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This story discusses suicide. If you are looking for help or know someone in crisis, please call the National Suicide Prevention hotline at 1-800-273-8255.
To the outside world, fashion designer Kate Spade seemed to have a charmed life that she worked hard to create. Yet behind closed doors, "...there were personal demons she was battling," her husband, Andy Spade, said in a recent statement following the designer's death by suicide on June 5 at 55.
"She was actively seeking help for depression and anxiety ... seeing a doctor on a regular basis and taking medication for both depression and anxiety," Spade said, stressing that her death was a "complete shock."
The world is waking up to another shocking headline today: Anthony Bourdain, the popular chef and television personality, has died by apparent suicide at age 61.
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Depression is the leading risk factor for suicide. It's also the leading cause of ill health and disability worldwide, according to the World Health Organization, with more than 300 million people suffering from the disease.
Rates of depression are on the rise among Americans from all age groups, but a lack of support for mental health issues combined with a common fear of stigma means many do not get the treatment they need to live healthy, productive lives.
For someone living with depression, being able to talk to a loved one or someone they trust is a first step to finding treatment and recovering. Depression increases the risk of several major diseases and disorders including addiction, suicidal behavior, diabetes and heart disease, which are themselves among the world's biggest killers.
And if you are concerned about a loved one, it's important to express your concern.
"Some people have the misconception that asking a person about suicide will increase the risk, but, in reality, asking doesn't increase the risk of suicide, but can save a life," said Dr. Jeffrey Borenstein, president and CEO of Brain & Behavior Research Foundation.
Some people with depression may experience very severe symptoms, and seek help. Others may have such subtle symptoms they don’t think depression is the problem. People with smiling depression may be able to put on a show in public, at work and even at home with their families, even though they're suffering on the inside.
Alarmingly, if a person is exhibiting a sudden sense of calm and happiness after being extremely depressed, it could mean he has made a decision to attempt suicide, according to Helpguide.org.
Like the classic signs of depression — persistent low mood and loss of pleasure — these more subtle symptoms can also affect “ ... how well a person is doing and how well a person is functioning,” said Dr. John Zajecka, professor of psychiatry at Rush University Medical Center.
A common misconception is that people need to be weepy and sad in order to be diagnosed with depression, Zajecka said. But some people may feel numb or angry, instead of hopeless.
Although “... one symptom does not a diagnosis make,” there are some subtle clues to depression that people should be aware of, especially if they persist, said Dr. Holly A. Swartz, professor of psychiatry at the University of Pittsburgh School of Medicine.
1. You noticed changes in sleep.
Maybe you used to be a person who used to sleep soundly. Now you don’t. Maybe you always functioned well with 6 hours of sleep per night. Now you find yourself sleeping the weekend away.
Changes in sleep patterns could indicate depression, Swartz said. “Sleep makes people function well, so the real problem is that for a depressed person, sleep isn’t restorative, and they aren’t refreshed or rejuvenated.”
People may also experience what’s called “psychomotor agitation,” which can cause restlessness and an inability to get comfortable, said Dr. Joseph Calabrese, a professor of psychiatry and director of the Mood Disorders Program at University Hospitals Cleveland Medical Center.
2. Your mind seems muddled.
“One of the things people really need to be mindful of is how well they are functioning cognitively,” Zajecka said. “Sometimes people can’t sit down for 30 minutes and watch TV or read or do anything that requires some focus.”
Other subtle signs of depression may include a kind of “slowness of thinking,” forgetfulness and difficulty in making decisions, he adds.
3. You worry too much and think too much.
The clinical name for excessive worry and over-thinking life situations or events is called “rumination.” Rumination can increase the chance of becoming depressed and make episodes of depression last longer.
“With rumination, people basically get caught in a loop of replaying negative situations or looking at neutral situations in a negative way or over-analyzing things,” Zajecka said.
Some research shows the “ruminators” among us do seek social support. But eventually that support lessens.
“A little self-reflection is good, but with rumination someone can become very self-absorbed and they talk about the same things over and over again, which becomes tough on the people around them,” Zajecka said. Those people may turn away, which can cause more rumination, depression and feelings of low self-worth and low self-esteem.
4. Your weight has changed.
Weight changes can be a warning sign of depression. Some people may start to eat too much. Others may lose interest in food.
These changes in your eating patterns may be accompanied by fatigue and a loss of pleasure. “Most people enjoy a good meal, and those who are depressed lose energy and interest, even in eating,” Calabrese said. Or they may overcompensate and just eat too much.
Overeating or loss of interest in food may have little to do with hunger since depression can affect chemicals or parts of the brain linked to both pleasure and appetite control.
5. You’re not as engaged or expressive.
If you notice that someone who was previously social and engaged with family, friends, work or the community but now “pulls back” from usual activities there’s a chance that person may be depressed, Swartz said.
Social withdrawal and isolation are indeed hallmark symptoms of depression. But another symptom to look out for is a “flat” or “blunted” affect, basically a decrease in emotional expression. You can even see it in a person’s face since facial muscles are less active, she added.
6. You hurt a lot.
Depression does hurt and may be the cause of many unexplained physical problems, including headaches, digestive issues and back pain, among others. “The pain is very real and some people may only see their doctors for vague physical pains and never get a diagnosis of depression when that’s the real problem,” Zajecka said.
Pain and depression share some of the same brain chemicals. These chemicals travel along specific nerve pathways. The end result is that depression can change how sensitive the brain is to pain, he added.
Depression and heart disease also go hand-in-hand. Research shows those with depression and heart disease are at greater risk of death. And depression, like high blood pressure and high cholesterol, is actually a risk factor for heart disease.
It can be treated:
If you have any concerns that you may be suffering from depression, or if any of these symptoms describe you, talk to your doctor. The good news: If you have depression, it can be treated.
Depression is generally treated with medication, psychotherapy (talk therapy) or a combination of both. “Depression is very common and there is good help,” Zajecka said. “A person doesn’t need to suffer. They really aren’t alone.”
This updated story was first published in 2016.