a depressive disorder themselves. Regardless of whether the causal factors for a depressive illness are genetic or environmental, both produce physiologic changes in the neurotransmitter systems within the brain.

Advances in pharmacological and psychotherapeutic treatments have allowed for very high rates of success in treating depressive disorders. However, only about one-quarter of individuals with a depressive disorder seek treatment. Of those who do seek treatment, over 90% can be successfully treated. Psychiatrists, medical doctors who specialize in treating mental illness, and clinical psychologists, who are trained in various modalities of psychotherapy, are experienced in treating depressive disorders. A general practitioner, family doctor, or other primary care physician can also initiate treatment for individuals with depressive disorders.

Unipolar Depression

While all individuals occasionally experience sadness, individuals with unipolar depressive disorders may experience extreme and profound painful sadness that persists for a period of weeks or even years. A loss of interest in activities such as work, hobbies, or spending time with family is common, and the individual may not be able to experience enjoyment or pleasure in activities they once enjoyed. The feelings of sadness and loss of interest may cause a depressed individual to have trouble functioning in occupational, social, or academic settings.

The unipolar depressive disorders include Major Depressive Disorder, Dysthymia, Seasonal Affective Disorder, and other similar depressive illnesses. These disorders share many of the same symptoms but differ in the severity of the illness, the timing of the onset, and the duration of the symptoms. Separate diagnostic categories exist for depressive illnesses caused by general medical conditions and those due to the direct physiologic effects of a substance. In a minority of individuals, depressive episodes might be accompanied by psychotic symptoms, for example hearing auditory hallucinations or having bizarre delusions.

There is a wide gradient in the severity of symptoms in unipolar depression, and the symptoms can vary dramatically. Mild depression may be characterized by a low-grade but persistent sadness, the inability to feel happy, or a low level of energy and interest. Severe depression can be so incapacitating that an individual is unable to get out of bed for weeks or months at a time or is in such great emotional pain that he or she is driven to commit suicide. While depressive illnesses are under reported to health care providers, they usually respond well once treatment is initiated.

Major Depression

A major depressive episode is characterized by either feelings of sadness or a loss of interest that persists for at least two weeks and causes difficulties in an individual's functioning at work, school, home, or in relationships with friends or family. Other common symptoms that might be present include:

A low mood for most of the day
Feelings of guilt
Feelings of worthlessness
Feeling nervous or anxious
Feeling slow and sluggish
Changes in appetite/weight loss or gain
Irritability or agitation
Trouble sleeping or sleeping too much
Decreased libido
Having trouble with concentration or memory
Loss of energy or feeling fatigued
Unexplained physical symptoms
Frequently experiencing breakdowns or crying
Thoughts of suicide or thoughts or wishes of death

Most individuals with major depression will not have all or even most of these symptoms. Individuals may also have "masked" depression, when they do not realize that they are depressed, but it is noticed by others. Major depressive episodes are classified as being mild, moderate, severe with or without psychotic symptoms (e.g., hearing voices). Subtypes of major depressive episodes include catatonic, melancholic, and atypical. If an individual has had more than one major depressive episode, then the diagnosis of major depressive disorder can be made.

Individuals with a major depressive episode or major depressive disorder are at increased risk for suicide. It is common for depressed individuals to feel that they are somehow responsible and "to blame" for the way they are feeling, and it is easy for them to believe that others are "better off without them". It is vital that professional help and treatment is sought as soon as possible and that treatment follows. Seeking help and treatment from a health professional dramatically reduces the individual's risk for suicide. Research studies have demonstrated that asking if a depressed friend or family member has thought of committing suicide is an effective way of identifying those at risk, and it does not "plant" the idea or increase an individual's risk for suicide in any way.^[1]

Both antidepressant medications and psychotherapy are used to treat major depression. Studies have demonstrated that the combination of an antidepressant medication with psychotherapy is more likely to be effective than either treatment alone. The selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft) and paroxetine (Paxil), serotonin-norepinephrine reuptake inhibitors such as venlafaxine (Effexor), and bupropion (Wellbutrin), a norepinephrine and dopamine reuptake inhibitor, are the most common first-line drugs used to treat major depression. These drugs are typically used first due to their favorable side effect profiles. Other older classes of drugs such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are sometimes used as well. Studies have demonstrated that most approved antidepressants have comparable efficacies, and so the selection of a particular medication is usually based on its side effect profile. Cognitive behavioral therapy, a type of psychotherapy that focuses on how thoughts and behaviors affect mood, has been shown to be effective in treating major depression. Other types of psychotherapy including psychoanalysis, psychodynamic psychotherapy, and interpersonal psychotherapy are also commonly used and may be effective as well.

Dysthymia

Dysthymia (also referred to as Dysthymic Disorder) is a chronic low grade depression that is less severe than a major depressive episode but that persists for at least two years during which the individual is not without the depressive symptoms for more than two months. Dysthymia is often characterized by a disinterest in activities, an inability to feel enjoyment or pleasure, and/or feelings of chronic sadness. Like with major depression, there is some decrease in functioning at work, school, or home or difficulty in relationships with friends or family members. Individuals with dysthymia can have the same symptoms as those with major depression. So-called "double depression" can exist when an individual with dysthymia develops a major depressive disorder as well. The treatment of dysthymia is largely the same as for major depression, including antidepressant medications and psychotherapy.

Seasonal Affective Disorder

Seasonal Affective Disorder (SAD) is a type of unipolar depression that develops annually, usually in the winter when the sun's light is less intense and the length of the day is shorter. People who live at higher latitudes tend to have less sunlight exposure in the winter and therefore experience higher rates of SAD. SAD is also more prevalent in people who are younger and typically affects more females than males.^[3]

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the criteria for Seasonal Affective Disorder include:

The person experiences a regular pattern of depressive episodes, which begin at a certain time of the year
The depressed mood also stops or changes at a regular time each year
It has lasted longer than 2 years
The person has experienced more seasonal types of depression than other types (major depression for example)

Eventually, with the onset of spring, the affected individual comes out of the depressive episode, and depending on circumstances, the improvement may be almost immediate. The emotional difficulties that occur with major depressive episodes may also occur with SAD; however, compared with individuals with non-seasonal major depressive episodes, individuals with SAD are more likely to report increased sleep, increased appetite, weight gain, and consuming greater amounts of foods high in sugars and carbohydrates.

The treatment of SAD usually involves antidepressant medications, especially the selective serotonin reuptake inhibitors (SSRIs), and bright light therapy. In bright light therapy, an individual sits directly in front of a specially designed bright light that usually delivers 10,000 lumens of light at a distance of 18 inches (46 cm). During the light exposure the lamp must be at the proper distance and directed towards the patients eyes, which must be open so that the light enters the eyes and hits the retina. The bright light exposure is typically prescribed for 30 to 45 minutes shortly after awakening in the morning.

A very small minority of individuals with Seasonal Affective Disorder have recurrent depressive episode during summer and starting to feel better towards winter. This is known as summer SAD and is quite rare.

Bipolar depression

Bipolar disorders (previously known as manic depression) are characterized by alternating periods of depressed mood and extremely elevated mood. A manic episode is a period of elevated mood that is often characterized by feelings of elation, increased energy, and racing thoughts. Some manic episodes are also accompanied by psychotic symptoms such as hallucinations or delusions, particularly delusions of grandeur.

Individuals with bipolar disorders people experience both poles of mood—the extreme highs and the extreme lows. The bipolar disorders include Bipolar I Disorder, Bipolar II Disorder, and cyclothymia ("cycling mood" in Latin).

Bipolar I Disorder

People with Bipolar I Disorder have periods where they meet the classification for major depression, then eventually their mood alters and they begin to experience the extreme opposite - increased energy and feelings of wellbeing. The major depression phase of Bipolar I can consist of the following:

Loss of interest and enjoyment
Reduced energy
Fatigue
Lethargy
Apathy
Depressed mood
Lowered concentration and attention
Reduced self-esteem and self-confidence
Guilt
Unworthiness
Becoming pessimistic

Diminished sleep and appetite

Ideas or acts of self-harm or suicide

The manic phase of Bipolar Disorder consists of quite opposing symptoms:

A distinct increase in energy and activity
Impaired judgement
Lack of insight
Distractability
Hostile behaviour
Disjointed thinking
Feelings of wellbeing
Physical efficiency
Mental efficiency

While a person experiencing mania may appear more sociable and talkative, they may feel like they are losing control with all these extreme feelings. With Bipolar I, the person may also experience paranoia and hallucinations which modify their perceptions of the world around them.

Bipolar II Disorder

A person with Bipolar II Disorder will experience both ups and downs such as those with Bipolar I, and feel the same sense of depression. However, the important difference between Bipolar I and II is that the person experiences hypomania, not mania. Hypomanic symptoms include becoming more sociable, feeling the constant need to talk, being extremely friendly, experiencing a decrease in the amount of sleep needed.

A person with Bipolar II Disorder will not have hallucinations or paranoid ideas. The manic feelings are less extreme in this type of Bipolar Disorder, however the impact on the person can be similar. The depression phase of both conditions is what causes the most impairment to life. This phase lasts longer than the manic or hypomanic phases and is considered to be the most distressing feature of Bipolar Disorder.

Cyclothymia

Cyclothymia is a related condition, however Bipolar Disorder can improve within a number of years, while Cyclothymia is a chronic condition that can last for a longer time. The Bipolar II symptoms do not necessarily lead to a disruption in social or occupational environments, however they have the potential to negatively impact the life of those affected.^[4]

Postpartum Depression

Postpartum depression does not differ diagnostically from other forms of unipolar or bipolar depression except that its onset is within the first four weeks after giving birth. It is thought to be brought about by the hormonal and social changes that follow birth including the constant time demands and interruption of sleep that occur with a newborn, a changing relationship with a partner, the loss of independence, losing contact with friends, adjusting to a different lifestyle, and increased financial pressures from new expenses and reduce income. Earlier life events may contribute to the susceptibility for postpartum depression. Women who have experienced poor parenting when they were young may be more at risk. A history of abuse is also a risk factor that can predispose a woman to postpartum depression. The severity of the depression can range from mild to very severe, and the length can vary from two weeks to months or even greater than a year.

It is quite common for women to experience the "baby blues", a short term feeling of tiredness and sadness in the first few weeks after giving birth. However, postpartum depression is different because it can cause significant hardship and impaired functioning at home, work, or school as well as possibly difficulty in relationships with family members, spouses, friends, or even problems bonding with the newborn.^[5]

Treatment of postpartum depression can be complicated by the fact that many women wish to avoid taking medications in order to continue breastfeeding. It is important to evaluate the possible benefits of pharmacological treatments versus the possible benefits of breastfeeding and the possible risks of breastfeeding if a medication will be prescribed. Not all medications are transmitted via breast milk, and of those that are transmitted via breast milk, some are transmitted at only trace concentrations and some might pose little or no risk to the infant. In the treatment of postpartum major depressive disorders and other unipolar depressions in women who are breastfeeding, nortriptyline, paroxetine (Paxil), and sertraline (Zoloft) are generally considered to be the preferred medications.

Pastor Ralph: Depression is very often found with accompanying Anxiety Disorders and it's important to be aware of thesepossibilities, so you can explain and present them for treatment.

PART 2. A Clinical Listing of Types of Depression & Symptomology, Taken from Wikipedia.orgClick Here for Wikipedia's Descriptions & Information on Depression.