Seeking assistance

When to Seek Assistance

If you are experiencing depressive symtoms seek professional help (i.e. doctor, counsellor). Any thoughts of ending your life should be discussed with your doctor, counsellor, or contact Student Wellness Centre.

SEEK HELP IMMEDIATELY if, at any time, thoughts of death or suicide are accompanied by:

  • a fear that you will hurt yourself
  • securing a means to self-harm (e.g. finding pills or a gun)
  • and/or a plan for suicide

Urgent Assistance

  • call the Suicide Crisis Line (306 933-6200 in Saskatoon)
  • call 911
  • ask a trusted friend or family member to take you to the hospital

What is depression

Understanding depression is the first step toward feeling better.

A wide range of emotional experience and expression is normal. It is natural to respond to life experiences (either satisfying and fulfilling or distressing and painful) with emotion. At some point, everyone experiences problems which result in feelings of irritability, sadness or self-blame. Such responses are usually short-lived.

Clinical depression occurs when these feelings, along with a set of additional symptoms, become:

  1. intense
  2. persist for several weeks and
  3. interfere with academic, social, family or occupational functioning

Common symptoms

Clinically significant depression is more than the emotional experience of sadness. When a person experiences depression, mood symptoms interact with cognitive, behavioral and physical symptoms.

Feelings:

  • Sad 
  • Irritable 
  • Hopeless 
  • Helpless 
  • Pessimistic 
  • Guilty 
  • Discouraged
  • Confused 
  • Anxious 

Thoughts:

  • Thoughts of worthlessness
  • Negative interpretations
  • Thoughts of death or suicide
  • Memory problems
  • Difficulty making decisions
  • Difficulty concentrating
  • Distorted thinking 

Behaviour:

  • Brooding
  • Restlessness
  • Lack of motivation
  • Social withdrawal
  • Frequent tearfulness or inability to cry
  • Loss of interest in previously enjoyed activities
  • Slowed speech and body movements
  • Placing unusual or excessive demands on others
  • Suicidal behavior 

Body:

  • Change in appetite
  • Reduced sex drive
  • Lack of energy
  • Aches and pains
  • Weight loss or gain
  • Disturbed sleep
  • More sensitivity to external stimuli

Types of Depression

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. (4th ed.). Washington, DC: Author

  • at least two weeks of depressed mood or loss of interest in activities
  • accompanied by at least four other symptoms of depression (e.g. change in appetite, disturbed sleep, decreased energy level, difficulty concentrating)
  • the symptoms persist for most of the day, nearly every day and interfere with important areas of functioning (e.g. school, relationships).
  • the symptoms are not a result of bereavement, substance abuse or a general medical condition (e.g. hypothyroidism).

Major depressive disorder is often treated with a combination of medication and psychotherapy

  • at least two years of depressed mood for more days than not
  • accompanied by at least two additional depressive symptoms
  • because the depressive symptoms have become so much a part of day-to-day experience, it may seem to the individual that “it’s always been this way.”
  • low interest in activities, self-criticism and feelings of inadequacy may be particularly prominent

Dysthymic Disorder is milder, yet more chronic than Major Depression

  • cycles of moods including depression, and mania (i.e. euphoric excitement) or irritability
  • periods of mania and depression can last from a few weeks to several months
  • during the cycle of mania, the individual may experience unreasonable optimism, hyperactivity, rapid speech, decreased need for sleep and have an extremely short attention span. They may do things which are out-of-character (e.g. spend money very freely, show disregard for the law).

There are different types of Bipolar Disorder. If you have been diagnosed with this disorder, ask your health care professional which type seems most applicable to you.

  • the onset and remission of depressive symptoms at characteristic times of the year
  • in most cases, the episodes begin in fall or winter and remit in spring

Age is a strong predictor of seasonality, with younger persons at higher risk for winter depressive episodes

  • depressive symptoms which occur within 4 weeks after delivery of a child
  • women with postpartum depression often experience severe anxiety, spontaneous crying, disinterest in their baby and insomnia
  • some women may also experience psychotic symptoms (e.g. believe that the baby is possessed by the devil)

Many feel especially guilty about having depressive feelings at a time when they believe they should be happy.

  • the essential features are: significantly depressed mood, marked anxiety, and decreased interest in activities
  • symptoms occur regularly during the last week prior to menstruation and cause impairment in the ability to function socially, occupationally or academically
  • the symptoms remit within a few days of the onset of menses and are always absent in the week following menses

How Is depression different than sadness or grief?

Sadness:

  • is a natural response to an emotionally painful experience
  • naturally resolves over time
  • does not usually disrupt everyday life in a significant way (i.e. you can continue to do your work, you maintain relationships with family and friends, etc.)
  • does not disrupt your sense of hope for the future
  • does not lower your self-esteem
  • does not significantly interfere with sleep, appetite, energy level, etc.

Grief:

  • is a natural response to loss
  • typically resolves over time
  • does not lower your self-esteem
  • involves reordering your sense of the world in the face of your loss
  • involves many different feelings including sadness, hopelessness, anger, etc
  • does not have the same chronicity of symptoms that depression may have

More about depression

  • Symptoms of depression usually develop over days to weeks 1
  • The duration of depression is variable 1
  • The first episode of untreated depression usually lasts an average of 6 -9 months 2.
  • In the majority of cases, there is complete remission of symptoms 1.
  • In some cases (perhaps 20% - 30%) there will be partial remission (i.e., some depressive symptoms will persist). 1
  • For a small number of individuals (5% - 10%), depressive symptoms will become chronic (i.e., continue for two years or more) 1.
  • Up to 15% of those with severe Major Depressive Disorder end their own life 1.
  • Substance abuse, anxiety disorders and eating disorders frequently co-occur with depression 3.
  • People who have experienced violence are at increased risk to experience depressive symptoms
  • It is unlikely that one particular factor causes or maintains depressed mood. Understanding the different factors that often contribute to depression is a first step toward feeling better.
  • A comprehensive treatment approach to depression is one that recognizes the various contributors to the development and maintenance of depression.

1. American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. (4th ed.). Washington, DC: Author.
2. Barlow, D., Durand, M. & Stewart, S (2006). Abnormal Psychology: An Integrative Approach. Toronto.
3. Nelson. Oltmanns, T., Emery, R. & Taylor, S. (2006). Abnormal Psychology. Toronto: Pearson.

Why am I depressed

Understanding your depressed mood is important. Your recovery efforts can target the factors that you see as contributing to, and maintaining, your depression. 

Consider the following:

  • Poor Self-care:

What maintains depressed mood?

Negative Self-Talk

Difficult life situations can leave people with beliefs about self, others and the world that become generalized in ways that interfere with experiencing life in more affirming ways. If your experience has taught you that you are not capable, that others are never helpful and that life is simply a set of problems, then you may become more vulnerable to depression.

Once you learn to identify and challenge negative views of self, others and the world, then you are in a strengthened position to deal with life stressors.

Poor diet

Our bodies are our physical selves. What we nurture ourselves with physically can enhance our well-being. Eating well-balanced, regular meals is important in managing a depressed mood.

Substance use

Certain substances, such as alcohol, depress us physiologically. Excessive reliance on mood-altering substances contributes to the experience of depression.

Sleep difficulties

Poor sleep habits (e.g. staying up all night) means people are robbed of the energy they need to take care of their physical health (e.g. exercise) and engage in coping strategies (e.g. attend therapy sessions).

Lack of exercise

Exercise enhances the production of endorphins (natural opiates that play an important role in emotion and pain reduction) in the brain and results in an increased sense of well-being. Without adequate exercise, endorphins are not released as readily and our bodies become sluggish and lethargic. This, in turn, negatively affects our mood and sense of self.

Stress

Chronic stress depletes your spirit and energy level, making it more difficult to cope with depression. In addition, stress is often accompanied by a sense of loss of control. This can also contribute to low mood.

Poor social support

Research shows that having the support of trusted others helps us to cope more effectively with stressors. Having supports enables us to identify, express and work through our feelings. Without adequate support we feel isolated, believe that we are alone in our experience and begin to feel hopeless about change.

Lack of purpose And goals

Being unsure about your values, goals and ability to make a contribution in the world can fuel depressed mood.

Overcoming depression

Strategies

Below is a long list of the many strategies that assist people in overcoming depression. It is not necessary to utilize all of the strategies at once in order to successfully manage depression. Instead begin by enacting a few key changes.

Accepting full responsibility for your depressed mood is the first step toward healing. Taking responsibility doesn’t mean blaming yourself. Chances are you have done what you could to manage with the knowledge and resources you have. Taking responsibility means deciding that you are ultimately in charge of initiating change in your life (even if you feel others may have contributed to your depressed mood).

Develop an attitude for recovery that helps you to be more accepting of your circumstances.

Open yourself to taking risks. Overcoming low mood will necessitate experimenting with some new ways of thinking and behaving. These new ways of coping are likely to feel unfamiliar, and even uncomfortable, at first. Be patient with yourself while you try some new ways of coping.

Be clear about the potential contributors to your depressed mood (e.g., cognitive distortions, poor social support) and the symptoms you experience. This will help you to target your strategies.

Work on developing a better understanding of yourself (e.g., your interests, values, goals, etc.). Knowing who you are will help you develop a recovery plan that feels right for you.

Set realistic goals for overcoming your depressed mood and for your life in general. Make affirming choices and work in a step-by-step manner.

Choose supportive relationships. Focus on choosing and maintaining relationships with people who care about, understand and support you. Choosing healthy relationships will make it easier to overcome depression.

Seek and accept support. Let people you trust know about your efforts to improve your mood. Talking to close friends or family members is one way of obtaining the support you need while you work to feel better.

Work to better recognize, accept and express your feelings. Taking care of your emotional self will help you to feel less depressed.

Strengthen your coping, problem solving and decision-making skills. Take charge of managing your life as well as you can.

Learn to recognize and challenge depressive thinking. Choose self-statements that are realistic and encouraging.

Take care of your physical health. Seek help for problems with drugs and alcohol.

Increase your activity level. While you may feel a lack of energy and motivation, convince yourself to stay as active as possible everyday. Choose to spend your time doing things that contribute to happiness and your wellbeing (e.g., exercise, pursue a hobby).

If you have been prescribed an antidepressant, take it as directed. If you experience difficulties with side-effects, speak to your physician. Never alter your dose or discontinue taking your medication without consulting your doctor.

Read about the successful management of depression.

Recognize your successes. Pay attention to the ways you have managed, the new skills you learn and how much relief you experience.

Imagine more success. Remain focused on what your life will look like when you are better managing your depression.

Be patient. Lasting change usually takes time.

Expect set backs. There will likely be times ahead when you will find it more difficult to manage your depression. This does not mean you have failed. Set backs are normal, and can usually be overcome by remaining focused on successful coping strategies.

Notice what might be interfering with your motivation for change. For some people there are payoffs (conscious or unconscious) to maintaining a mood problem. For example, you may want to overcome depressed mood that leaves you reluctant to socialize with others. If, however, your depression means your reassuring and supportive partner will most often stay home to keep you company, your motivation for change may be decreased. Ask yourself if there are any payoffs to your depression (try not to blame yourself if you discover any).

Bear in mind that experiencing some low mood is natural. Everyone experiences low mood at some time or another.

Find out for yourself. Some people express hesitation and skepticism when presented with coping strategies that are anxiety-provoking or require energy and effort. Decide if you are willing to experiment. Discover for yourself if these strategies work. Ultimately, you can always “change back” if you wish.

An attitude for recovery

You have learned specific strategies you can continue to use in better managing your low mood. In the weeks and months ahead, it will be important to continue to utilize these techniques to help you maintain and build on your progress. A second and equally important task will be the management of your attitude toward depression. Your overall beliefs about depression, and how you think you should respond to it will be critical to your recovery.

Consider the following:

Depression does not need to be a secret

Many individuals who experience problems with depression hide this from others, feeling ashamed or embarrassed. Some feel worried about the stigma of being perceived as having a mental health problem. Combined, these feelings erode self-esteem and make you more vulnerable to depression. When depression is no longer a secret, you can better make decisions to support and help yourself (instead of working to protect yourself from the opinions of others). You can also more easily access the support and assistance you deserve. This strengthens self-worth and further guards against low mood.

Depression is not an enemy

It is natural to want to fight against the depression that disrupts your life and makes it difficult for you to live more peacefully. However, rejecting and resisting depression requires your time and energy. Ultimately, it increases feelings of tension and frustration, making you more vulnerable to depressed mood. Acknowledging and accepting depression as a legitimate part of your experience removes the resistance. Tension is reduced and a sense of calm can develop. Instead of investing your energy into fighting the villain, you are freed up to better use your coping strategies.

You do not have to hide from depression

As you know, one of the most successful ways of overcoming depression is to directly face the symptoms. Avoidance only perpetuates the problem. By choosing to attend to distressing symptoms, you discover you can cope. When you face depression, instead of running from it, the balance of control shifts to you. By consciously choosing to face how you feel.

Imperfection is acceptable

Some individuals who learn specific depression management strategies become convinced that these strategies must work each time they are implemented in order for them to cope. In reality, life is complicated and magical solutions don’t exist. While the strategies you have learned are effective, they are not perfect. It is likely that there will be moments ahead when you feel less successful in your efforts to manage depression. This, however, does not mean that you have failed or that you are unable to cope. Accepting the likelihood of setbacks (and choosing to see these as learning experiences) will release you from the pressure that comes with believing that the strategies should work and that you must always cope well.

Wilson, R. (1996). Don’t Panic: Taking Control of Anxiety Attacks. New York: Harper Perennial.

Learning to manage low mood is work. Do this work in small steps. This will help to prevent feelings of discouragement, maintain your motivation and energy level, and increase the chances that your changes will be lasting.

Step by step plan

Plan to overcome depression by setting achievable goals and working in small steps.

Being clear about how you will better manage and overcome depression is key. Working in a planned, step-by-step manner works best for most people. In addition, meeting small, daily and weekly goals helps people to experience success and sustain lasting change.

Download workbook

Download the Overcoming Depression workbook to help you work through the following steps.

Step 1
Take stock of what you know about yourself and your symptoms. Are your symptoms primarily impacting your thoughts, feelings, body or behavior?

Step 2
Take some time to think about the different factors that contribute to and maintain depression. What factors are relevant for you?

Step 3
Take a look at the list of strategies (see above) that people use to help themselves overcome depression. Given your particular symptoms and the factors that seem to maintain your depression, where are your initial efforts best spent? Would you do well to focus more on your thoughts, feelings, body or behaviour?

Step 4
Choose ONE small goal for the upcoming week. Record it. Over the course of the week, pay attention to how you do and answer the questions about your progress

Step 5
Continue to set small, weekly goals and monitor your progress. If necessary, make adjustments in your plan (e.g., begin to focus on improving your sleep if you start to struggle with insomnia; see a doctor about your medication if you experience side-effects that are difficult to manage).

Step 6
Take credit for your success as you continue to set manageable goals.

Managing Setbacks

  • Expect them to happen.
  • Remember that SETBACKS ARE NORMAL. They are a natural part of the change process.
  • Remind yourself that, in order to experience a setback, you must have first had progress. Credit yourself for what you have already accomplished.
  • Actively choose to persevere. A few steps backwards does not mean you are at the same place you began.
  • Decide to use the setback as a learning experience. It can guide your future efforts. Instead of beating yourself up, choose to look for information about your coping style then use this to your benefit.
  • Stick with what you know works.
  • After reasonable effort, abandon what doesn’t work and try something different.
  • Sometimes, ‘trying different’ can be more effective than ‘trying harder’.
  • Ask yourself if there are other strategies you have learned but not yet tried. Implement those. The best protection against future setbacks is frequent and continued focus on the skills you have learned. Challenge and change any negative self-talk about your setback.
  • Seek support. Let a trusted friend or family member know about your efforts and frustration.
  • Review the information you have received about depression.
  • Choose a book from the ‘Suggested Reading’ list and learn more about the management of depression.
  • Seek assistance with difficulties (e.g. relationship problems) that may be perpetuating your depressed mood.

Signs of Trouble

If you can’t make it better, don’t make it worse

Prevent what you can. Developing strong self-soothing, relationship and problem solving skills will help you to avoid problems that will worsen your depression.

Know the signs of trouble. Pay attention to how you are coping with life’s stressors. Watch out for potential signs of trouble, including the following:

  • Poor or dropping grades
  • Missed assignments and exams
  • Performing below potential
  • Skipping classes
  • Excessive use of drugs or alcohol
  • Problem gambling
  • Difficulty relaxing
  • Continually feeling overwhelmed
  • Chronic worry or anxiety
  • Relationship difficulties
  • Difficulties with sleep
  • Over or under eating

Act quickly. For some students, personal problems interfere not only with mood but with academic life. Once you realize that you are experiencing a problem, begin using effective coping strategies. Don’t wait for things to get worse.

Know when to seek professional help. Talk to a professional (e.g., doctor, counsellor) if you are experiencing a personal problem that is:

  • intense
  • persists over time
  • interferes with life

Getting help

If you have symptoms of depression that are intense, persist and interfere with your life, please seek professional help.

Talk to your doctor

  • Speak to your health practitioner in order to rule out a medical cause for your symptoms.
  • At the USask, students can meet with a physician a the Student Wellness Centre

Seek counselling

  • A mental health professional will work with you to understand and address the factors that contribute to and maintain depression.
  • At the USask, counselling is available at the Student Wellness Centre.

Urgent assistance

If you are experiencing depressive symtoms seek professional help (i.e. doctor, counsellor). Any thoughts of ending your life should be discussed with your doctor or counsellor.

 SEEK HELP IMMEDIATELY if, at any time, thoughts of death or suicide are accompanied by:

  • a fear that you will hurt yourself
  • securing a means to self-harm (e.g. finding pills or a gun)
  • and/or a plan for suicide

Urgent Assistance

  • call the Suicide Crisis Line (306 933-6200 in Saskatoon)
  • call 911
  • ask a trusted friend or family member to take you to the hospital