The Multiple Symptoms of Depression
Section 12: 25 Symptoms you suffer in Depressive Illness and Questionnaire.
Section 13: Fears, Phobias and Hyperventilation in Depression.
Section 14: OCD (Obsessive Compulsive Disorder) and Depression.
Section 15: Becoming High (Bipolar Disorder).
SECTION 12
There are multiple symptoms associated with depressive illness, and most people have a number (usually not all) of the following symptoms.
In fact, the most common symptoms in depression are losing pleasure in life, being unusually tired, having trouble thinking and remembering clearly, and perhaps also having a range of unusual physical symptoms, for which your doctor cannot find a clear explanation in terms of physical illness.
The following is a detailed description of the symptoms of depressive illness:-
1. SEVERE CONTINUOUS TIREDNESS: this is a very common symptom in depression, so that you feel tired and exhausted all the time. Even if you sleep, you may wake up feeling as if you have not slept at all. While tiredness due to physical causes, or tiredness due to being over-medicated, usually causes people to yawn, the tiredness of depression usually does not make people yawn or feel they are about to nod off to sleep.
2. MULTIPLE PHYSICAL SYMPTOMS: aches and pains in various parts of the body, especially affecting the stomach and bowels, are very common in depression. Dizziness is also a frequent symptom, and many people feel aches and pains in their muscles and joints. Research shows that the more symptoms a patient has for which there is no clear explanation, the more likely it is that the person has depressive illness.
3. INABILITY TO FEEL EMOTION: for many people, this is the most worrying symptom before they realise they are actually suffering from depressive illness. You may find you cannot feel any of the normal positive emotions in life, so that you do not feel any pleasure or interest in the things you used to like and do. You may find you have lost your emotional feelings for those nearest and dearest to you, and many people are distressed to find they seem totally emotionally numb in the relationship with their partner and their children.
4. SADNESS OR UNHAPPINESS: this is a core symptom of depressive illness, whereby people feel miserable and sad, often with no real reason that they can identify. Many people are very puzzled that they have these feelings, when they can see logically that they have many good things in their life and in their relationships. In some people, the feeling of sadness is so intense that they describe it as a blackness descending upon them, or a cloud descending upon them. The feeling may be more intense at various parts of the day, either in the morning (presumably due to fluctuations in your biorhythms), or in the evening, when tiredness makes many physical and psychological symptoms worse.
5. NEGATIVITY AND PESSIMISM: depression convinces your brain that everything is negative, always was negative, and always will be negative. You may find that you are so pessimistic that you are locked onto the problems associated with every aspect of life, and see the problems and negatives as far more important than the positives of life. It is like having a filter over your mind, which excludes good things, and allows in only bad things, and magnifies them. Depression makes mountains out of molehills. We all have problems, but depression convinces you that your problems are huge, and can never be overcome.
6. TROUBLE THINKING AND REMEMBERING: this is almost an inevitable symptom in everybody with depressive illness. You may find that you are more absent-minded than usual. In most people however, they find they have much more trouble making decisions (even simple decisions such as what food to buy from the supermarket). Very quickly, people find that they have trouble with their work, as they cannot deal with the information they need to handle at work. Things may get to the stage where you cannot read magazines or books, as you very quickly lose track of what you have already read. Sometimes, it becomes too difficult to follow a simple TV programme, or even follow normal conversation.
Problems with keeping your mind on your normal activities, and problems with your memory, may make you afraid you are getting Alzheimer’s Disease at an early age. In the vast majority of cases, your mental clarity and your memory will return one hundred per cent to normal once you have recovered from depression.
7. TEARFULNESS OR CRYING: when you are depressed, you may find you are tearful much more easily, and you may find you cry in situations where you normally would not have done so. You may find you cry watching a sad movie, where previously you would not have cried. You may find you cry watching something sad on TV, so that some people cannot watch the evening news without crying. It is very common for people with depressive illness to cry when someone starts being understanding and sympathetic towards them.
When depression is severe, many people describe how they wish they could cry, but have lost the ability to do so. Also, one of the features of antidepressants is that they rapidly stop people crying, even if they wish to do so.
8. REDUCED ABILITY TO COPE: depression makes everything ten times, or a hundred times, the effort it used to be. Accordingly, people with depression very quickly find they cannot cope with their previous duties and responsibilities. Also, the slowed up thinking, the memory problems, and the difficulty concentrating described in the above paragraph all make it more and more difficult to carry out your normal tasks. Depression makes everything too much of an effort, and the exhausted feeling that people have during depression makes this worse. Things can be done, but with almost superhuman effort at times, like trying to function with a broken leg.
9. INABILITY TO ENJOY THINGS: depression takes away the enjoyment of the normal activities of life, so that things you used to enjoy or have a great interest in will no longer appeal to you. You may find you have given up your previous hobbies or pastimes, and feel that there is absolutely nothing in life you could think of doing which would be enjoyable. Similarly, people may take a holiday in the hope of solving whatever is wrong with them, only to find they feel even worse, as they realise they are unable to enjoy themselves even on holiday.
10. AVOIDING FRIENDS: many people with depression find everything such an effort, that they wish to avoid contact even with their friends. You may find that you do not return telephone calls, or make excuses not to meet your friends. Depression often prevents people enjoying social interactions they previously enjoyed enormously.
11. POOR SLEEP: all forms of sleep disturbance are common in depression. You may find you have difficulty getting off to sleep at night, or you may find that you are frequently waking up during the night, often feeling terrible. Many people find they wake up one, two or three hours before they normally would have to get up in the morning, and are unable to go back to sleep. Even if you do manage to sleep well, many people wake from sleep during depression, feeling as tired as when they went to bed. In a small minority of cases, people sleep excessively due to being depressed, either “to escape”, or sometimes if they are suffering “winter depression”.
12. REDUCED INTEREST IN SEX: for many people, this is one of the first symptoms to appear when they are getting depressed, and one of the last symptoms to be wiped out when they recover. You may find you are generally less interested in sex than before you became ill, or slower to respond to sexual advances than would normally be the case. Many people find it impossible to have sex when they are depressed, and some people are revolted at the idea of having sex.
Do keep in mind that about fifty per cent of people taking modern antidepressants get sexual problems due to the antidepressants. Accordingly, if you feel a lot better after you have had treatment for your depression, but you still have sexual problems or no interest in sex, this may be a side effect of the medication, rather than meaning you are still depressed.
13. LOSS OF APPETITE: when depressed, many people lose interest in food, and find that they no longer enjoy the foods they used to like. Many people find they have to push themselves to eat a reasonable amount of food. Some people lose considerable amounts of weight due to being depressed.
In some cases, people overeat when depressed. Also, keep in mind that probably all antidepressants, and especially the older antidepressants, make people gain weight, sometimes even without eating abnormal amounts.
14. REDUCED SELF CONFIDENCE: this is very common in depressive illness, and you may find you are much more nervous in social situations, less able to express your point of view, and generally less able to deal with other people. Many people with depressive illness start to believe that really they are quite worthless as human beings.
15. ANXIETY AND TENSION: it is almost inevitable that people who are depressed will also be very anxious, nervous or uptight. This may manifest itself in a whole range of physical aches and pains, as well as a continuously uncomfortable, frightened feeling, as if you were about to do an important exam or have an important interview. Anxiety produces lots of physical symptoms, such as headaches, pains in the face and jaws, chest pains, stomach pains and indigestion, and bowel pains. Some people with anxiety find they clench their jaws during the day, or grind their teeth at night.
16. IRRITABILITY AND ANGER: when feeling terrible, it is almost inevitable that we will snap at other people. While we may be able to keep up a facade for people who do not know us very well, it is too much of an effort to do this all the time, so depressed people find themselves snapping and being angry at those closest to them, often feeling very guilty afterwards.
17. PERSONALITY CHANGE: many people feel something terrible has happened to their personality, so they are no longer able to be confident, extrovert or friendly. In many cases, family and friends may comment on this personality change.
18. SLOWED UP OR AGITATED: depending on how the depression affects people, some people will find they move and talk more slowly, as depression is in many ways a slow form of paralysis of the mind. In its most extreme case, people used to become catatonic, ie totally paralysed physically by depression.
In other people, the major symptom is one of being very worked up and agitated, so that people may find they cannot sit still, and may pace around the room. People may play with their hands and fingers continuously, as they feel this internal state of distress.
19. THOUGHTS OF DEATH: this is a serious symptom, as the alien that is depressive illness starts to convince you with the lies it is telling you. You may feel life is too much of an effort, or that the future is only going to be negative. You may feel you need an escape from this distressing situation and the distressing symptoms you feel, and you may either wish you were not alive, or consider ending your life. Please believe me that this is in fact totally wrong, and you are being controlled by an illness, which is telling you lies about reality. Depressive illness can be cured in almost every case, and people then are amazed that they could have even contemplated the idea of not being alive. You may wish to leave this site and see the free site suicidedoctor.com. If you have suicidal ideas, it is very important you ask a friend or family member to stay with you until you can get professional help to stop the illness that makes you think this way. Alternatively, you may wish to go asleep for a few hours until these thoughts pass.
20. HEARING VOICES: In very severe depression, people may hear voices when there is nobody around. Typically, these voices are horrible, threatening and frightening. This is a sign of a serious chemical problem, which a doctor can wipe out with modern powerful medications.
21. DELUSIONS: This is the jargon name for totally convincing but totally false ideas that get locked into your mind when you are very ill. They are false chemical messages implanted into your brain by the illness. It is very hard to step back from these thoughts, and accept the possibility that they are chemical bits of wrong information, just like a computer virus. In depression, people may believe they have done something dreadful in their past, or that they have got some terrible disease, or that they are being punished for something they have done. People may also become convinced they have got disastrous financial problems, when in fact this is not the case.
22. OBSESSIVE COMPULSIVE DISORDER: Ten to twenty per cent of people with depressive illness will develop obsessive compulsive disorder (OCD) during their illness. They may find they have to check repeatedly that they have locked the door, have turned off the gas or electricity, or find that they have to clean things repeatedly. This condition will automatically disappear once the depression has been treated effectively.
23. PHOBIAS AND PANIC ATTACKS: In depressive illness, a number of people develop panic attacks, whereby they become extremely frightened, may feel they are going to die or go crazy, or feel something terrible is about to happen to them. In some people, they only get these feelings in certain places, such as crowded places or public transport, or places from which they cannot escape. Some people find it difficult to leave home as a result of these fears. These symptoms will usually disappear when the depression has been treated.
24. FEELING GUILTY: Depression makes you think negatively about everything, and particularly about yourself. You may find that you are much more distressed about your faults and failings, and while everybody else may see you as just a normal human being, the depression will tell you, you are a terrible person, who has let other people down, or who is a failure. It is important to keep in mind that you are being given totally incorrect feedback by this computer virus in your brain.
25. MULTIPLE PHYSICAL SYMPTOMS: Many people who have depression wish that doctors and others would understand how physically terrible they feel. It is like having a very bad flu’, so that everything hurts, everything is exhausting, and it does require a huge effort to get out of bed and do the normal things of life. Some people get severe pains in various parts of their body, as various systems go into spasm in response to the depression. Rather than having huge amounts of physical treatment for these various physical symptoms, it is often much more appropriate to consider the diagnosis of depressive illness.
SUMMARY
You need to have a number of the above symptoms, on a fairly continuous basis, for at least two weeks, to get diagnosed as having depressive illness. There is a lot of uncertainty about the best approach to people who have fewer symptoms, or symptoms for a shorter period of time, but early treatment is now considered the best approach. If you are unsure whether or not you have depressive illness, you may wish to complete the questionnaire about depressive illness, and see how many symptoms you actually do have.
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For most of the time over the past two weeks |
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1. |
Have you had trouble keeping your mind on things you were reading, or watching on television? |
YES |
NO |
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2. |
Have you had more trouble with your memory than usual? |
YES |
NO |
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3. |
Have you feeling unusually tired every day? |
YES |
NO |
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4. |
Have you found it hard to enjoy life? |
YES |
NO |
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5. |
Have you had a lot of different physical symptoms or unusual pains? |
YES |
NO |
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6. |
Have you been feeling emotionally numb, not caring, sad, unhappy or miserable? |
YES |
NO |
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7. |
Have you been feeling more pessimistic or negative than usual? |
YES |
NO |
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8. |
Have you lost interest or enjoyment in the things you normally do? |
YES |
NO |
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9. |
Have you been less motivated, less productive, or found it more difficult to cope than usual? |
YES |
NO |
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10. |
Have you been sleeping worse than usual? |
YES |
NO |
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11. |
Have you been less interested in talking to people or mixing with people than usual? |
YES |
NO |
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12. |
Have you been more worried, nervous or uptight than usual? |
YES |
NO |
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13. |
Have you been more easily tearful, or crying more than usual? |
YES |
NO |
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14. |
Have you enjoyed your food less than usual? |
YES |
NO |
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15. |
Has your sexual interest been less than usual? |
YES |
NO |
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16. |
Have you been less self-confident than usual? |
YES |
NO |
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17. |
Have you been more anxious, nervous or worried than usual? |
YES |
NO |
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18. |
Have you been more easily annoyed or more impatient than usual? |
YES |
NO |
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19. |
Has life seemed meaningless? |
YES |
NO |
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20. |
Has dying looked like a good option? |
YES |
NO |
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RESULT: Answering ‘Yes’ to more than 2 or 3 questions suggests you could have depression. Answering ‘Yes” to lots of the questions makes it increasingly likely you do have depression, the illness that can cause lots of suffering for you (and lots of worry for those close to you) but the illness can be very effectively wiped out.
If in fact you find you have a large number of symptoms, it makes the diagnosis of your illness more certain, and it also provides a bigger chemical target for antidepressant medications to assist you.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
SECTION 13
In almost everybody who suffers from depressive illness, anxiety/fear/tension becomes a prominent symptom. Furthermore, marked loss of self-confidence also develops, so that people become nervous in social situations and general interactions that previously would not have made them nervous.
A large number of people with depressive illness develop phobias during depressive illness, ie totally unreasonable fears to such a degree that they are forced to avoid certain situations.
AGORAPHOBIA is a fear of leaving the house alone, and commonly develops in people who have depressive illness. Agoraphobia can develop without depressive illness, but this typically occurs in young adults. A person, in their thirties or later, who develops agoraphobia for the first time, must be considered as very likely to have underlying depressive illness as a cause of his or her agoraphobia. The agoraphobia typically will disappear once the depressive illness has been brought under control. Apart from fear of leaving the house, some people’s agoraphobia manifests itself as becoming extremely anxious in enclosed spaces, such as public transport, shopping centres or cinemas. If you have depressive illness, and you are tempted to avoid places that make you anxious, or tempted to stay indoors because of your anxiety, it is important you try to fight off these fears and do the opposite as much as possible, to minimise this complication of your depressive illness. It helps if you regard your symptoms as an enemy trying to control you, with you determined to fight back.
SOCIAL PHOBIA is the development of symptoms of extreme anxiety and embarrassment in social situations, and again develops in some people as a result of depressive illness. Again, fighting the symptoms off as soon as they appear, by doing the exact opposite and mixing more than ever before if possible, is helpful in avoiding this complication. Again, the social phobia is likely to subside once the depressive illness has been brought under control.
PANIC DISORDER is a common complication of depressive illness, in which people get sudden and terrifying episodes, which may go on for up to an hour or longer, and may occur very frequently. The person becomes terrified that they are about to die, lose control or lose their mind, or becomes convinced some terrible catastrophe is about to happen to them. The symptoms can be controlled temporarily by the use of powerful tranquillisers, until the underlying depressive illness is brought under control.
HYPERVENTILATION (over-breathing) often happens to people who are anxious, without the person involved being aware that they are in fact over-breathing in response to stress or anxiety. While slow deep breaths may be calming in certain situations, especially if accompanied by a deliberate decision to relax one’s muscles, rapid breathing clears out all the carbon dioxide in your body, which in fact disturbs the chemical balances within the blood stream. As a result, people develop tingling of both hands, both feet, or the face, especially around the mouth. If the over-breathing continues, people may develop nausea, chest pain or dizziness. All of these symptoms can simply add to the fear, and in turn add to the hyperventilation.
If you do suffer from this condition, the understanding that you are breathing too rapidly is the major step to solving the problem. Hold your breath for as long as you can, let it out, and hold it out for as long as you can, and then take in the next breath and hold it in for as long as you can. You may have to repeat this process for the next 10 or 20 breaths to correct the problem, as your body automatically produces more carbon dioxide, and reducing your breathing prevents the carbon dioxide from escaping too rapidly. While textbooks may suggest people with hyperventilation rebreathe their own expired air from a paper bag, cupping your hands and holding them in front of your mouth will achieve the same effect without making you look strange.
There is considerable research evidence to suggest that many forms of anxiety are very similar to depressive illness, and indeed that antidepressant medications have a major role to play in the treatment of many anxiety related symptoms and phobias. Antidepressants, especially the modern agents, very effectively put a lid on the severity of anxiety, and are non-addictive.
Of course, particularly when depressive illness is less severe, and particularly in cases when phobias develop without depressive illness, using one’s logic to fight off fear, and forcing oneself to confront feared situations step by step are very useful approaches, being the fundamentals of what is known as Cognitive Therapy.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
SECTION 14
Obsessive Compulsive Disorder is a condition affecting two to three per cent of the population at some stage in their lives, with half the cases having first symptoms appearing in childhood. People are driven to carry out repeated actions (such as cleaning, hand washing, checking gas or power switches, counting, touching, etc) or indulge in repetitive thought patterns (known as obsessions), to avoid extreme anxiety and panic reactions if they resist.
It is estimated that about twenty per cent of people with depressive illness develop this condition as part of the depressive illness, and typically the condition automatically subsides once the depressive illness has been treated.
Many people who have developed Obsessive Compulsive Disorder without having depressive illness, do eventually go on to develop depressive illness, due to the stress of their condition.
In fact, antidepressants which specifically target the serotonin neurotransmitter pathway in the brain (such as Clomipramine / Chloripramine or the newer generation of antidepressants such as Prozac, Luvox, Paxil, Zoloft) are dramatically effective against obsessive compulsive disorder, even in the absence of depressive illness. This finding strongly suggests an abnormality in the serotonin pathway as a prominent characteristic of this illness. Furthermore, these antidepressants reduce levels of anxiety and emotional distress considerably, allowing the sufferer with obsessive compulsive disorder to resist the drive to carry out their actions or thoughts while remaining much less distressed than they would otherwise become.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
SECTION 15
(bipolar disordeR (see also www.bipolarillness.com.au)
Becoming high
The very fact of developing depressive illness in response to stress is an indicator of some vulnerability in the person’s biochemistry. Some people have an associated vulnerability to another mood illness, known as Hypomania. This is commonly referred to as “going high”. People who have suffered both depressive illness and hypomania are labelled as suffering from Bipolar Disorder, which was previously called Manic Depressive Illness (manic is another word for going high, and has nothing to do with being crazy or being a maniac).
Many people, and their families and friends, do not recognise as illness the early episodes of being high. Typically, the person is elated, although sometimes they can be simply very angry. The person has lots of energy, and in particular has much less need for sleep than usual, and may for example describe two or three hours sleep a night as perfectly restful and adequate. The person tends to talk a lot, make multiple telephone calls, have a great sense of extraversion and confidence, and may indulge in inappropriate spending or inappropriate sexual activity. The condition can lead to major social disruption, with long term consequences for the person involved, once the illness has stopped. Your doctor will know of various medications which can stop this illness rapidly, and may suggest Lithium or anticonvulsant medications to prevent the condition returning.
It is estimated that about five per cent of cases of people becoming hypomanic / high, are actually induced by taking antidepressant medication for treatment of depressive illness, with the treatment in effect being too successful. Giving antidepressant medications to patients with bipolar disorder for treatment of a depressive phase of the disorder, runs the risk of precipitating a hypomanic episode, and specialist intervention is usually advised.
Suicide in bipolar disorder
Unfortunately, bipolar disorder is a life-threatening illness, with fifteen per cent of sufferers dying from suicide. Recent research indicates the highly beneficial effects of taking Lithium, and perhaps other mood stabilising agents such as anticonvulsants, over very many years, ideally for one’s lifetime. Lifetime prevention may be a nuisance, but the risk of suicide is very high in this disorder, and the severity of the illness suffered in bipolar illness tends to be extremely unpleasant.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.