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A Simple Self-Assessment Can Detect Early Signs

by Frederic Flach, M.D., K.H.S.

Recognizing the early signs of clinical depression is usually something that you have to do for yourself. People are reluctant to confront others with the possibility that they may be experiencing a depression--even many physicians dealing with their patients may hesitate to say anything.

On the surface, it sounds innocent enough, a helpful suggestion, reaching out to someone you care about to help him or her take that first step toward getting better. Would that it were that easy. Here's the risk: that saying "you could be depressed" can frequently be heard as "you're really weak" or "you are out of your mind." Does this sound absurd? Maybe, but recent surveys still show that more than half the American population regards depression as a weakness of character or a serious mental illness.

The other reason that we hesitate to call someone's attention to depression is that the signs and symptoms are emotions and behaviors that we have ourselves. To identify your depression, I first must be willing to admit to it in myself.

You may be having trouble sleeping. You may be extremely sensitive and easily hurt. You may be feeling overwhelmed by worry and see no solutions to your predicaments. But before I can be comfortable in connecting these distresses together into the full picture of depression and pointing it out to you, I have to be prepared to acknowledge my own vulnerability.

This is one reason why someone who has been successfully treated for depression is in the strongest position to reach out to you, if he or she can put aside the stigma that still surrounds needing psychiatric therapy.

Recovered individuals have another important asset: when they say to you they understand what you are going through, they mean it and you know they mean it. It's called empathy, the ability of one person to truly know what another is experiencing. And whether empathy is found in a family member, a friend, a doctor or a counselor, it has a remarkable power to heal.

But for the moment, you are largely on your own. It's a little like a woman examining herself to be sure she doesn't have a suspicious lump that warrants further investigation. It's like sitting in the waiting room and filling out the health questionnaire your doctor's receptionist has given you, so that he or she can scan your answers and identify possible trouble spots before actually examining you.

Fortunately, this self-appraisal is quite straightforward. All it requires is a little self-discipline and a splash of honesty. Answer these questions with a YES and you should seriously consider talking with your primary care physician, or a psychiatrist, or a mental health professional to find out more.

- Do you feel sad, down, dejected, dismayed?

- Have these blue feelings been hanging around for weeks or more?

- Are you having trouble sleeping? Do you wake up early in the morning, feeling just awful and unable to get back to sleep?

- Has this insomnia been going on for more than a few weeks?

- Has your appetite been poor for a while and have you lost 10 or 15 pounds in a few weeks without even trying?

- Have you gained 15-20 pounds or more over the past weeks because you're the kind of person who eats anything in sight when you are unhappy?

- Has your sexual drive diminished, if it's there at all?

- Do you have a hard time concentrating?

- Do you have a hard time making decisions?

- Do you have a negative outlook? Here consider the whole range of pessimistic thoughts, from total hopelessness to the more subtle tendency to assume whatever is going to happen won't turn out right.

- Are you a little bit afraid most of the time? Or very afraid without apparent cause?

- Have your relationships with those around you, at home or work, deteriorated? Do you find yourself irritable, short-tempered, getting into arguments? Do you feel rejected?

- Have you begun to avoid social contacts? Have you started to let your phone ring until the answering machine picks up the message, after which you do not return calls even to the best of friends?

- Do you put things off, including answering these questions?

The more yeses, the more suspicious you should be that you are depressed. AND THIS IS A GOOD THING, NOT A BAD THING. Now something can be done to help you feel better and prevent you from wrecking your life and bringing pain to those who love you. Next stop: your doctor (who hopefully is up-to-date), your clergyman (who hopefully has the prerequisite knowledge and perspective), a very-well-recommended psychiatrist, or a very-well- recommended mental health professional.

A final footnote: Depression isn't always subtle. It can hit some people like a ten-ton tank, leading them to be utterly hopeless, demoralized, considering suicide as a way out. It can also disguise itself in the form of physical complaints--a wide variety of symptoms like headaches, fatigue, intestinal upsets, and the like, that defy medical diagnosis. And getting medical help for depression isn't just a luxury. Untreated depression can lead to a host of physical disabilities and significantly shorten your life span.


Frederic Flach, M.D., K.H.S., is an internationally recognized psychiatrist and author whose highly acclaimed books include THE SECRET STRENGTH OF DEPRESSION; PUTTING THE PIECES TOGETHER AGAIN; A NEW MARRIAGE, A NEW LIFE; RESILIENCE; THE SECRET STRENGTH OF ANGELS; and FAITH, HEALING, AND MIRACLES. In 1996 he was awarded the Maxine Mason award by the National Alliance for the Mentally Ill (NAMI). He has appeared on numerous radio and television programs across the country, including Today, Good Morning America, CBS This Morning, Good Day New York, and Donahue.

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