What is Depression?
Information provided by Mental Health America
The word depression is used in many different ways. People feel sad or blue when bad things happen. However, everyday “blues” or sadness is not a depressive disorder. We all may have a short-term depressed mood, but we cope and soon recover without treatment. A major depressive disorder lasts for at least two weeks and affects a person’s ability to work, to carry out usual daily actives, and to have satisfying personal relationships.
Mood disorders affect nearly 1 of 10 adults in a given year. The most common is major depressive disorder, which affects 6.8 percent of adults in any one year. The median age of onset is 32 years, meaning that half of the people who will have an episode will have had their first episode by this age. Depression often co-occurs with anxiety or substance use disorders. Depression is more common in females than in males. It often recurs. Once a person has had an occurrence of depression, they are prone to subsequent episodes.
Symptoms of Depression
A person who is clinically depressed would have at least one of these two symptoms, nearly every day, for at least two weeks:
An unusually sad mood
Loss of enjoyment and interest in activities that used to be enjoyable
The person also might have these symptoms:
Lack of energy and tiredness
Feeling worthless or feeling guilty though not really at fault
Thinking often about death or wishing to be dead
Difficulty concentrating or making decisions
Moving more slowly or sometimes becoming agitated and unable to settle
Having sleeping difficulties or sometimes sleeping too much
Loss of interest in food or sometimes eating too much. Changes in eating habits may lead to either loss of weight or weight gain
Not every person who is depressed has all these symptoms. People differ in the number and severity of symptoms. Even if the symptoms don’t add up to an official diagnosis of a depressive disorder, the impact on life can still be significant.
Symptoms of depression affect emotions, thinking, behavior, and physical well-being. Some examples are as follows:
Sadness, anxiety, guilt, anger, mood swings, lack of emotional responsiveness, feelings of helplessness, hopelessness, irritability.
Frequent self-criticism, self-blame, worry, pessimism, impaired memory and concentration, indecisiveness and confusion, a tendency to believe others see you in a negative light, thoughts of death and suicide.
Crying spells, withdrawal from others, neglect of responsibilities, loss of interest in personal appearance, loss of motivation, slowed down, using alcohol or other drugs.
Chronic fatigue, lack of energy, sleeping too much or too little, overeating or loss of appetite, constipation, weight loss or gain, headaches, irregular menstrual cycle, loss of sexual desire, unexplained aches and pains
How a Person with Depression May Appear
A person who is depressed may be slow in moving and thinking, although agitation can occur. Even speech can be slow and monotonous. There can be a lack of interest and attention to personal hygiene and grooming. The person usually looks sad and depressed and is often anxious, irritable, and easily moved to tears. Mild depression may be successfully hidden from others, while with severe depression, the person may be emotionally unresponsive and described as “beyond tears.”
The thinking of a person with clinical depression often has themes of hopelessness and helplessness, with a negative self-image: I’m a failure. It’s all my fault. Nothing good ever happens to me. I’m worthless. No one loves me.
Or there may be pessimism about life or the future: Life is not worth living. There is nothing good out there. Things will always be bad.
Other Mood Disorders
People with bipolar disorder (previously called manic depressive disorder) have extreme mood swings. They can experience periods of depression, periods of mania, and long periods of normal mood in between. The time between these episodes varies greatly from person to person. Approximately 2.8 percent of US adults experience bipolar disorder in any given year. The median age of onset is 25 years, which means that half the people with bipolar disorder will have had their first episode by this age. Bipolar disorder is equally common in males and females.
Depression experienced by a person with bipolar disorder has some or all of the symptoms of depression listed previously. A person cannot be diagnosed with bipolar disorder until he or she has experienced both an episode of mania and an episode of depression. It may, therefore, take many years before an accurate diagnosis is made and appropriate treatment provided.
Mania appears to be the opposite of depression. A person experiencing mania will have an elevated mood, be overconfident, and be full of energy. The person might be very talkative and full of ideas, have less need for sleep, and take uncharacteristic risks. Although some of these symptoms may sound beneficial, such as increased energy and being full of ideas, they often get people into difficult situations. They could spend too much money and get into debt, become angry and aggressive, get into legal trouble, or be sexually promiscuous. These consequences may cause havoc with work, study, and personal relationships. The person can have grandiose ideas and may lose touch with reality (that is, become psychotic). In fact, it is not unusual for people with this disorder to become psychotic during depressive or manic episodes.
Depression Following Childbirth
Approximately 21.9 percent of women will experience depression during their first postpartum year. Contributing factors are hormonal and physical changes and the responsibilities of caring for the baby. Feeling sad of having the “baby blues” after giving birth is common, but when these feelings last for more than two weeks, this may be a sign of a depressive disorder. Having had a previous episode of depression increases risk for postpartum depression, and symptoms often already are present during pregnancy.
A depressive disorder following childbirth is called postpartum or postnatal depression. The symptoms do not differ from depression at other times. However, depression at this time has an impact not only on the mother, but also on the mother-infant relationship and on the child’s cognitive and emotional development. For this reason, it is particularly important to get good treatment for postpartum depression. Treatment not only helps the mother’s depressive symptoms, but also can improve the mother-child relationship and the child’s cognitive development.
Formerly known as seasonal affective disorder (SAD), major depressive disorder with seasonal pattern is characterized by a depressive illness during the fall and winter months, when there is less natural sunlight. Prevalence increases with higher latitudes. The depression generally lifts during spring and summer. People with SAD are more likely to experience the following symptoms of depression: lack of energy, sleeping too much, overeating, weight gain, and a craving for carbohydrates.
What Causes Depression?
Depression has no single cause and often involves the interaction of many diverse biological, psychological, and social factors. People may become depressed when something very distressing has happened and they feel powerless to control the situation, such as the following:
A breakup of a relationship or living in conflict
Loss of a job or difficulty finding a new one
Having an accident that results in long-term disability
Bullying or victimization
Being a victim of crime
Developing a long-term physical illness
Death of a partner, family member, or friend
Depression can also result from:
The effects of medical conditions; for example, Parkinson’s disease, Huntington’s disease, traumatic brain injury, stroke, hypothyroidism, systemic lupus erythematosos
Having a baby (see Depression Following Childbirth)
The side effects of certain medications or drugs
The stress of having another mental disorder, such as schizophrenia, an anxiety disorder, or an eating disorder
Intoxication or withdrawal from alcohol or other drugs
Premenstrual changes in hormone levels
Lack of exposure to bright light in the winter months (see Seasonal Depression)
Caring full-time for a person with a long-term disability
Some people will develop depression in a distressing situation, whereas others in the same situation may not. Those most prone to develop depression are:
People who previously have had an episode of depression
People who have family members who have had episodes of depression
People with a more sensitive emotional nature
People who have had a difficult childhood (for example, those who experienced physical, sexual, or emotional abuse, neglect, or overstrictness)
Depression is believed to be caused by changes in natural brain chemical called neurotransmitters. These chemicals send messages from one nerve cell to another. When a person becomes depressed, the brain has fewer of these chemical messengers. One of these is serotonin, a mood-regulating brain chemical. Many antidepressant medications work by changing the activity of serotonin in the brain.
Importance of Early Intervention for Depression
Early intervention is important. People who have one episode of depression are prone to subsequent episodes. They fall into depression more easily with each subsequent episode. For this reason, some people go on to have repeated episodes throughout life. To prevent this pattern from occurring, it is important to intervene early with a first episode of depression to make sure it treated quickly and effectively.
Mental Health First Aid Action Plan for Depression
Action A: Assess for risk of suicide or harm
Action L: Listen nonjudgementally
Action G: Give reassurance and information
Action E: Encourage appropriate professional help
Action E: Encourage self-help and other support strategies
Action A: Assess for risk of suicide or harm
If you think someone you know may be depressed and in need of help, approach the person about your concerns. It is important to choose a suitable time when you and the person are available to talk, as well as a space where you both feel comfortable. Let the person know that you are available to talk when they are ready; do not pressure the person to talk right away. It can be helpful to let the person choose the moment to open up. However, if the person does not initiate a conversation, you can begin a dialogue. Respect the person’s privacy and confidentiality unless you are concerned the person is at risk of harming self or others.
The main crises associated with depression are as follows:
The person has suicidal thoughts and behaviors
The person is engaging in nonsuicidal self-injury
If you have no concerns that the person is in crisis, you may ask them how they are feeling and how long they have been feeling that way, and then move on to Action L.
Facts of Suicide in the United States
A national survey of US adults found that in a 12-month period, 3.7 percent had serious thoughts about suicide, 1.1 percent made a plan, and 0.6 percent attempted suicide.
Suicide is the 10th leading cause of death. In 2013, suicide took the lives of 41,149 people. They left behind friends, families, and whole communities scarred by this loss.
In 2013, suicide was the second leading cause of death among 15 to 24 year olds and 25 to 34 year olds.
In 2013, 17 percent of high school students in the United States reported that they had seriously considered attempting suicide during the 12 months before the survey. Eight percent of students reported they had attempted suicide one of more times during the same period.
Males are four times more likely to die by suicide than females, but women attempt suicide three times as often as men.
In 2013, people 45 to 64 years old have the highest rate of suicide (19.1 percent), and those 85 years and older have the second highest rate (18.6 percent).
Toxicology reports from suicide decedents in 2010 tested positive for the following: alcohol (33.4 percent), antidepressants (23.8 percent), opiates includes heroin and prescription pain killers (20.0 percent), marijuana (10.2 percent), and cocaine (4.6 percent).
In 2010, approximately 84 percent of people who completed suicide had symptoms of a mental health problem.
Having depression increases the risk of suicide. Of the 84 percent who had a mental health problem, 44 percent had a current mental health diagnosis. A person may feel so overwhelmed and helpless about life events that the future appears hopeless. The person may think suicide is the only way out. However, not every person who is depressed is at risk for suicide, nor is everyone who is at risk for suicide necessarily depressed. Encourage people to talk about their feelings, symptoms, and what is going on in their mind. Be alert for any of the warning sides of suicide:
Warning Signs of Suicide
Threatening to hurt or kill himself or herself
Looking for ways to kill himself or herself, seeking access to pills, weapons, or other means
Talking or writing about death, dying, or suicide
Feeling rage or anger, seeking revenge
Acting recklessly or engaging in risky activities, seemingly without thinking
Feeling trapped, like there is no way out
Increasing alcohol or drug use
Withdrawing from friends, family, or society
Experiencing anxiety or agitation, being unable to sleep, or sleeping all the time
Undergoing dramatic changes in mood
Feeling no reason for living, no sense of purpose in life
People may show one of many of these signs, and some may show signs not listed.
If you have seen warning signs, engage the person in a discussion about your observations. If you suspect someone may be at risk of suicide, it is important to directly ask about suicidal thoughts. Do not avoid using the word suicide. It is important to ask the question without dread and without expressing a negative judgement. The question must be direct and to the point. For example, you could ask,
“Are you having thoughts of suicide?”
“Are you thinking about killing yourself?”
If you appear confident in the face of a suicide crisis, this can be reassuring for the suicidal person. Although some people think that asking about suicide can put the idea in the person’s mind, this is not true. Another myth is that someone who talks about suicide isn’t really serious. Remember that talking about suicide may be a way for the person to indicate just how badly they feel.
Facts on Nonsuicidal Self-Injury
Many terms are used to describe self-injury, including self-harm, self-mutilation, cutting, and parasuicide. There is a great deal of debate about what self-injury is and how it is different from suicidal behavior. Here, the term nonsuicidal self-injury is used to refer to situations where self-injury has no suicidal intent. It is not easy to tell the difference between nonsuicidal self-injury and a suicide attempt. The only way to know is to ask the person directly, “Are you suicidal?”
There are many different types of nonsuicidal self-injury, including:
Cutting, scratching, or pinching skin enough to cause bleeding or a mark that remains on the skin
Banging or punching objects to the point of bruising or bleeding
Ripping and tearing skin
Carving words or patterns into skin
Interfering with the healing of wounds
Burning skin with cigarettes, matches, or hot water
Pulling out large amounts of hair
Deliberately overdosing on medications when this is not meant as a suicide attempt
Nonsuicidal self-injury is common in young people. A survey of college students in the United States found that 15.3 percent had engaged in nonsuicidal self-injury at some time in their lives. Another study of college students demonstrated that 11.7 percent reported engaging in nonsuicdal self-injury at least one time. No significant differences in rates of nonsuicidal self-injury were found between males and females in this age group.
People who engage in nonsuicidal self-injury do so for many reasons, including:
To escape unbearable anguish
To change the behavior of others
To escape from a situation
To show desperation to others
To get back at other people or make them feel guilty
To relieve tension
To seek help
Recent research suggests that adolescents may be more likely to engage in nonsuicidal self-injury when close friends or other peers engage in similar behaviors.
Let the person know that you are concerned and are willing to help.
If there is concern about suicidal thoughts, see First Aid for Suicidal Thoughts and Behaviors.
If you have serious concerns about suicide and suicidal thoughts, call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
If there is concern about nonsuicidal self-injury, see First Aid for Nonsuicidal Self-Injury.
Action L: Listen nonjudgmentally
If you believe the person is not in a crisis that needs immediate attention, you can engage the person in conversation, such as asking how they are feeling and how long they have been feeling this way. Listening nonjudgementally is important at this stage as it can help the person to feel heard and understood while not being judged in any way. This can make it easy for the person to feel comfortable and talk freely about their problems or ask for help.
Tips for Nonjudgemental Listening
It is tough to be nonjudgmental all of the time. We automatically make judgements about the people from the minute we first see or meet them based on appearance, behavior, and what they say. Nonjudgmental listening is not about avoiding those judgements— it is about ensuring that you don’t express those negative judgements, as they can get in the way of helping. If you have decided to approach someone with you concerns, it is a good idea to spend some time reflecting on your own state of mind first to ensure you are in the right frame of mind to talk and listen without being judgmental.
Although the focus of your conversation is the person’s feelings, thoughts, and experiences, you need to be aware of your own. Helping someone in distress may evoke an unexpected emotional response in you; you may find yourself feeling fearful, overwhelmed, sad, or even irritated or frustrated.
In spite of any emotional response you have, you need to continue listening respectfully and avoid expressing any negative reaction. This is sometimes difficult and may be made more complex by your relationship with the person or your personal beliefs about the situation. You need to set aside these beliefs and reactions in order to focus on the needs of the person you are helping to be heard, understood, and helped. Remember, you are providing people with a safe space to express themselves, and a negative reaction may block that sense of safety.
Effective Communication Skills for Nonjudgemental Listening
You can be an effective nonjudgmental listener by paying special attention to two areas:
Your attitudes, and how they are conveyed
Effective communication skills, both verbal and nonverbal
The key attitudes are acceptance, genuineness, and empathy.
Adopting an attitude of acceptance means respecting the person’s feelings, personal values, and experiences as valid, even if they are different from your own or you disagree with them. Do not judge, criticize, or trivialize what the person says because of your own beliefs or attitudes. This may mean withholding any and all judgments that you have made about the person and his or her circumstances.
Genuineness means that what you say and do shows that you are accepting of the person. This means not holding one set of attitudes while expressing another. Your body language and verbal cues should reinforce your acceptance of the person. For example, if you tell the person you accept and respect their feelings, but maintain a defensive posture or avoid eye contact, the person will know you are not being genuine.
Empathy means being able to imagine yourself in the other person’s place, showing them that they are truly heard and understood by you. This doesn’t mean saying something glib such as “I understand exactly how you are feeling” —it is more appropriate to say that you can imagine what they might be going through. Remember that empathy is different from sympathy, which means feeling sorry for or pitying the person.
Using the following simple verbal skills will show you are listening:
Ask questions that show you genuinely care, and seek clarification about what you are hearing.
Check your understanding by restating what they have said and summarizing facts and feelings.
Listen not only to what the person says, but how it is said; tone of voice and nonverbal cues will give extra clues about feelings.
Use minimal prompts, such as “I see” and “ah,” when necessary to keep the conversation going.
Be patient, even when the person may not be communicating well, is repetitive, or is speaking more slowly and less clearly than usual.
Don’t be critical, and don’t express your frustration at the person for having such symptoms.
Avoid giving unhelpful advice such as “pull yourself together” or “cheer up.”
Do not interrupt the person, especially to share your opinions or experiences.
Avoid confrontation unless necessary to prevent harmful or dangerous acts.
Remember that pauses and silences are okay. Silence can be uncomfortable for many people, but the person may need time to think about what has been said or may be struggling to find the right words. Interrupting the silence may make it difficult for them to get back on track and may damage the rapport you have been building. Consider whether the silence is awkward, or just awkward for you.
Nonverbal communication and body language express a great deal. Good nonverbal skills show you are listening, while poor nonverbal skills can damage the rapport and negate what you say.
Keep the following nonverbal clues in mind:
Pay close attention to what the person says.
Maintain comfortable eye contact. Don’t avoid eye contact, but do avoid staring; you can do this by maintaining a level of eye contact that seems most comfortable to the person.
Maintain an open body position. Don’t cross your arms over your body, as this may appear defensive.
Sit down, even if the person is standing, as this seems less threatening.
It is best to sit alongside and angled toward the person rather than directly opposite him or her.
Do not fidget.
Cultural Considerations for Nonjudgmental Listening
If you are assisting someone from a cultural background different from your own, you may need to adjust some verbal and nonverbal behaviors. For example, the person may be comfortable with a level of eye contact different from what you are used to or may be used to more personal space.
If these differences are interfering with your ability to be an effective helper, it may be helpful to explore and try to understand the person’s experiences, values, or belief systems. Be prepared to discuss what is culturally appropriate and realistic for the person, or seek advice from someone from the same cultural background before engaging him or her.
Action G: Give reassurance and information
Treat the Person with Respect and Dignity
Each person’s situation and needs are unique. It is important to respect the person’s autonomy while considering the extent to which the person is able to make personal decisions. Respect the person’s privacy and confidentiality unless yo are concerned that the person is at risk of harming self or others.
Do Not Blame the Person for the Illness
Depression is a real health problem. It is important to remind the person that it is a health problem and they are not to blame for feeling “down.”
Have Realistic Expectations
Accept the person as he or she is, and have realistic expectations. Everyday activities like cleaning house, paying bills, or feeding the dog may seem overwhelming. Let the person know that personal weakness or failure is not the cause of depression and that you don’t think less of them as a person. Acknowledge that the person is not “faking,” “lazy,” “weak,” or “selfish.”
Offer Consistent Emotional Support and Understanding
It is more important for you to be genuinely caring than for you to say all the right things. The person really needs additional love and understanding to get through the illness, so be empathetic, compassionate, and patient. People with depression are often overwhelmed by irrational fears; you need to gently understand. It is important to be patient, persistent, and encouraging when supporting someone with depression. Offer the person kindness and attention, even if it is not reciprocated. Let the person know that there is no risk of abandonment. Be consistent and predictable in your intentions with the person.
Give the Person Hope for Recovery
Reassure the person that, with time and treatment, they will feel better. Offer emotional support and hope for a more positive future in whatever acceptable form they will accept.
Provide Practical Help
Offer the person practical assistance with tasks, but be careful not to take over or encourage dependency.
Offer the person information about depression. If the response is positive, it is important that you give resources that are accurate and appropriate to the situation. Don’t assume the person knows nothing about depression, because they, or someone else close to them, may have previously experienced depression.
What Isn’t Supportive?
Don’t tell someone with depression to get better, as they cannot “snap out of it” or “get over it.”
Do not be hostile or sarcastic when the person attempts to be responsive, but rather accept these responses as the best the person has to offer at that time.
Do not adopt an over involved or overprotective attitude toward someone who is depressed.
Do not nag the person to try to get them to do what they normally would.
Do not trivialize the person’s experiences by pressuring them to “put a smile on your face,” to “get your act together,” or to “lighten up.”
Do not belittle or dismiss the person’s feelings by attempting to say something positive like, “You don’t seem that bad to me.”
Avoid speaking to the person in a patronizing tone of voice, and do not use overly compassionate looks of concern.
Resist the urge to try to cure the person’s depression or provide answers to their problems.
Action E: Encourage appropriate professional help
Everybody feels down or sad at times, but it is important to be able to recognize when depression has become more than a temporary experience and when to encourage that person to seek professional help. Professional help is warranted when the depression lasts for weeks and affects a person’s functioning in daily life. Many with depressive disorders do not seek professional help. In the United States, only 57 percent of people who had major depressive disorder in the past year received professional mental health care or other services. Even when people do seek help, they can delay for many years. These delays affect long-term recovery. People with depressive disorders are more likely to seek help if someone close to them suggests it.
Discuss Options for Seeking Professional Help
Offer the person help to manage feelings. If they feel they do need help, discuss the options they have and encourage them to use these options. If the person does not know where to get help, offer to help them seek assistance. It is important to encourage the person to get appropriate professional help and effective treatment as early as possible. If the person would like you to support them by accompanying them to an appointment with a health professional, don’t take over completely; a person with depression needs to make their own decisions as much as possible. Health professional often do not recognize depression; it may take some time to get a diagnosis and find a health care provider with whom the person is able to establish a good relationship. Encourage the person not to give up seeking appropriate professional help.
Professionals Who Can Help
A variety of health professionals can provide help to a person with depression:
Primary care physicians
Mental health professionals
Certified peer specialists
Only in severe cases, or where there is a danger a person might harm himself or herself, is a depressed person admitted to a hospital. Most people with depression can be treated effectively in the community.
Treatments Available for Depression
Most people recover from depression and lead satisfying and productive lives. There is a range of effective treatments for depression.
Supportive counseling involves being a good listener and providing emotional support. The therapist also may give information about depression and teach problem-solving skills. This type of treatment is most appropriate for mild depression.
There is good evidence for psychological therapies that have been developed to treat depression, such as cognitive behavioral therapy (CBT) and interpersonal psychotherapy. CBT is based on the idea that how we think affects the way we feel. When people get depressed, they think negatively about most things. There may be thoughts about how hopeless the person’s situation is and how helpless the person feels, with a negative view of himself or herself, the world, and the future. CBT helps the person recognize unhelpful thoughts and change them to more realistic ones. It also helps people change depressive behaviors by scheduling regular activities and engaging in pleasurable activities. It can include components such as stress management, relaxation techniques, and sleep management. Interpersonal psychotherapy helps people resolve conflict with others, deal with grief or changes in relationships, and develop better relationships. Research shows a better outcome when psychological therapy is given in combination with antidepressant medication. There is some evidence that a form of CBT, called dialectical behavior therapy, can be helpful for people who self-injure. Its main goals are to teach coping skins for stress, to regulate emotions, and to improve relationships.
Anti depressant medications have proven effective with adults who have depression. While controversial in the mental health community, electroconvulsive therapy (ECT) has been reported as effective for some adults with severe depression. However, ECT also has been known to cause negative side effects, such as memory loss. For people with bipolar disorder, mood stabilizer medications can help reduce the swings from one mood to another.
What if the Person Doesn’t Want Help?
The person may not want to seek professional help. Find out if there are specific reasons why this is the case. For example, the person might be concerned about finances, not having a doctor they like, or being hospitalized. These reasons may be based on mistaken beliefs, or you may be able to help the person overcome worry about seeking help. If the person still doesn’t want help after you have explored the reasons, let them know that if they change their mind about seeking help, they can contact you. Respect the person’s right not to seek help unless you believe that they are at risk of harming self or others.
Action E: Encourage self-help and other support strategies
Other People Who Can Help
Encourage the person to consider other available support, such as family, friends, faith communities, support groups, or others who have experienced depression (peer supporters). Some people who experience depression find it helpful to meet with others who have had similar experiences. There is some evidence that these mutual help groups can help with recovery from depression and anxiety. Family, friends, and faith community networks also can be an important source of support for a person who is depressed. Recovery from symptoms is quicker for people who feel supported by those around them.
People who are depressed frequently use self-help strategies. The person’s ability and desire to use self-help strategies will depend on their interests and the severity of their depression. Therefore, do not be overly forceful when trying to encourage the person to use self-help strategies.
Lifestyle and complementary therapies that have some scientific evidence for effectiveness include:
Exercise, including aerobic (jogging or brisk walking) and anaerobic (weight training).
SAMe (S-Adenosyl methionine)—a compound made in the body and available as a supplement in drug stores.
St. John’s wort (hypericum perforatum)—an herbal remedy widely available in drug stores.
Self-help books based on cognitive behavioral therapy (CBT).
Computerized therapy—self-help treatment programs delivered over the Internet or on a computer; some are available free-of-charge.
Relaxation training involves teaching a person to relax voluntarily by tensing and relaxing muscle groups; some programs are available from the Internet for free download.
Light therapy—bright light exposure to the eyes, often in the morning.
In addition to seeking out scientific evidence of what treatments and support work for depression, it is important to look at what consumers find helpful. A large Internet survey asked those who had received treatment for depression to rate the effectiveness of treatment. Rated as most effective were some antidepressant medications, CBT, interpersonal psychotherapy, other types of psychotherapy, and exercise.
For depression and suicidal intentions
American Association of Suicidology
Founded in 1968, the American Association of Suicidology (AAS) promotes research, public awareness programs, public education, and training for professionals and volunteers. In addition, AAS serves as a national clearinghouse for information on suicide.
American Foundation for Suicide Prevention
The American Foundation for Suicide Prevention (AFSP) provides information about suicide, support for survivors, prevention, research, and more. The Suicide Prevention Action Network merged with AFSP in 2009.
Brain & Behavior Research Foundation
This site provides information and downloadable fact sheets on depressive disorders.
Mental Health America
Visit Mental Health America’s site for information on mental health, getting help, and taking action.
This website is sponsored by Mental Health America as part of the Campaign for America’s Mental Health. The mission of this website is to educate people about clinical depression, offer a confidential way for people to get screened for symptoms of the illness, and guide people toward appropriate professional help if necessary.
The CBT website has been evaluated in a scientific trail and found to be effective in relieving depression symptoms if people work through it systematically. The site teaches people to use ways of thinking that will help prevent depression.
National Alliance on Mental Illness
NAMI is a nonprofit, grassroots, self-help, support, and advocacy organization of individuals with mental disorders and their families. This website provides many resources on mental disorders, including depression, that are helpful for people who have experienced a mental illness and their families, including support groups, education, and training.
National Council for Behavioral Health
To locate mental health and additions treatment facilities in your community, use the “Find a Provider” feature on the National Council’s website.
National Institute of Mental Health
This US government site gives a wealth of up-to-date information on depression and suicide in the form of downloadable booklets and fact sheets.
Postpartum Support International
Postpartum Support International’s (PSI’s) website receives more than 100,000 visitors a year who resource PSI for support, education, and local providers. PSI’s toll-free help line serves more than 1,000 callers a month and is staffed by a volunteer team of PSI-trained responders who rapidly refer callers to appropriate local resources, including emergency services. 800-944-4PPD (4773).
Two progressive relaxation tapes can be downloaded from the website of Hobart and William Smith Colleges in Geneva, New York.
Suicide Prevention Resource Center
The Suicide Prevention Resource Center has fact sheets on suicide by state and by population characteristics, as well as on many other subjects.
These two self-help books based on CBT for depression have been found effective in trials:
Burns, D. D. (1999). Feeling good: the new mood therapy (revised edition). Quill Publishers, New York, NY.
Lewinsohn, P. M., Munoz, R. A., Youngren, M. A., Zeiss, A. M. (1992) Control your depression (revised edition). Simon & Schuster, New York, NY.
Other books that may be useful:
Beiling, P. J. and Antony, M. M. (2003) Ending the depression cycle. New Harbinger Publicaions, Oakland, CA.
This is a depression relapse prevention workbook based on CBT principles.
Ellis, T. E. (1996) Choosing to live: how to defeat suicide through cognitive therapy. New Harbinger Publications, Oakland, CA.
This CBT-based self-help book focuses on learning thinking strategies for overcoming suicidal thoughts.
Greenburger, D., and Padesky, C. (1995) Mind over mood: change how you feel by changing how you think. Guilford Press, New York, NY.
This is a CBT-based self-help book for depression, anxiety, and interpersonal problems.
Knaus, W. J. (2012) The cognitive behavioral workbook for depression, second edition: a step-by-step program. New Harbinger Publications, Oakland, CA.
This CBT manual can be used alone or in conjunction with therapy. It also can be purchased as an eBook directly from the publisher (www.newharbinger.com).
American Psychiatric Association Answer Center
Live operators available 8:30 a.m. to 6 p.m., Eastern time, refer you to local board-certified psychiatrists.
American Psychological Association Public Education Line
Follow the automated instructions and press the number 1. Then an operator refers you to local board-certified psychologists.
National Suicide Prevention Lifeline
This hotline is available 24 hours a day. Phone calls are transferred to trained counselors in more than 130 sites nationwide. This service has a new feature for veterans. When veterans, their families, or friends call this number and press 1, they can talk to a trained, caring professional in a specialized veterans call center. Calls are free and confidential, 24 hours a day, 7 days a week. This feature of the hotline is a partnership between the Department of Veterans Affairs and the Substance Abuse and Mental Health Services Administration in the Department of Health and Human Services.
The Trevor Project
This is a free and confidential suicide prevention help line for gay and questioning youth that offers hope and someone to talk to 24 hours a day.
American Self-Help Group Clearinghouse
A keyword-searchable database of 1,100 national, international, model, and online self-help support groups, including many for depression. Also listed are self-help clearinghouses world-wide, research studies, information on starting face-to-face and online groups, and a registry for persons interested in starting national or international self-help groups.
Depression and Bipolar Support Alliance
On the homepage of this website, click on “Find Support.” You will be able to find out if a support group is meeting in your area. These are peer-led support groups.
National Alliance on Mental Illness
NAMI is a nonprofit, grassroots, self-help, support and advocacy organization of individuals with mental disorders and their families. This website provides many resources on mental disorders, including depression, that are helpful for people who have experienced a mental illness and their families, including support groups, education, and training. On the home page, click on “Find Support.”
On the home page, click on “Find a Meeting” to find the next Recovery International meeting in your area.
Recovery International, a Chicago-based self-help mental health organization, sponsors weekly group peer-led meetings in many communities, as well as telephone and Internet-based meetings.
For nonsuicidal self-injury
Focus Adolescent Services
This website is designed for parents and covers a wide range of mental health problems; it has a section on self-injury. Information and resources can be obtained weekdays only, 9 a.m. to 5 p.m. Eastern time, at 410-341-4216.
S.A.F.E. Alternatives (Self-Abuse Finally Ends)
S.A.F.E. Alternatives is a residential treatment program for people who engage in self-injury. The website includes information about self-injury an information about starting treatment.
S.A.F.E. information line: 1-800-DON’T CUT (366-8288)
Conterio, K. and Lader, W. (1999) Bodily harm: the breakthrough healing program for self-injurers. Hyperion, New York, NY.
Written by the directors of the S.A.F.E. Alternatives program, this book is suitable for people who engage in self-injury and their families and friends. It includes case studies and diaries of people in recovery, tools for removing barriers to care, and information about the treatments suitable for self-injury.
Kettewell, C. (1999) Skin game. St. Martin’s Press, Griffin, NY.
A memoir of self-injury. The author, an acclaimed author and journalist, engaged in a pattern of self-injury for many years, starting in early adolescence.
Levenkron, S. (1999) Cutting: understanding and overcoming self-mutilation. Norton Books, New York, NY.
This book is suitable for a range of audiences, including people who engage in self-injury, families and friends, and health professionals who wish to better understand the behavior. It explains that the psychological motivations for nonsuicidal self-injury, common risk factors, and benefits of treatment.
If you feel you or a loved one might be suffering from depression, contact us and we can help you get connected to resources in your area.
If you or a loved one are experiencing suicidal thoughts, call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
For more information and resources, visit tlaiorg.org. Reach out and ask for help; together, we are stomping out the stigma surrounding mental health.