DEPRESSION by stariya


									Depression or the “Blues”                      Depression, the “blues,” down in the
dumps – are they all the same, and how do you deal with them?

Metropolitan EAP sponsored a workshop on this topic and the attached handouts are
being distributed on-line for those employees who were unable to attend the program.
For further discussion of this topic, contact your Employee Assistance Program at 212-
352-3274(EAP4). Metropolitan EAP is a confidential service paid for by the U.S. Army
Corps of Engineers and the Office of Thrift Supervision and is staffed by outside private
professionals. It is available at no cost to family members as well as employees.

A few introductory comments may be helpful in utilizing the handouts. Everybody has
probably experienced minor depression when faced with a disappointment, loss, death
of a loved one, or a sense of failure or rejection. This is diagramed on the handout
entitled Types of Depression as “normal mood”. In this case the person has temporary
or transient depression related to some misfortune in their life. Some of the symptoms
may be the same as those suffering the more severe Clinical Depressions (sadness, loss
of interest or pleasure in life, loss of self esteem). The difference is that in a Clinical
Depression the symptoms are more severe and/or last longer.

Note that with Dysthymic (clinical level depression) the person’s mood is chronically
lowered and depressed. In contrast, Major Depression has more severe down periods
(untreated can last for six months) and then returns to a normal mood level. Up to
15% of people experiencing Major Depression become so distraught they commit

Utilizing the same handout, depressions are categorized as either unipolar (one direction
or pole) or bi-polar (two directions or poles). Dysthymic and Major Depression are
unipolar – they go only down. In contrast, Cyclothymic and Bi-polar or Manic
Depression go down as well as up. In the “up” state the person can become manic,
hyperactive, grandiose, euphoric, and experience an inflated sense of self-esteem. In
this manic state the individual may spend his life savings, engage in indiscriminate
romances, tell people off, or quit his job with no alternatives. The person often talks
non-stop, has racing thoughts, and decreased need for sleep. This state is initially
experienced as pleasurable until it results in painful or dangerous consequences.

The more severe depressions (Major Depression and Bi-polar) have a strong genetic
predisposition – they run in families. Especially with these two conditions, medication is
extremely helpful and effective. Talk therapy and waiting it out can be disastrous with
these conditions, although it may work with the less severe ones.

The first step is to identify what type of depression you have. If it continues for more
than a few weeks or has debilitating symptoms, get professional help. For the more
transient or everyday depression, talk therapy can be very helpful in itself. We can only
deal with feelings we become aware of and then can decide how to approach the
The holidays are a good example of the importance of becoming aware of your feelings,
so you are not knocked for a loop when you are hit unexpectedly. Look at the handout
and take the Holiday Inventory. What is your ideal for the holidays, how realistic are
they, and what is one thing you would like to have happen that is not likely to occur?
Allow yourself to feel the sadness of departed family members and recall the good
times. If there are difficult family members, reduce the time you spend with them.
Remember to balance your needs with the needs of others.

Whether to get help with a Clinical Depression, or to help you traverse a difficult time in
your life, the Employee Assistance Program is here to help. You and your family
members are entitled to up to six counseling sessions with a professional counselor at
no cost to you. You may attend during work hours (administrative leave) or after hours.
In all cases, the nature of your problem and what is discussed will remain confidential.
If you choose to go during work hours the EAP counselor will give you a card to
document your attendance (no further information will be released).

For further information contact Metropolitan EAP Inc. at 212-352-3274(EAP4).
                              MOODS & DEPRESSION

  *                  *                       *                                 *
Normal           Minor                   Dysthymia                       Major Depression
Mood             depression              Cyclothymia                     Bi-polar Disorder


            Sadness/unexplained crying

            Diminished interest or pleasure in former activities (sex, job, family)

            Feeling of worthlessness

            Diminished self esteem (feel like a loser, incompetent, unattractive)

            Feeling of excessive guilt/responsibility (brooding about the past or
             castigating self for trivial matters)

            Decreased energy, fatigue, exhaustion, or listlessness

            Disturbed sleep (usually early morning insomnia)

            Appetite changes (especially loss of appetite)

            Difficulty thinking, concentrating, or making decisions

            Social withdrawal

            Fearfulness

            Irritability

            Agitation and inability to sit still or retardation with slowed thinking, speech,
             and body movements

            Feelings of hopelessness and helplessness

            Recurrent thoughts of death or suicide

      Genetic/biochemical: Major Depression 1½ -3X more common among first-degree relatives.
       Bi-polar up to 24% have first degree relative with it. Identical twins 70% concordance rate,
       fraternal twins 23%, 10-20% first degree relatives for Bi-polar, (Endler), Major Depression 7.4%
       concordance for first degree relatives (Endler).

      Loss (loved one, job, health, goals…) or misfortune.                           Helplessness,
       powerlessness, sense of failure

      Holidays: Life/relationships don’t live up to expectations (happy loving
       family/remember past losses and empty chairs). Be prepared for this and mourn
       and talk through before the holiday/re-evaluate unrealistic expectations.

Transient or Clinical Depression? Everybody experiences minor depression or
sadness in their lives. However, it is important to know difference between transient &
Clinical Depression. If it continues for more than a few weeks or debilitating symptoms
occur, get professional help.

To help in this normal process with Transient (Everyday or Minor) Depression

      Mourn your losses (grieve vs become depressed/melancholic). Must face and
       work through the painful and difficult feelings before you can go on.

      Identify the personal significance of the “depressing” incident; to your self
       esteem, identity, or sense of safety.

      Re-evaluate your expectations, values, and goals. Are they realistic (i.e. only
       worthwhile if earn $100,000 year, if husband is always attentive, or kids don’t
       have problems)?

      Identify both the good and bad things in your life and about yourself (in
       depression see as all bad).

      Stand back and try to view your situation, as an objective observer would do it.

      What would make you feel better about yourself/your life? What do you want out
       of life? Is it realistic? What is keeping you from achieving this goal?

      Substitute something for the loss or develop a new life interest (religion after loss
       of loved one, new goal, hobby, expand social network, community involvement).

      Start an exercise program.
1. Identify your sensitive issues or triggers (i.e. when do you get depressed or down).

2. What are your true or real feelings (sadness, anger, betrayal, inadequacy,

3. What effect does it have on your self-esteem or sense of who you are as a person
  (i.e. undesirable, bad, evil, mean, inadequate, ugly, stupid, incompetent, unworthy)?

4. Is this a particularly sensitive issue for you? If yes, can you identify what in your past
   may cause it (i.e. felt unwanted by father so tend to be sensitive/overreact when feel
   rejected by men)? Do you interpret, as this particular man does not want me or that “I
   am no good and no one will love me”?

5. Stand back and evaluate the situation/incident from an objective observer’s
   standpoint. How would he/she assess the situation and you?

6. What steps/actions can you take to not be so vulnerable to this particular issue?

      Go to counseling
      Talk it over with a good friend/spiritual guide
      Re-evaluate your expectations? Are they realistic?
      Practice viewing it objectively
      Look and take responsibility for your role in the problem
      Improve yourself (expand education, lose weight, develop savings plan)
      Have other supports (not all eggs in one basket – develop other friends).

6. What have been the major losses in your life (people, health, youth, finances,
   prestige)? Have you mourned and let go?
Holiday Inventory: Holidays are often a time of depesssion or sadness.

1) Identify your IDEAL. Allow yourself to fantasize: what would your ideal holiday be?
   What are your secret expectations and hopes for the holidays?

2) Have you had these expectations in the past and were they realized? What
   expectations do you have that are likely to be disappointed or not come true?

3) What is the true spirit/meaning of your holiday (spiritual, cultural, humanistic)?

4) What are the problems in your life and do the holidays only escalate them? Can
   something is done about the situation? What actions can you take to increase the
   chance of having some of your holiday expectations met?

              Are you holding on to grudges? Hurt often turns to anger and it may be
               easier to strike back in anger than tell someone they hurt your feelings. If
               you or the person had a limited time to live would you hold on to the

              What is your role in the problem (most of us are not totally innocent)? Do
               you see only your way and not the other's point of view (world from their
               shoes)? How would they see the quarrel – what would happen if you
               truly listened to their view vs listen only to counteract?

              Which of your personality traits/personal issues may be playing a role
               (i.e. critical & judgmental, want to be taken care of vs adult
               responsibilities, or righteous anger)?

              Are you expecting someone to be who he or she is not (want mother to
               be more loving, husband more communicative)? What keeps you from
               accepting them for who they are if it cannot be changed? What feelings
               would you have to experience if you accepted them for who they are vs
               how you'd like them to be (face fact of bad marriage, estranged family,
               etc)? Are you holding onto how you would like it to be rather than how it

5) What is one thing (concrete activity) you can do now to improve this holiday or make
   it one to remember? Could you take your kids to a special event (Rockefeller Center
   tree/ice skating)? Spend time, not money; such as bake cookies with kids, listen to
   your teenager about what is important to him/her, etc.
                           HOLIDAY SELF-INVENTORY
1. What are you most sad or disappointed about as you think about how your holidays
are likely to be? List three of the most disappointing.




2. What are the best memories of past holidays?

3. What do you have in your life currently that you are grateful for?

4. What is the one thing you could do differently this year to make this a better holiday
for you? Please be specific.

5.What would you need to change about yourself or your life to make next year's
holidays better?

       METROPOLITAN EAP….49 West 12th Street, Suite 1D, NY, NY 10011

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