A depressive disorder is a "whole-body" illness, involving your body, mood, and thoughts. It affects the way you eat and sleep, the way you feel about yourself, and the way you think about things. A depressive disorder is not a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help over 80% of those who suffer from depression. Bipolar depression includes periods of high or mania. Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Also, severity of symptoms varies with individuals.

Symptoms of Depression and Mania:

Depression:

• Persistent sad, anxious, or "empty" mood.
• Feelings of hopelessness, pessimism.
• Feelings of guilt, worthlessness, helplessness.
• Loss of interest or pleasure in hobbies and activities that you once enjoyed, including sex.
• Insomnia, early-morning awakening, or oversleeping.
• Appetite and/or weight loss or overeating and weight gain.
• Decreased energy. fatigue, being "slowed down"
• Thoughts of death or suicide, suicide attempts.
• Restlessness, irritability.
• Difficulty concentrating, remembering, making decisions.
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain.

Mania:

• Inappropriate elation
• Inappropriate irritability
• Severe insomnia
• Grandiose notions
• Increased talking
• Disconnected and racing thoughts
• Increased sexual desire
• Markedly increased energy
• Poor judgment
• Inappropriate social behavior
• Fatigue or loss of energy nearly every day

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Why is there suicidal tendencies when depressed?

Depression must be thought of as a potentially fatal illness. Depression can shut down the survival instinct or temporarily suppress it. Therefore, depressed suicidal thinking is not the same as the suicidal thinking of normal people who have reached a crisis point in their lives. Depressive suicides give less warning, need less time to plan, and are willing to attempt more painful and immediate means, such as jumping out of a moving car. They may also fight the impulse to suicide by compromising on self-injury -- cutting themselves with knives, for example, in an attempt to distract themselves from severe mental pain. Again, relatives and friends are likely to be astonished by how quickly such an impulse can appear and be acted upon. Nearly 80 percent of all depressed people contemplate suicide, and 20 percent to 40 percent of those attempt it.

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How can family and friends help the depressed person?

The depressed person needs diversion and company. But too many demands can increase feelings of failure. Do not accuse the depressed person of faking illness or laziness or expect him or her to "snap out of it." Eventually, with treatment, most depressed people do yet better. Keep that in mind, and keep reassuring the depressed person that with time and help, he or she will feel better.

The second most important thing is to offer emotional support. This involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully. Invite the depressed person for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused.

Depressed people often frustrate and alienate those around them. "Try not to take it personally," says San Francisco psychiatrist Michael Freeman, M.D. "They have an illness. They can't help it." Of course, that's often easier said than done. It's very difficult to control your temper when a close relative or friend never returns your calls, hardly gets out of bed, answers you in monosyllables, acts completely self-absorbed, seems to have no interest in you or doing anything you liked to do together, and doesn't keep dates or follow through on commitments. Get mad if you must, but then, get over it. Keep reminding yourself that the person is ill, and not responsible for his or her many failings.

If the person responds to you after a long period of silence and neglect, work hard not to be sarcastic: "So, after 121 phone calls, you finally call me back. Thanks a lot." Try to accept the contact as matter-of-factly as possible: "Oh, hello, Marcy. It's nice to hear from you. How are you feeling?"

Don't feel that you have to apologize to others for your depressed loved one's lack of sociability or responsibility. When mutual friends remark that the person never RSVP'ed for their anniversary party, simply explain that he or she has been seriously depressed, and that the illness has crippled the person's social skills.

Guard against falling victim to depression yourself. Don't get dragged into the emotional whirlpool that has sucked your loved one into an emotional abyss. "Stay involved with other people," Dr. Spielman urges. "Work at not becoming isolated." Solidify other family and social connections. Pursue hobbies and other interests. Have fun. Consider getting some counseling yourself.

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