If you want to know what the face of a person who experiences depression looks like just take a second, look up, and observe the faces of the people around you. Better yet, look in the mirror because like it or not, depression is an equal opportunity invader.

According to the World Health Organization, depression is the leading cause of disability for both males and females worldwide.  The impacts of depression on our society are catastrophic, but unless you are directly impacted, you may not be aware. Depression is also the catalyst for many other life issues such as alcohol and drug abuse, job loss, and family stressors.

At the crisis point, depression can lead to suicide. In 2016, there were almost 50,000 suicides recorded in the US by the Centers for Disease Control and Prevention.  This is sadly the same number of people that it takes on a Saturday to fill the football stadium of my alma mater. In addition, for every person who completes a suicide, it is estimated that another 20 may attempt to end his or her life.

While these statics are enough to throw us all into a depressive state, when recognized and properly treated the outcomes for depression are very good. In the last few decades, large developments have been achieved in our understanding of the diagnosis and treatment of depression. Coupled with better scientific understanding of the brain, great advances have been made in both psychotherapy approaches and improved pharmaceutical options.

So, what causes depression? There are many things that can lead to a depressive episode such as genetics, environment, situations and stress. Having a family history of depression attributes to approximately 40 percent of depressive episodes, therefore, it is important to know your family history and share that with your doctor.  For example, someone who has a family history of depression and then has the situational stress of a new baby is at a greater risk for post partum depression.

Family environmental stressors can lead to depression in children as well as impact us later in adulthood such as the case of Adverse Childhood Experiences. Life situations such as job loss, separation, divorce and death can lead to depressive episodes. Moreover, living under increased levels of stress for long periods of time can lead to depression. This type of pervasive stress can eat away at the chemicals in our brain that regulate moods.

The field of public health loves an acronym! The average American can spout out a few health acronyms such as F.A.S.T.  (Facial drooping, Arm weakness. Speech difficulties, Time) used to recognize the onset of a stroke. These acronyms work great for health conditions that have warning signs that are visually apparent. However, defining depression is very complex since this disorder is sly and sneaky like a fox, fooling the most unsuspecting and educated person.

It sure fooled me! I mean come on…I know about depression. I grew up with mental illness and depression all around me. In addition, I am a trained mental health provider with a magic therapy chair to protect me. Right? Apparently not, because no one, including myself, is immune to the dark abyss of depression. While depression can be complex, I will use the acronym R.I.S.E. to help us with our understanding of depression.


Feeling down depressed or hopeless

Feeling worthless or guilty

Feeling irritable/on edge most of the time

Loss of interest in doing things

Sleeping too much or too little

Unusual level of fatigue and lack of energy

Changes in appetite

Difficulty concentrating

Thoughts that you would be better off dead

These are the “classic” signs of depression. To diagnose major depressive disorder healthcare providers would  look for 5 or more of these symptoms lasting greater than two weeks.  HOWEVER and I mean a BIG however, remember that since depression is sly and sneaky symptoms can manifest in many ways depending on the person. For example, depression in men or teenage boys often presents with anger since that is a more socially acceptable emotion for men than sadness.

It is also estimated that up to one third of those who experience depression experience more symptoms of irritability, distractibility, and anxiety. Depression doesn’t always fit into the nice little box that we have created for it. If you or someone you are concerned about has experienced marked changes in their emotional state it is worth exploring the cause for changes.


If you suspect depression in yourself or someone you care about make an appointment with your primary care doctor. This is the ideal place to start because there are many health issues that can cause depressive symptoms that should first be ruled out.

If your doctor gives you a diagnosis of depression and prescribes medication also ask for a referral to a therapist. While medication can be helpful with addressing the symptoms of depression, working with a trained mental health provider can assist you with uncovering the root of your depression. In addition, you will create lifelong coping skills to help you better manage the ups and downs along the journey.

I often see patients who do not have an established relationship with a primary care doctor. If this is your situation, don’t let this be an excuse or barrier to starting treatment. Begin by going to a walk in urgent care facility. They should be able to steer you in the right direction until you get established with a primary care doctor. If you have medical insurance you can contact your insurance company to find physicians and therapists in your area who accept your insurance coverage.

Once treatment has begun, be patient with yourself or family member in treatment. Depression is diagnosed on a spectrum using the labels of mild, moderate, and severe. The amount of time needed to resolve symptoms will vary based on the severity of symptoms and other individual variables. If things seem to not be moving forward at all, share your frustrations with your doctor and therapist. Honest communication with providers is essential for the best treatment outcomes for depression.


Many people recognize they are depressed but press on and do not seek treatment because “only weak people get depressed”. Depression is a physical disease just as much as cancer. Statements such as “People should just focus on what is going well and try to be happy about that” just add salt to the wound of a person swimming upstream against the currents of depression. There is nothing that a person experiencing depression would like to do more than to feel some joy!

Whether you have experienced depression or not, help stamp out stigma by speaking up when people say unhelpful statements. We would never ask someone with diabetes to just give their pancreas a pep talk and not seek medical help!


Realizing that we are all at risk for depression is a great first step. Continue to educate yourself and others on how to best manage mental wellness (sharing this blog is a great place to start!).

As mentioned above, environmental and stress contributes to a large portion of depressive episodes. Take some time to evaluate your lifestyle and see what you can do to lessen stress and add more peace in your life. Even just small adjustments can make a huge impact. If you know you need to make changes, but do not know where to start, this is a great time to work with a mental health provider who can assist you with these changes.

While not all episodes of depression can be prevented, when recognized and treated early, the impacts on the individual and family are far less. So be vigilant, speak up if you are struggling and don’t be afraid to ask a friend or family member about how they are really feeling.

Imagine if we were able to fill that college football stadium with all the people whose lives are saved rather than lost due to the impacts of depression. The dream of reducing the impacts of depression begins with early recognition and treatment. We can all be a part of the solution to R.I.S.E. against depression.

As always, until next time may you be well, may you be loved, and may you know true peace.

Read more about Melissa C. Harrell and her work. Like Resiliency Counseling and Consulting, PLLC

The purpose of this blog is to offer educational information related to mental wellness. Resiliency Counseling & Consulting, PLLC and Melissa Harrell do not offer diagnosis or treatment through this medium. If you feel that you or a family member needs to access mental health services, first contact your primary care physician for assessment and direction in your area. If you need immediate help, please contact the National Suicide Prevention Lifeline at 1-800-273-8255.







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