How To Tell the Difference Between the Blues and Symptoms of Depression: 6 Tell-Tale Signs

By Sunda Friedman Tebockhorst, PhD, LPC

“The opposite of depression is not happiness, but vitality.”
This quote from writer Andrew Solomon contains some important wisdom about the nature of the beast we call depression. It is normal to experience sadness, to have days of feeling grumpy or down. We all have days like this, sometimes a few in row. It is normal to feel sad in response to distressing life events – these are the bumps in the road of life, and for most of us, we navigate over the bumps and get on with the life we recognize as ours. However, when the obstacle is not the normal vicissitudes of daily life, but rather a run-in with depression, this can be altogether a different story. Life becomes a foreign and exhausting experience, where it feels like there is no respite and no hope for a more engaged tomorrow. Here are some things to look for if you aren’t sure whether or not you might benefit from help for depression. If you have found that, for more than two weeks or so:
1. Everything is exhausting: the tasks of daily living – getting the mail, taking out the trash, doing the dishes, talking to friends or family – are overwhelming and extraordinarily demanding. If it feels like doing the little things of everyday life is just too much to face, you may be dealing with depression.
2. Everything is annoying: for many people, and this can be especially true for men, who in our culture our discouraged from acknowledging that they feel down or sad, depression shows up as extreme irritability. If you find that you are responding to the other people and events of your life with intractable bouts of extreme irritability not in proportion to the events in question, you may be dealing with depression.
3. Everything is overwhelming: you used to find that life was a pretty comfortable place for you, but now find that even minimal levels of stimulation are overwhelming for you. People in your life talk too much or talk too loud, bright colors are intrusive, any change in plans or routine is unbearable, even music, books or movies you used to enjoy demand too much energy – if this sounds familiar, you may be dealing with depression.
4. Everything is un-interesting: you used to enjoy your hobbies, had activities or events in your life that predictably brought you pleasure, but now, nothing is pleasurable or enjoyable. If food tastes bland, jokes are never funny, you don’t look forward to things you used to, you can’t seem to care what’s going on around you, you may be dealing with depression.
5. Anything could provoke tears: if you find that you cry frequently, sometimes for reasons you don’t understand, or for no reason at all, you may be dealing with depression.
6. Nothing provides relief: if you have come to a place where you feel no hope that things will change or improve, and/or you feel helpless to gain traction and return to a place where life held some pleasures, if a sense of defeat and purposelessness has invaded your daily routine, you may be dealing with depression.
It’s important to note that, if several or all of these things ring true for you, you do not have to just suffer through it. There are effective tools for managing and resolving depression, most notably, therapy and medications. Statistically speaking, the best outcomes in terms of recovery happen when we use both of these approaches together; you will have to find the specific remedy that best suits your particular needs. What’s most important is that you know that you don’t have to keep struggling and you certainly don’t have to accept that this is just the way things are. Depression is an awful monster that can take over people’s lives, whisper horrible things in their ears, and prove a relentless and formidable burden. While you may not know what to do to get rid of this monster if it has invaded your life, you don’t have to do it alone. A skilled therapist can help you move back to a place of vitality and engagement in life. Please – if this describes you or a loved one – know that we as a community of experienced therapists would like to help you begin the work of taking back your life from this monster. There is hope, and there is help. Finding the right therapist can be a great first step.

Grief and Loss in Parenting

By Miki Fire, Psy.D.
Clinical Psychologist

As a relatively new parent, I have spent a lot of time reflecting on the experience of this new role. Like many of you, my experience in parenting has come with some unbelievable moments of joy; the feeling of holding your baby for the first time, of seeing your baby laugh or smile at you, watching as your baby begins to crawl and then stand and eventually walk and run. Of course, there are all the challenges as well; trying to soothe a colicky baby, endless hours of rocking and bouncing and shooshing your little one to sleep (not to mention your own sleep deprivation), or trying to communicate to a toddler that he needs to have patience and wait a few seconds before you can give him that toy he’s reaching for. Alongside these there might also be myriad challenges in parenting alongside your partner who may have his or her own different ideas of what’s best.

Most of what we are exposed to—in the popular media, in our pediatrician’s office, in the conversations at the playground and even at most new parent support groups—are these kinds of ups and downs.

What we hear much less about, if ever, is a much more subtle experience, yet one that is absolutely felt, and that is the grief and sense of loss that is also associated with parenting. Especially in the early years of being a parent, the feelings of sadness and outright grief and mourning can be quite intense, yet are rarely discussed. Because we don’t often talk about this grief, we sometimes wonder if it’s normal, we may pathologize it, push it away, or simply keep it to ourselves

Have you ever noticed, as a parent, how painful the experience can be? How much that sense of love for your child also brings with it a sense of sometimes overwhelming heartache? How in each moment, even if that moment has been unbelievably trying, there is sometimes a surprising sense of nostalgia for that same experience once it has passed?

Why is there such a sense of grief and loss in parenting?

I think that the first days and weeks and months of parenting can be so new and, for many of us challenging, that we tend to feel primarily the relief and joy with each new development. “Ah, she is finally sleeping five hours straight! She doesn’t need to be burped every time she eats! I can put her down for a few minutes and make myself a cup of tea without her fussing!” But what we don’t always feel as strongly, at least not on the surface, is the ending that comes with each new moment, each achievement.

Not one instant can be held on to. Not one day is the same. The minute a new milestone is achieved whatever preceded it is gone, simply folded into the next movement. Your baby’s balancing on two knees becomes a crawl, then a crouch, which becomes an unbalanced stand, a first step, a walk, a run. Even with language, those little gurgles and raspberries which become babbling and eventually actual words. Once you have a child that has mastered the art of language, it might be hard to imagine that you lived with an essentially non-verbal being for a couple of years! Whatever the development, each new movement echoes some past experience, but we never go back, ever. Our tendency is often to focus on the new step our baby has taken, but we don’t necessarily say goodbye to the previous stage that has now been mastered.

Of course there will be more firsts. In fact, all there ever will be are firsts. But every first is also a last. As parents we often joke about how once you have finally mastered some aspect of your child’s development she is on to the next milestone, leaving you to have to figure out a whole new set of tricks. There is joy and relief in moving onto what is new, but there is also a sense of ineffable loss for whatever phase has now come to an end.

If we really think about this experience for a moment, we can begin to touch on the poignancy of this ongoing experience. In a way, being a parent is to witness what it truly means to be alive, as a human being. To know that each day, each moment, each breath, comes and then goes. Parenting, in this way, gives us a very palpable sense of impermanence.

And of course this reflection of impermanence so perfectly revealed in our children is true for everything. As adults we tend to not see the subtle changes that are happening; maybe because they appear so much less dramatic they are missed, easily overlooked, or even denied. Changes tend to blend into one another affording us the illusion that things are essentially the same. It may not be until we are much older, or witnessing the aging process in our own parents, that we have a palpable sense of the passing of time. But it is simply impossible to not see how quickly everything ends when you are in the presence of your child.

And for many people, this constant experience of endings brings with it a feeling of deep heartache. People may have warned you about many of the other challenges of becoming a parent, but rarely do people warn you of the bittersweetness that comes as each day comes to an end and your child is one day older. Yes, there is a deep sigh at the end of a long day, after all the toys have been cleaned up and you can finally sink into the couch with a good book. But for some people there is also a sense of loss. This feeling may be experienced as a sense of depression even. It may be felt as a general fatigue or apathy. Maybe a tearfulness that you cannot explain, or even a feeling of agitation or irritation. We sometimes talk about post-partum depression or “baby blues,” but we rarely acknowledge that these feelings of malaise may actually be normal and appropriate grief for this new experience.

Because in addition to the sense of loss that can come with watching your child change so rapidly is also a very reasonable experience of mourning that may come with the huge transition you are experiencing as a parent. There may be a sense of loss for the person you felt you were before you had children, or the relationship you and your partner had that was just the two of you. If you already have children there may be a feeling of sadness and loss that you no longer can spend all of your parenting time with your other child or children, that this energy is now shared.

We are generally told that we should be happy and grateful to bring children into the world. But rarely are we told that it is okay to also feel pain for the life we have left behind. And this life is truly behind us, even when our children are older and we can work more, spend more time with our friends and alone, it will never be the same.

A part of you may wonder, what can I do about all of this? What should I do about all of this?

Grief is an experience that many people attempt to bypass because it can often be so painful. But my clinical experience has repeatedly shown me that grief is an incredibly important experience that, if possible, is best travelled through, not around. Especially for anyone who has experienced bouts of depression or anxiety that have not lifted easily, there may be a fear that if you turn towards the feelings of sadness and loss, they may just get bigger and more stuck. When you first turn towards your grief, it may feel like it does get bigger, more poignant, or more painful. This is normal. If it is too much to be with, then let yourself turn away towards something else. But notice when you are intentionally avoiding feelings of grief. Even just this noticing is a subtle acknowledgment of the grief that might be there. Here are a few suggestions for how to be with your grief.

  1. Begin my simply acknowledging that all of the feelings you are having as a parent are completely normal. Give them permission to be here.
  2. When you notice a difficult emotion, like sadness or some pain, just let yourself acknowledge it is there. You don’t have to do anything more. In fact, with the busyiness of parenting, you may not have space to really do more than this.
  3. Find a time in the day when you can turn more fully towards whatever feelings have been coming up. Maybe this is while your child is napping, at school, or in bed for the night. During this time, just give your whole body and mind permission to feel whatever feelings may be there and have been there. Even this is enough. You don’t have to do anything with the feelings, just feel.
  4. If it is hard to just stay with your feelings in an unguided way, here are some suggestions for ways to turn towards, and acknowledge your grief: Use a journal and let yourself write openly about your grief, paint, draw, or engage in any other art form on the theme of grief, set aside 10 minutes to simply sit quietly and invite your feelings to be with you. Just by setting an intention to be present with your feelings, any activity has the potential to be a practice in more fully processing your grief.
  5. Talk with someone. A friend, your partner, a therapist. Naming your feelings can be one of the more powerful ways of working with grief. When we put words to our inner experiences it often leads to a shift in the experience itself and a deeper sense of meaning.

In essence, my suggestion is, take it all in, let whatever feelings you might have in this process be here in their complete fullness. And know that, even whatever you are feeling now will not be with you forever. Grief (unlike some clinical depressions) does have a way of moving and changing. The grief you may feel as a parent will inevitably shift as your child changes.

And remember, really being honest about these feelings and letting yourself really feel is an extraordinary gift, not only for yourself, but also for your child. You are teaching him or her that emotions, even difficult ones, are okay, survivable, and can even serve as doorways to something new.

(If this blog resonates with you in any way, or if you have any additional thoughts, suggestions or questions in regards to this topic I welcome any comments!)

Considering Medication for Your Child’s Psychological Issues

Q: Some parents I know seem in a rush to have their children go on medication for things like depression and hyperactivity. What should parents do before making the jump to medication?

A: For psychological disorders, a thoughtful and accurate diagnosis is key to developing an effective treatment plan. What elementary child does not have occasional concentration problems in class? Does this mean that he/she has Attention Deficit Hyperactivity Disorder (ADHD)? Similarly what adolescent isn’t moody from time to time? Do we diagnosis him/her with Bipolar Disorder? Many mental health professionals would agree that these two disorders are highly over diagnosed in children and adolescents. This is a significant concern because both ADHD and Bipolar Disorder are typically treated with strong psychoactive drugs. Once diagnosed, patients may be on these drugs for the rest of their lives.

The accuracy of a diagnosis is a function of gathering information from multiple sources and thoughtfully ruling out other variables that may better explain the symptoms. For example poor concentration is also a symptom of depression. Some would argue that mood swings are a normal function of hormonal changes in adolescence. While it can be costly, considering formal testing by a trained psychologist can dramatically increase our objective data and thus increase the accuracy of our diagnosis. There are specific psychometric tests that can assess attention impairment (e.g. the TOVA), mood disorders (the MMPI), and other psychological conditions. A comprehensive psychological evaluation would include a battery of tests; an analysis of the child’s medical, family, educational, and social history; as well as surveying parents, teachers and children, in order to get a convergence of multiple data points as to the source(s) of the presenting problem. In the end the cost of a thorough psychological evaluation may be far less than the impact of an incorrect diagnosis.
When accurately diagnosed and treated, medications can prove to be a great blessing in treating conditions like ADHD and Bipolar Disorder. We just want to do everything we can to be sure of the root cause, which allows us a much better chance of developing a treatment plan to address it.

Self-Harm Behavior

By Dr. Jan Hittelman

“My 13-year-old daughter is a cutter. She also smokes. I have done everything I can to stop her, but she did it again last night and I took her to the emergency room. On the way home, I asked her what I could do to help her stop cutting. She said if I would let her smoke cigarettes at home, that would help, because smoking soothes her and helps alleviate her need to cut.”

“What should I do?”

Cutting and cigarette smoking share a common thread; both are unhealthy ways to deal with negative emotions. While all of us struggle with feelings like sadness, anger, and anxiety, we each deal with our feelings very differently. Some adolescents have tremendous difficulty experiencing and working through their negative emotions and are limited to self-harm behaviors as a maladaptive coping mechanism. It is difficult for most of us to understand, but for some individuals cutting can seemingly provide their only source of relief and often develops into an addictive behavior that is very difficult to stop.

Common misconceptions regarding cutting are that it is a suicidal gesture and/or attention-seeking behavior. Those that cut use it as “a way to survive” and are usually not looking to kill themselves. Given how effectively they hide their scars by wearing long sleeves and purposely cutting in areas that are generally under clothing, this is clearly not an attention-seeking behavior. Rather, cutting is a desperate behavior that demands our attention.

Self-harm behaviors are a serious indicator that the individual needs professional help. It is important that the mental health professional have expertise in not only treating adolescents but also self-harm behaviors. Common co-occurring issues that also need to be treated or ruled-out include: history of sexual abuse, family dysfunction, risky sexual behavior and substance abuse.

Finding the right therapist for your daughter, who can help her learn how to deal with negative emotions in a more effective way and thereby reduce (and eventually extinguish) her self-harm behaviors (including cigarette smoking), would be the critical next step.

Screen Time Addiction

Q: How do I know when my child is spending too much time on the computer or playing video games?

A: As more people engage in high tech recreation, there are increasing concerns regarding the effects of these activities and the potential harm of excessive computer and video game use. Some of the key factors to consider are:

Time dedicated to computer and video game use: Many experts recommend limiting use to two hours a day. A more practical time guideline can be based on the individual and the impact of use on daily functioning.

Impact on healthy daily functioning: Excessive use is more of a concern if it negatively interferes with school performance, peer socialization, family interaction, exercise/weight control, and interest in other activities.

Behavioral Effects: There are numerous studies that show a correlation between exposure to violent video games and aggressive thoughts or behavior. None of these studies, however, can demonstrate long-term impacts or conclude that video gaming itself causes aggressive behavior.

What’s a parent to do? The first step is to have an open discussion with your children regarding computer and video game use. If your child has a healthy social life and continues to function well at home and in school, simply monitoring use may be sufficient. If the amount of daily use time is excessive and/or you have concerns about your child’s social, emotional or behavioral health, try setting clear guidelines. In addition, consider gaming and recreational computer time as a reward for completing homework, household chores, or engaging in prosocial activities. Help your child replace use time with other fun activities. Simply taking away the activity and leaving a vacuum, will likely lead to conflict and efforts to “get around” newly imposed rules.

It is also important to understand that excessive videogame/computer use may be a symptom of underlying emotional issues (e.g. depression, anxiety, social adjustment, etc.). Addressing the surface behaviors without treating these issues will only result in a reoccurrence of the undesired behaviors and/or new ones taking their place. If you have concerns about your child, consider an assessment by a mental health professional to determine the extent of the problem and better understand the underlying issues that may be fueling the behavior.