Look For the Signs: Depression, Suicide, and How To Help

Contents: About the campus campaign to raise awareness What Is Clinical Depression? Common Symptoms of Depression Types of Depression How is Clinical Depression Different from Normal Stress and Sadness? What Causes Depression? Men and Depression Depression and Suicide Bipolar Disorder Getting Help Self-Care Strategies for Coping with Depression Seeking Professional Help Getting Academic Support When Depressed How Can Family and Friends Help? How Faculty and Staff Can Help a Depressed Student Suicide Know What to Look For Common Misconceptions about Suicide

Look for the Signs: About the Campaign
Across the nation, depression has become a serious and prevalent issue among college students. Unfortunately, depression is often stigmatized, ignored, or untreated. The UC Berkeley campus is addressing this problem by raising students' awareness to the signs of depression and what can be done to treat it. We hope the information in this campaign will help students understand the seriousness of this issue, recognize the signs of depression, and encourage them to seek appropriate treatment. In doing so, we hope to make mental health and wellness a greater priority for UC Berkeley students and staff, and to promote a positive and educated outlook toward depression.

What is Clinical Depression?
Clinical depression is a serious medical illness that negatively affects how you feel, the way you think and how you act. Individuals with clinical depression are unable to function as they used to. Often they have lost interest in activities that were once enjoyable to them, and feel sad and hopeless for extended periods of time. Clinical depression is not the same as feeling sad or depressed for a few days and then feeling better. It can affect your body, mood, thoughts, and behavior. It can change your eating habits, how you feel and think, your ability to work and study, and how you interact with people. People who suffer from clinical depression often report that they "don't feel like themselves anymore."

Clinical depression is not a sign of personal weakness, or a condition that can be willed away. Clinically depressed people cannot "pull themselves together" and get better. In fact, clinical depression often interferes with a person's ability or wish to get help. Clinical depression is a serious illness that lasts for weeks, months and sometimes years. It may even influence someone to contemplate or attempt suicide.

People of all ages, genders, ethnicities, cultures, and religions can suffer from clinical depression. Each year it affects over 17 million American men and women (source: American Psychiatric Association). While clinical depression is common, it is frequently unrecognized and untreated.

There are different types and levels of clinical depression. Mental health counselors and psychiatrists are trained to diagnose and treat clinical depression. With the right treatment, most people who seek help get better within several months. Many people begin to feel better in just a few weeks.

Common Symptoms of Depression
There are different forms of clinical depression with different combinations of the following symptoms:

Physical:

• Sleep disturbances-insomnia, oversleeping, waking much earlier than usual
• Changes in appetite or eating: much more or much less
• Decreased energy, fatigue
• Headaches, stomachaches, digestive problems or other physical symptoms that are not explained by other physical conditions or do not respond to treatment

Behavioral/Attitude:

• Loss of interest or pleasure in activities that were once enjoyed, such as going out with friends, hobbies, sports, sex, etc.
• Difficulty concentrating, remembering, or making decisions
• Neglecting responsibilities or personal appearance

Emotional:

• Persistent sad or "empty" mood, lasting two or more weeks
• Crying "for no reason"
• Feeling hopeless, helpless, guilty or worthless
• Feeling irritable, agitated or anxious
• Thoughts of death or suicide

Types of Depression:
Depression can come in different forms. It may start suddenly or build up over a period of weeks, months, or years. The following are descriptions of the three most prevalent forms, though for an individual, the number, severity and duration of the symptoms may vary.

• Major Depression: a combination of symptoms (described above) that interfere with one's ability to work, sleep, eat and enjoy once pleasurable activities. These episodes can occur once, twice or several times in a lifetime.
• Dysthymia: a less intense type of depression that involves long-term, chronic symptoms that are less severe, but keep one from functioning at full ability and from feeling good.
• Bipolar Disorder (also known as manic-depressive illness): periods of depression alternate with periods of elation and increased activity, known as mania.

How Is Clinical Depression Different From Normal Stress and Sadness?
Feeling sad and depressed is often a normal reaction to a stressful life situation. For example, it is normal to feel down after a major disappointment, or to have trouble sleeping or eating after a difficult relationship break-up. Usually, within a few days, perhaps after talking to a friend, we start to feel like ourselves again.

Clinical depression is very different. It involves a noticeable change in functioning that persists for two weeks or longer. Imagine that for the last three months you've slept more than 10 hours a day and still feel tired, you have stomach problems, you're unable to cope with life, and you wonder if dying would solve all your problems. Or, imagine not being able to sleep more than four hours a night, not wanting to spend time with family or friends, and constantly feeling irritable. And when friends try to reach out to you, you get even more upset and bothered. You lose perspective, and you don't realize that what you're experiencing is abnormal. You want to just "wait it out," and you don't get help because you think it's weak to ask for help or you don't want to burden your friends.

These are some of the experiences that people can have when they suffer from clinical depression. Unlike normal stress and sadness, the symptoms of clinical depression persist and do not go away no matter how much the individual wants.

The following three dimensions are useful when talking to a health care provider about whether you are experiencing normal life stress or clinical depression.

• Frequency: How often do you feel sad or depressed? Every day? Three times a week? Once a month? All the time? Only when something negative has occurred
• Severity: How bad is it? Do you feel suicidal? Are you able to get up in the mornings and face another day? Totally hopeless and stuck in a dark hole? Or just kind of lousy and negative?
• Duration: How long does it last? Until you see your partner? Until you go home for the weekend? A few hours every night? Does it drag on for days, weeks, or even months? Have you felt somewhat depressed your whole life?

What Causes Depression?
There is no simple answer. Research suggests that a variety of factors may play a role in vulnerability to depression.

Biological factors: You may have heard about chemical imbalances in the brain that occur in depression, suggesting that depression is a medical illness. Depression does seem to have a biological component. Research suggests that depression may be linked to changes in the functioning of brain chemicals called neurotransmitters. Current research focuses on the serotonin, norepinephrine and dopamine systems. The usefulness of antidepressant medications suggests that brain chemistry is involved in depression. However, it is also possible that biological changes happen as a result of being depressed.

Some kinds of depression seem to run in families, suggesting a biological vulnerability. This seems to be the case with bipolar depression and, to a lesser extent, severe major depression. However, having a biological vulnerability does not mean you are destined to become depressed. Not everyone in a family develops depression, suggesting that other factors are involved. In addition, depression can occur in individuals who have no family history of depression.

Stress: Psychological and environmental stressors can contribute to a depressive episode. Common stressors among college students include:

• academic demands
• transitions-re-entry to school, being new to Berkeley
• balancing school, work, family, social life
• financial responsibilities or worries
• family concerns
• social isolation
• difficulties in relationships with friends and romantic partners
• being on one's own in a new environment
• exposure to new ideas, new people, and temptations
• awareness of sexual identity and orientation
• preparing for life after graduation, career decision-making

A major loss, chronic illness, relationship problems, work stress, family crisis, or unwelcome life changes can often trigger a depressive episode, even in individuals without a family history or genetic predisposition.

Psychological Tendencies: Psychological make-up can play a role in vulnerability to depression. People with low self-esteem, who consistently view themselves and the world with pessimism, or are readily overwhelmed by stress, may be especially prone to depression.

Alcohol or Other Drug Use: A lot of depressed people, especially young adults and men, have problems with alcohol or other drugs. Sometimes the depression comes first and people try alcohol or other drugs as a way to escape it. Other times, the alcohol/drug use comes first, and the drug itself, or withdrawal from it, or the problems caused by substance use, may lead to depression. Sometimes you can't tell which came first. The important point is that when you have both of these problems, the sooner you get treatment, the better. If you are taking medication for depression and abusing alcohol or other drugs, your medication will not work effectively. Medication should never be discontinued without talking to your doctor.

You may feel you know exactly why you're depressed. Other times, however, the reasons for depression are not as clear. The causes of depression are quite complex. Very often it is a combination of genetic, psychological, and environmental factors. Regardless of the cause, depression is almost always treatable. You do not need to determine the cause of your depression to get help.

Men and depression
Depression can strike anyone regardless of age, background, socioeconomic status or gender. However, in any given year, 12% of women (nearly 12 million women) in the United States are diagnosed with depression compared to 7% of men (over 6 million men). Important questions remain about the causes underlying this gender difference and whether depression truly is less common among men, or whether men are less likely than women to recognize, acknowledge and seek treatment for depression.

Research at the National Institute of Mental Health (NIMH) on depression awareness has shown that many men are unaware that physical symptoms such as headaches, digestive disorders, and chronic pain can be associated with depression. Depression in men can present itself differently than in women. Men are more likely to acknowledge fatigue, irritability, loss of interest in hobbies, sleep disturbances, and discouragement, rather than feelings of worthlessness or guilt. Men's depression is more often masked by alcohol or other drugs, or by the socially acceptable habit of working excessively long hours.

Even if a man realizes he is depressed, he may be less likely to seek help. Men express concern about seeing a mental health professional, thinking that people would find out and it might have a negative impact on their job security, promotion potential, or health insurance benefits. Men may fear that being labeled with a diagnosis of mental illness would cost them the respect of their family and friends. On campus, male students may be more concerned about their standing in their academic department, or being labeled as weak, if they seek help. Encouragement and support from concerned family members and friends can make a difference. Significant others play an important role in helping men recognize their symptoms and getting treatment.

Depression and Suicide
A person who is clinically depressed may experience so much emotional pain and hopelessness that they begin to think about suicide as a way to end their problems. Feeling as if you want to die in order to escape your problems can be a serious sign that you are suffering from clinical depression. Counselors and psychiatrists can help you to reduce these feelings and work with you to treat your depression. See the section on suicide for more information.

Suicidal thoughts, impulses, or behaviors should always be taken seriously. If you are thinking about hurting or killing yourself, SEEK HELP IMMEDIATELY.

Bipolar Disorder
Bipolar disorder is characterized by cycling mood changes: severe highs (mania) and severe lows (depression). Sometimes the mood switches are dramatic and rapid, but most often are gradual. When in the depressed cycle, an individual can have any of the symptoms of a depressive disorder. When in the manic cycle, an individual is overly "up" or irritable. Someone in a manic state may appear excessively talkative and energetic, with little need for rest or sleep. This can affect thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, an individual in a manic phase may feel elated, full of grand schemes, or engage in reckless spending sprees or increased sexual activity. Individuals who are in a manic state may feel in possession of special powers or abilities that others can't understand.

This condition is treatable; contact a mental health resource for more information and assistance.

• Mental Health Resources for Cal Students
• For UC Berkeley Staff

Getting Help
Self-Care Strategies for Coping with Depression
Although professional help is available for treating depression, there are many things you can do to help maintain your mental health and improve your ability to cope with depression. The following are some suggestions:

• Develop a more healthful, balanced diet. This helps you keep moods balanced and overall health status strong.
• Get regular exercise. If you feel lethargic and tired, the last thing you may feel like doing is exercising. However, exercise has been shown to affect the same neurotransmitters in your brain that are involved in depression. Any regular exercise can help -- swimming, biking, walking.
• Get sufficient sleep. Cutting short on sleep can contribute to a downward spiral in other areas. If you are having trouble sleeping, consider your sleep habits. If you are sleeping too much, stick to a regular schedule and try to find activities or responsibilities that will get you out of bed in the morning. Students can talk with a health educator about making changes in sleep patterns.
• Develop stress skills and time management skills. These will be helpful in surviving college and keeping yourself from feeling overwhelmed. There are many good self-help books on stress management in the Tang Self-Care Resource Center. Students also can meet with a health educator to discuss their particular situation and stressors.
• Pay attention to your feelings. Learn to be aware of your feelings and not let them build up to the point where they overwhelm you, bring you down, and cause even bigger problems in your life.
• Develop and use a support system. Talking to people you trust can give new perspectives and support. Let your family and friends know if you just need them to listen, if you just want to vent, or if you just need a hug. Let them know that you don't need them to "fix" the problem or "make it all better."
  
  Cal Students can make discuss healthy lifestyles with a Clinical Health Educator

Seeking Professional Help
People often try to deal with problems themselves. This might work, but often it isn't enough. For example, you may find that even with the strategies provided above, you continue to feel depressed. Sometimes people get so depressed that they can't mobilize themselves to use these strategies.
If you are at the point where depression is seriously affecting important aspects of your life, or if you are considering suicide, you must seek professional help. If you have questions about how you are feeling or any concerns about whether you might be depressed, these are also reasons to talk to someone. Contact a primary care physician, a psychologist, psychiatrist, social worker or other mental health professional. For students, these resources are available at the University Health Services and are available to you regardless of your insurance plan. If you're uncertain who can help, talk to your family, Resident Assistant, advisor, or other adults in your life.

Types of professional help available
If you think you might be depressed, discuss this with a health care or mental health professional who can address your concerns. Many effective treatments for depression are available and can provide relief from symptoms in just a few weeks. The most common treatments are psychotherapy (talk therapy), antidepressant medication, or a combination of the two. The best treatment for an individual depends on the nature and severity of the depression. Sharing your preferences and concerns with your treatment provider helps determine the course of treatment.
Counseling or psychotherapy is often the best place to start. While talking to friends and family may be helpful, there are often limitations to how much they can help. You may be reluctant to share certain aspects of your life with them or you may be concerned about overwhelming them with your problems. Talking to a trained professional can provide the outside perspective you need to understand where you are stuck and how to take steps to get better.
Antidepressant medications can also be very helpful, especially with serious depression or with depression that is resistant to psychotherapy treatment. While medications are generally not seen as substitutes for therapy, they can help the person get back on track more quickly and can "lift the cloud" so the person can function better and move toward "getting things back to normal".
Together, antidepressants and psychotherapy have been shown to be the most effective to prevent relapse in the future. Antidepressants can be quite helpful in relieving symptoms while psychotherapy helps to enhance the person's understanding of the depression and his or her coping strategies for dealing with the condition or with the situations that led to the depression in the first place.

Counseling Options
Finding the right therapist is very important. It is important to consider whom you feel most comfortable with, in terms of gender, age, race and ethnic origin. In addition, therapists vary in terms of their style and orientation. Orientation refers to the approach the therapist takes in working with you on the depression. Here is an overview of the most common types of psychotherapy used with depression:

• Interpersonal Therapy: This approach can help identify and resolve the problems in relationships that are contributing to the depression.
• Cognitive-Behavioral Therapy (CBT): This approach focuses on the negative, inaccurate, self-defeating and/or pessimistic thoughts, beliefs and perceptions that are contributing to the depression. CBT not only focuses on identifying and changing thought patterns but also on making specific behavioral changes to reflect and reinforce the new thoughts and beliefs.
• Psychodynamic Therapy: This approach focuses on past experiences and how they might be contributing to your current depression, perhaps in ways of which you are not aware.

Getting Academic Support When Depressed
Students often struggle with what to tell their professors or instructors when they are depressed and unable to complete their work. If you have a good relationship with your instructors, you may choose to tell them that you are depressed and getting help, and talk to them about how it has affected your schoolwork. They may be willing to give you extra time on assignments, or arrange for an "incomplete" in a course, when needed.
If you are uncomfortable sharing this, you might consider disclosing that you have some personal or health issues. If you have sought help, University Health Services may be able to provide documentation of your sessions, or, when appropriate, verify that you are ill without disclosing the nature of the problem. Click here for more information on academic adjustments.

If you need to take time off from school, you might consider a personal withdrawal through your school or a medical withdrawal through the Tang Center. For more information about medical withdrawals, click here.

Disabled Students Program (DSP) can be helpful in advocating for accommodations for students who have a documented diagnosis of depression.

How Can Family And Friends Help?

The understanding, affection, and involvement of family and friends can play a vital role in assisting a depressed loved one. The following can help:

• Listen carefully, sensitively, and without judgment to the concerns and feelings of the depressed person. Allow and accept expression of feelings.
• Encourage the depressed person to continue to talk about his/her concerns.
• Empathize: Genuinely communicate your understanding of the depressed person's concerns as he/she describes them, both in content and feeling.
• Take Seriously any remarks about suicide. A depressed person may experience hopelessness, which may lead to contemplating suicide. Report any remarks about suicide to the depressed person's therapist and/or consult with Counseling and Psychological Services at (510) 642-9494, University Health Services.
• Respect Differences: Assume that different individuals will respond differently to depression. Be flexible and encourage support of one another in different ways.
• Offer Hope: Assist the depressed person to identify available alternatives, but refrain from evaluating, fixing, advising, criticizing, moralizing, correcting, offering glib assurance, or making a decision for the depressed person.
• Become Involved: Encourage a depressed loved one to seek professional help w/ a competent mental health care worker. On occasion, you may need to make an appointment and/or accompany him/her to his/her first appointment. Consider inviting the depressed person for outing, to the movies, for walks, and other physical and social activities.
• Be Available and Follow-Up: Continue to encourage the depressed loved one to stick with treatment and to practice the coping techniques and problem-solving skills he or she is learning through psychotherapy. Remain open to further discussions. Let them know you are available if they need you. Check back on the person's progress.
• Care for Yourself: Living with a depressed person can be very difficult and stressful on family members and friends. The pain of watching a loved one suffer from depression can bring about feelings of helplessness and loss. As you help a depressed loved one, your role is to provide support and to suggest other options when support is not enough. Remember your own limits and do not become more involved than your time and skill permits.
• Consult: If the issues are beyond your ability to help, you can call and talk with a therapist at Counseling and Psychological Services (510) 642-9494 about how you can better help your friend or family member. Counselors are available by phone during CPS office hours.

Sources:
American Psychological Association--http://www.apa.org
CAPS at University of North Carolina--http://caps.unc.edu
National Institutes of Mental Health (NIMH)--http://www.nimh.nih.gov

How Faculty and Staff Can Help a Depressed Student

Faculty and staff are often in the position of noticing when students have a problem with depression. It can be confusing and overwhelming to experience a student in distress and faculty and staff are often unsure what to do. Here are some thoughts about how to identify students who need help, and actions you can take

Signs of Distress: Trust your intuition when you are concerned about a student. Here are some behaviors you might observe in a student who is depressed and needs help.

• Crisis persisting after 6 - 8 weeks
• Student overwhelmed: everything is a problem
• Uncontrolled crying or other mood swings
• Concentration, memory problems, extreme difficulty with decision-making
• Sleeping impaired: too much or insomnia; eating problems
• Hopelessness about future
• Worthlessness, extremely low self-esteem
• No energy
• Debilitating anxiety or agitation; irritability-frequent arguments, physical acting-out
• Confusion
• Poor self-care (looks dirty, smells, beyond "Berkeley" norms)
• Suicidality- references to their life being over soon
• Unexplained changes in behavior: grades, mood, drug use, social withdrawal, sexual acting-out
• Academic issues: not attending classes, missing assignments/exams, disruptions in class
• Unusual or alarming e-mails

What can you do?

• Express concern - don't be afraid to be direct and name the behaviors you have observed.
• Suggest and encourage counseling. Ask the student if s/he has thought about talking to a counselor. Explain how counseling might be helpful in providing an unbiased perspective and support from someone trained to deal with issues such as theirs. Normalize counseling-explain that many students see a counselor and the range of issues for which they seek help. Self-disclosure of your own help-seeking may be powerful for students. It's okay to express your limits-don't try to diagnose or do the counseling with the student.
• Explain how to use Counseling and Psychological Services (CPS), which offers crisis counseling, brief counseling for personal, family, career concerns. Students can make an appointment by stopping by the CPS office. Click here for CPS office hours. Appointments with counselors are usually within a few days. Students in crisis can see a counselor on an immediate, drop-in basis. Offer to walk the student down to CPS or to call from your office.
• Follow up with student. Due to confidentiality restrictions, CPS can't tell you whether a student has been seen at CPS. If you have concerns, consider setting up a follow-up meeting with the student to check in.

Phone consultation with CPS counselors: If you are unsure whether a student needs help, or how to discuss counseling with a student, please call (510) 642-9494 during CPS Office Hours.

After-Hours Emergencies: Call University Health Services After-Hours Assistance Line at (510) 643-7197. If a student is in imminent danger, call 911.

Other resources: A guide for faculty and staff dealing with students in distress is also available here.

Suicide

Over 30,000 people in the US kill themselves every year. Suicide is the second-leading cause of death among college students, after accidents (source: American Foundation for Suicide Prevention). It is an issue that needs to be of concern to everyone in the University community. Although not all depressed people are suicidal, most suicidal people are depressed. Over 60% of all people who commit suicide suffer from depression (source: American Foundation for Suicide Prevention) and 70% of people who commit suicide tell someone in advance. Here are some suggestions on how to identify students who might be suicidal and what to do:

Know what to look for--A person might be suicidal if he or she:

• Talks or jokes about committing suicide
• Engages in self-destructive or risky behavior
• Makes statements that seem hopeless
• Has difficulty eating or sleeping
• Gives away prized possessions
• Loses interest in family, friends and/or activities
• Is preoccupied with death and dying
• Has recently experienced the death of a loved one
• Loses interest in his or her personal appearance
• Increases alcohol or other drug use
• Makes a will or other final arrangements
• Has attempted suicide before

Ways to be helpful if you think someone is considering suicide

• Do take it seriously.
• Voice your concern-ask what is troubling the person.
• Be willing to listen.
• Be direct about the issue-ask if the person has considered killing him/herself and if s/he has a specific plan. Ask how far s/he has gone in carrying it out.
• Help the person find professional assistance immediately. If the person is suicidal, bring him/her to CPS for urgent services, or to the local hospital emergency room when CPS is closed. Your friend will be more likely to seek help if you accompany him/her.
• Take action by removing means for committing suicide, such as guns or pills.
• Do not leave the person alone if s/he is in imminent danger. Call 911.
• What not to do
• Don't be sworn to secrecy-- never keep a plan a secret. Seek support. Consult with others; call CPS. Don't assume the situation will take care of itself.
• Don't leave the person alone.
• Don't act surprised or shocked at what the person says.
• Never call the person's bluff--don't challenge or dare.
• Don't challenge or debate moral issues.

Common Misconceptions about Suicide (from http://www.save.org): The following are common misconceptions about suicide.

1. "People who talk about suicide won't really do it."

NOT TRUE
Almost everyone who commits or attempts suicide has given some clue or warning. Do not ignore suicide threats. Statements like "you'll be sorry when I'm dead," "I can't see any way out" -- no matter how casually or jokingly said -- may indicate serious suicidal feelings.

2. "Anyone who tries to kill him/herself must be crazy."

NOT TRUE
Most suicidal people are not psychotic or insane. They must be upset, grief-stricken, depressed or despairing, but extreme distress and emotional pain are not necessarily signs of mental illness.

3. "If a person is determined to kill him/herself, nothing is going to stop him/her."

NOT TRUE
Even the most severely depressed person has mixed feelings about death, wavering until the very last moment between wanting to live and wanting to die. Most suicidal people do not want death; they want the pain to stop. The impulse to end it all, however overpowering, does not last forever.

4. "People who commit suicide are people who were unwilling to seek help."

NOT TRUE
Studies of suicide victims have shown that more then half had sought medical help within six month before their deaths.

5. "Talking about suicide may give someone the idea."

NOT TRUE
You don't give a suicidal person morbid ideas by talking about suicide. The opposite is true --bringing up the subject of suicide and discussing it openly is one of the most helpful things you can do.

Disclaimer: The information provided here is not intended to diagnose, treat or provide a second opinion on any health problem or disease. It is meant to support, not replace, the relationship that exists between an individual and his/her clinician.

Special thanks to the Counseling and Psychological Services interns who helped to research and develop this information: Peggy Yang, Ernesto Escoto, Suzanne Raffeld and Amber Weikel.

Last revised: January, 2004

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