Question: Hello, I am writing to you because I read a question that someone had asked you a few years ago which was similar to my situation but not exactly. My 26 yr old son lives with me now and suffers from severe depression which is getting worse all the time. Since high school he has entered school multiple times but never finished. He moved to a larger city for almost a year and seemed to be happier then, met a girl he really liked, decided to go back to school.... He was in a very high pressure and stressful program and in the semester before what would have been his last he fell apart. He dropped out, came home and that was nearly 2years ago. About 14 months ago he broke up with the girl, said it was too hard to keep a relationship going if he wasn't going back to school where she lived and that she wouldn't want to stay with a failure like himself. Since then he has sunk lower and lower. He constantly lives in his head which is not a happy place. He beats himself up over all the failed attempts in the last 8 years since high school. Last fall he got a job, minimum wage and I think it perked him up temporarily but he quit it 2months ago and has done nothing. He doesn't do drugs and drinks very minimally. He was very addicted to a video game as an escape from reality but the last weeks I haven't seen him playing it much. I begged him to take some classes at the local community college and he has been doing that for a month now. So that is the history briefly. He says the constant mental chatter never ceases and that he will never be able to meditate. He has no friends, except his best friend who lives away and is about to get married. He goes no where and does nothing except school now. His health is starting to be affected. He eats very little, usually 1 meal a day, if that. I am single and I do not have the funds to support him. I paid for his school with a credit card. I have been able to get him to go to the chiropractor for his back which I also pay for with credit card. He has done minimal counseling the first year he was home, but he doesn't believe there is any help out there for him. He is loosing hope and he has said to me many time that it isn't worth it, that there is no point. I'm a pretty upbeat person but this is getting really, really hard. My other son also suffers from depression he is only 21. He also entered college right out of high school and didn't make it through the first year. We did get him treatment which he kept up for about 8 months after that he stayed home for another year. He went back to school last year, nearly dropped out in the spring semester but stuck it out barely getting by. He is back there again and is on meds and seems to be doing ok. I just have stay in touch with him regularly and try to make sure he's alright. Honestly, this almost sounds like a plea for help for myself, but if my kids are doing well then I can easily get on top of the world. I just don't know what to do for my oldest son that is at home now. He feels he's wasted the past 8 years and just can't get out of that place and he won't seek help. He has no joy, no goals, no interests and has virtually cut himself off from all emotion. He is basically shutting down. This situation would be a tragedy for any young person, but it is even more so for him because he is brilliant, an extremely intelligent and very handsome young man. I have to say that where we live I'm not sure we have access to quality mental health care anyway, but I would find the means somehow to pay for it if he were willing to get help.

Rev. Christopher Smith Says...:

When your children are suffering, it is something that a caring parent does not like to see. Parents like the person asking this question can be defensive and realize that it is sounding like it is about them and not their children. This may in fact be the most appropriate place to start. If the young adults were engaged in addictive behaviors, the actions described might be seen as codependent. Being able to truly address these situations as the children's situations and to keep responsibilities where they belong is the first component of a healthy response. As a parent, you have to be healthy yourself and be coming from a good emotional place to be providing the best responses possible.

Having said that, it is important also to have a good evaluation as the starting place to getting help and for the child to believe that help can actually make a difference. While this can only really be done by someone local who can do this in person, there are some things in the description of the oldest son's experience that I would want to know more about to ensure that we were going down the right path and optimizing the chance for him to find a way back to wholeness and peace. I would want to know more about the "constant mental chatter". I would want to know more about his historic goals. What supports have helped matters in the past? This gives more direction.

Depending on what is going on for the young adult, things that seem positive may in fact not be. If there was a lot wrapped up in prior attendance in a quality four-year school and being almost done may mean that there are greater negative impacts to being back in community college than the positives that are initially thought of (especially until work is done that helps to guide a particular direction and helps to begin to heal older wounds). Also, what supports have been accessed for the fact that serious mental illness with these impacts would certainly meet the criteria for being a disability.

Question: What can you do when your friend is depressed and they tell you they don’t want you to call or come over anymore? Do you just ignore their wishes and go over anyway or is it better to respect their wishes because seeing friends makes them feel worse?

Rev. Christopher Smith Says...:

It is natural to want to support a friend when they are depressed. It is also natural to try and support that friend in the same way that you would want to be supported. The real challenge is to work out what you can do that will be helpful for that friend as well as be percieved by your friend as supportive.

There is no single correct answer about what to do if your friend states that they don't want you to call or come over any more. The specifics of the situation are really important. Let's look at a few exmples.

If the depressed friend has a history of periods of severe depression, that friend may have already realized that they need social contact to help them heal emotionally but also will know that this is something that will be rejected when they are depressed. In this case, the friend may already have spoken with you to indicate that no matter what they say that they hope you will continue to engage them. If something like this is the case, then ontinuing to engage woudl actually be respecting their wishes and not continuing would be respecting the depression rather than the friend's wishes.

If on the other hand, the trigger for this particular depressive episode is related to something that the depressed friend feels ashamed of and that this occurred in connection to you, then the depressed friend may need time away from you to process what took place before they can engage with you. If you are engaging too early, this may actually not help your friend and in fact reverse any progress that they have made. In this case, you might want to respect their wishes for you to give them some space and support other friends that are still able to visit.

Another possibility is that the depressed friend is not finding the contact to be supportive. In this case, the depressed friend does not necesarily want to stop you from visiting or making contact, but simply desires that this be conducted in a different way. This is where it is important to understand what is actually seen as support. The answer to this is certainly different from person to person but it can also vary for a particular person from time to time. This is a delicate area to consider. You have to be willing to be very honest with yourself and truly look at the situation through the depressed friend's glasses. Sometimes other mutual friends can be helpful when you are considering this.

In addition to these kinds of considerations, there are other factors that you shoudl consider. Is your depressed friend getting professional help? How long has the depression lasted and is this appropriate for an event that took place? (For example, if their spouse just died two weeks ago, depression is a normal response.) Is your friend at risk because of their depression - this could be in terms of suicide or just self harm from neglect? Does the depressed friend have other supports? Are there other ways to be supportive (truly supportive) that respect the limits the depressed friend has instituted?

The good news is that while this is a difficult decision, if you do think through it carefully, it is possible to come to a conclusion that will determine how to proceed. As you do proceed, you will be considering the situation from the depressed friend's viewpoint, truly respecting them and preserving their human dignity in the situation. As you do this, it is possible to work out what to do so that both you and your frined are able to be on a path towards wholeness and peace.

Question: Hi! I'm 16 and I think I have been struggling with anxiety and depression for the last two years but I never told any one about it (whenever I tried my mum said it was because of "hormones" and my friends and people overall think it's just my personality) because I'm not exactly sure or even know what's wrong with me. Anyway I would like your opinion on it. When I was 14 I had no friends and I was very shy, also because my parents fight a lot I would just be sad all the time, I cried a lot but acted normal and I guess that no one really noticed that something was wrong enough. Then when I was 15 things got better about the shyness, I made friends and guess I became happier, still I had a very negative image of myself ( I tought that I was very ugly and I was disgusted with myself, and used as an excuse for my lack of friends). This Summer I overcame this problem as I started to be more optimistic and focus in positive thoughts and exercising. Now even though I feel beautiful I still have a hard time talking with people that I don't feel comfortable with (everyone beside my friends and relatives) as I just can't avoid feeling judged and like I'm not good enough or interesting enough as a person. Still this isn't the worse and it's relatively easy to deal with. What concerns me the most is that I'm very moody and anxious. I'm usually a happy, bubbly and nice person during like two weeks then during 2/3 days I feel awful, cranky, sad, annoyed, almost physically sick and I just have this horrible feeling like I'm in a black hole and like there's no hope, then I'm normal for like two weeks again. I know this sounds and is silly but I can't avoid it when it happens. I'm also anxious about lots of things, I try to distract my self but I still feel anxious, sometimes I even feel my heart beat fast inside my body. I just know that this isn't normal and because during the summer I've been normal with out any of these symptoms for like a month. Recently I've been diagnosed with polycystic ovarian syndrome and I read some studies that show it might be connected to depression and anxiety so maybe if I treat it this will go away? But my mum doesn't even let me take the contraceptive pill (which should control it)! I know that this is 2 much but what do you think my problem and is and what should I do? I'm confused.

Rev. Christopher Smith Says...:

In order to be able to o any sort of diagnosis, a mental health professional would need to meet with you, inlcuding exploring things that have happened before now. With thatbeing said, let me share a few things that might be helpful that are more general. However, let me stress again that you should probably sek a local person to see to help get your particular answers.

Normal adolescence can feel like a roller coaster emotionally. You are learning to handle things that you will have to face thoughout your life and the way you are encountering them is challenging and can certain promp worry and sadness. It is also true that in later adolescence pople are increasingly likely to have the first episode of certain serious mental illnesses. This is a reason to seek professional help to distinguish between these two options. When the swings are more dramatic or when responses are too extreme, there is a greater chance that something else is going on. The good news though is that there is hope for those who get appropriate help.

Another aspect that adolescents have to deal with is working out how they relate to other people. Developing their own identity and being able to value what they do is important. Unfortunately, the path for this is not without its own bumps. It is natural to not know how other people are reacting and so to wonder whether someone actually likes you. One of the questions to ask around this is whether your worries are stoppng you from doing what you need to do in life.

The initial question also highlights that some metnal health syptoms actually come from other illnesses. A good counselor/therapist would help screen for these possibilities. Of course, there is also the possibility that only part of the symptoms are being caused by the other illness and what you are experiencing is actually from both the other illness and a mental illness.

Your questions are good ones and show that you are willing to explore what is going on with you. This is a good sign that you will be able to find a path that leads to you experiencing wholeness and peace. Whatever is going on, you might find it helpful to speak with a counselor/therapist and have someone to talk to that is not already involved in your life. This is the case whether you are experiencnig normal adolescent challenges or something that is more serious.

Question: My dad is a life long heavy drinker and smoker. 6 weeks ago he had a heart attack and emergency bypass surgery. Now he’s on a bunch of medications. He didn’t even know he had heart disease but apprantly his blood pressure was through the roof. He hasn’t had a drink or a smoke since the heart attack, which is incredible for him. But he is so changed that I am worried about him. He used to be very vital and funny and now he is like the opposite. He just goes to work and then goes home and sits in front of the TV. He seems depressed but I am not sure what to do. My questions are: Is it still normal for him to be depressed this long after his heart attack and surgery? Would quitting alcohol after drinking every day for a lifetime cause depression? He is on statins and beta blockers. Should he talk to his doctor about his depression to see if the medications might be causing it or is it still too soon for this? I understand that you can only give very general responses, but I’d appreciate having a starting point to know what to do or to know if I should just wait a bit longer.

Rev. Christopher Smith Says...:

When a person is made to face their own mortality, a lot of other things can happen for the person. This type of experience can result in spiritual yearning and discernment. This type of experience can lead some people to be more engaged in life trying to get as much as they can out of life while other people can be overcome by fear in the realization that their life could have been over. In either case, and in your case your dad seems to have been more in the latter category, there is hope and with appropriate support and guidance a person can come back to a new sense of health and wholeness.

Having considered the fact that the depression could be coming from your dad's response to the critical event he went through, there are other possibilities as well. Alcohol withdrawal (the acute stage of which he could be past) can include depressive symptoms and these can also occur when a person is facing the consequences of their former life with alcohol. It is also possible that new medications (or combinations of medications) could have depression as a side effect. The fact that you (and possibly he) are concerned is a good indicator that you should raise these questions with his physician. I f he is not seeing a counselor, this would also be a good idea as that source of support would be helpful in this situation. Also a local counselor who can assess him in person will be better equipped to determine how concerning his situation is and what might actually be contributing to his depressive symptoms.

Question: My sister is clearly depressed. She lost her job 18 months ago and has spiraled from a high energy person to a person that sleeps the day away so she won’t have to face it. I could list a thousand examples of the differences from then and now but there is no way there isn’t something seriously wrong. What is so frustrating is that she won’t admit it and she won’t do anything about it and when I try to bring up the subject now she closes up right away and it is like I am talking to a wall and so I end up listing all these reasons why I think she is depressed and it feels like I am in a courtroom putting her on trial for not being good enough. How do I convince her to get help without making her feel worse about herself than she already does and when by now, she doesn’t even want to talk to me anymore because she knows I keep nagging her about getting help.

Rev. Christopher Smith Says...:

When someone you love is struggling with depression, it can be really frustrating. They have changed from the person that you knew into someone who is behaving in ways that they never would have previously. This is the case whether or not the depression has triggering events that you can point to. As much as you want them to get help, they also need you to be providing a supportive environment. This can be a difficult balance to maintain.

It is important for you to be able to find things to acknowledge that are positives in your loved one's life. On the surface, you may feel that their whole life is being affected in negative ways by their depression. The reality is that depression can be pervasive through many dimensions of a person's life. However, if you pay attention, you can often fin some things that you can affirm. In the areas that you cannot affirm, rather then simply talking about those areas, see if there is a way that you can assist the person to begin moving to a more positive place. For example, rather than complaining about how they never cook good meals, offer to come over and cook supper with them. Not only will this help in the preparation of a meal, there will also be some social interaction. When you prepare the meal, you may also prepare several extra servings that you can help your loved one refrigerate or freeze so they can eat them later. As you move alongside your loved one, you are able to help them to address areas that need to be addressed and will be considered more of an ally rather than a prosecuting attorney. As you do this, it is also important to not enable them to continue to engage in unhealthy behaviors because you are simply stepping in and taking over making their involvement unnecessary. This is a careful line to try and walk.

As you reestablish yourself as an ally with your loved one, this will then make them more receptive to your suggestion that they seek professional help. Especially if you live together, but always possible, you can also suggest getting help for you as a family unit. There are family therapists that will work with adult siblings. As the therapist works with the two of you, you will probably find your actions being challenged and changed as well as the focus will not be just on your loved one. However, in the midst of family therapy, your loved one will begin to get help and may be open to further intervention when it is raised by the therapist.

One final cautionary note is important. If your loved one is or becomes a danger to themselves or others then it is critical that you act right away. If your loved one is expressing suicidal thoughts or even an intent to commit suicide, then you need to find a way to get your loved one to a mental health professional or to the local emergency room for an evaluation. If you are not able to get them to go, then you need to discover what the processes are in your locale to force intervention (in some locales this is as simple as calling the police whereas other locations are more complicated and involve working first with a particular agency). If your loved one is already upset with you, they are likely to be even more upset when you do this, however their life may require you to act in a way that will make them upset with you.

As you move through these ideas and use these types of resources, it is possible to make a difference not only in the condition of your loved one but also in your relationship. As you do this, you and your loved one will be able to find peace and wholeness.

Question: Is the modern lifestyle causing more people to get depressed than in decades of the past? Do you think as many people were depressed 100 years ago as are depressed today?

Rev. Christopher Smith Says...:

There are many different types of "getting depressed" that will yield different answers as to whether it is more prominent today than in the past.

The first distinction that should be made is between actual rates of depression and diagnosed rates of depression. It is certainly true that people are more likely to be diagnosed with depression in the present era than was the case a hundred years ago. Some of this is due to changes in society, some of this is due to changes in medical training and some of this is due to changes in ranges of treatment. Today, there are few asylums or asylum-like institutions. This was not the case a hundred years ago. There have been great advances in terms of the different treatments that are available and thus the likelihood of being diagnosed has also increased.

Similar to the above is a change in the stigma around depression and also around counseling. There is still great variability among different subgroups within our culture - for example the Asian-American community still has a high degree of stigma towards getting any type of mental health care whereas in the some communities of better off Americans there is almost a stigma about not being in therapy.

While these differences may well contribute to a higher rate of diagnosed clinical depression, this does not indicate anything about changes in the underlying rate of depression. Determining this is much more difficult, for euphemisms and all sorts of other references were used to describe problems in the past and even these may have been covered up in the writing of history.

Beyond the biologically based depression, there is also experienced sadness related to events surrounding a person. By its nature, this will be very cyclical. For example, when the economic market experienced a downturn, many people will find their life situation to be adversely affected. This in turn can lead to depression. Economic forces, and the stressors they put on people's lives have certainly been a factor in people seeking help presently, but depression linked to their situations was also felt by people in the 1930s. During great crashes in that era, there were people who were so effected that they jumped out of their windows to their death. If you modulate for the current world situation, can you see trends in the rates of depression based on environmental situations? This is hard to judge.

As you look for peace and wholeness in your world, I would suggest that you should not only be asking whether people are getting more depressed now than in the past, but how we are now dealing with it compared to the past. In this answer, I think you will find hope. Also, even if there is a higher degree of awareness about depression, this means that there is the possibility of getting help sooner and more effectively. These are trends that bring promise for improvement.

Question: I was bitten pretty badly by a German Sheppard when I was 11. I could have been killed but the owner of the dog saved me in time. Ever since then my fear of dogs has gotten worse and worse. Now I am 26 and I can’t even go to the park because there could be dogs there. Even watching a dog show on TV is difficult and unpleasant. If I want to get past my fear is exposure therapy the best choice? How long would it typically take for me to see some results? Do I need to find a person who specializes in this type of therapy or would any therapist feel comfortable with this type of thing?

Rev. Christopher Smith Says...:

It is impossible to address your particular situation without fully assessing your background , but there are some general points that can be helpful when looking at your situation.

Addressing fears and its associated anxiety can be done in more than one way. Exposure therapy is a strong option to be pursued when there are strong fears, similar to the type you describe. The idea behind exposure therapy is to provide you with a series of experiences, each of which is faced with the supportive presence of a therapist, that gradually work you up to being able to face the situation that is most distressing for you. Generally, the steps between exposures needs to be small enough to enable the client to be able to make the progression. As a result, a person going through exposure therapy should be able to see some results fairly quickly even if fuller and more significant result take a longer period of time to obtain.

In looking for a therapist, it is important to know that therapists only work within the area that they have appropriate training and experience. As such, not all therapists will be qualified to offer exposure therapy and even not all therapists will be involved in the treatments of fears. In addition to the base competence issues, there are some additional complications that arise in connection with exposure therapy. While some parts of the treatment may be done during an office visit, there are portions of the treatment that will not be able to be completed in the office and requires working in the field. There are some therapists who do not feel comfortable doing this as well as other therapists who are concerned about other aspects (liability, ability to bill insurance, for example) related to providing exposure therapy. As a result, if this is the form of therapy that you decide to pursue, it would be important to ask about this when you are first calling a potential therapist.

Question: I am feeling a little bit down for no reason and this has been going on for about 2 weeks. The odd thing is I am all of a sudden sleeping like 10 or 11 hours a day and dragging myself out of bed even then. I am normally totally rested after about 7. Does this sound like depression. I am a little depressed but I would not have said it was serious enough to count as depression.

Rev. Christopher Smith Says...:

Depression takes on many forms and has a range of symptoms that can be associated with it. Many people focus on the idea that depression is sadness but there are different degrees of this (including some diagnoses that do not include depression in them) and other symptoms that can be associated with depression (especially at different ages). When someone describes a drastic increase in sleep, not feeling rested even after sufficient amount of rest and difficulty starting new days, there are certainly signs that indicate that depression should be considered. The best way to determine whether these things combined with some sadness is depression is to get an evaluation from a qualified mental health professional who can explore things with you and help determine what is going on as well as find ways that will help to return you to health and wholeness.

On the other hand, things that seem to be presenting as depression are not always depression. There are other illnesses (such as thyroid problems) that can also have symptoms that are very similar to depression. Similarly, the symptoms you describe would be normal during the acute stages of grief. These are one of the reasons that it is important to work with a qualified mental health professional to help you determine what is actually going on.