depression interview essay

• It's Not Just You

Allie Brosh on Her New Book and the Trouble With Solutions

( SUBSCRIBE here to have It’s Not Just You, a new newsletter by Susanna Schrobsdorff, TIME Editor at Large, delivered to your inbox weekly. A version of this article appeared in this week’s It’s Not Just You.)

🌞 Well hello! I’m so glad you’re here. We have an interview with the fierce and funny author and artist, Allie Brosh , plus advice on recognizing if someone you love is struggling with depression even if they’re not physically near you, and dogs, lots of dogs.

ALLIE BROSH AND THE TROUBLE WITH SOLUTIONS

This week, instead of an essay I wanted to share the art and words of Allie Brosh , author of the brilliant graphic memoirs, Hyperbole and a Half , and her most recent bestseller, Solutions and Other Problems .

We’re entering a particularly isolating and daunting winter for those already struggling with mental health issues, so I thought it would be soul-edifying to hear from Allie, who’s been so open and wise about all the hard stuff—depression, anxiety, and loneliness. For those who don’t know her comedic stories, Allie draws herself as a little creature with froggy eyes and a flying yellow ponytail. And she describes the tone of Solutions and Other Problems , as:

A wildlife documentary about one really weird animal, which was written and directed by the animal.

Hyperbole and a Half , Allie’s first book, came out seven years ago and inspired a million memes. Between then and now, she basically disappeared from the Internet, leaving her fans worried and longing for her return. In that time, she navigated the loss of her younger sister Kaiti to suicide, the end of a marriage, and serious medical issues.

It’s all in Solutions and Other Problems, along with goofy tales of childhood and hilarious takes on modern inanities including tyrannical and invasive smart devices like a car stereo that “will not stop until it is certain that I am adequately interacted with and all my needs have been met, forcibly if necessary.”

In a section called “The Serious Part,” Allie writes about her family after her sister died. And because I’m also someone who lost a sibling to suicide, I can say that Allie’s words about how complex this kind of grief can be are as real and true as any I’ve read.

She writes of her sister: We’d always had a strange relationship and I wasn’t prepared for it to be over. I don’t think either of us understood how much I loved her. It seemed like there’d be enough time to sort it out. But we’ll never get to sort it out. And I’ll never get to say sorry. And I’ll never know why.”

🌺 THE INTERVIEW

Here’s Allie’s take on everything from self-help culture to things about severe depression that might surprise you if you haven’t experienced it, and why solutions are often the start of problems.

Susanna Schrobsdorff: Solutions and Other Problems is a genius title—what does it mean to you?

Allie Brosh : So, you know that thing where you have a problem, and in trying to solve the problem you generate a brand new type of problem? It’s sort of about that. How the solutions themselves become the next generation of problems. Because no solution is perfect.

You had a chapter about trying to practice loving-kindness, joking that you’d always thought you’d be one of the greats at that. It was so funny, but it was deeper than that too.

Among other things, that chapter was secretly about intentions. You can have good intentions, and end up causing weird things to happen, but you’ve still got to try, you know?

It was also about the one-way grocery-store friendships I have. Grocery-store people are my people. There have been years where going to the grocery store was my main form of socialization. It felt comforting to go to the grocery store. Because that’s where my friends were. They didn’t know they were my friends, but I like it that way. There’s no pressure. I see them, they see me, and that’s enough.

What do you think about our self-improvement culture generally?

I think self-improvement itself is a good thing, but sometimes the message gets a little muddled. Like, it sort of feels like self-help books are designed more to sell books than to offer practical help. There’s not a lot of realism in there. A realistic self-help book wouldn ’ t sound like “Easily banish your anxiety with these simple tricks!” It would sound like “Moderately improve your anxiety over a span of many years by continuously choosing to do the hard thing instead of the easy thing, and there’s no real end point—you have to keep going indefinitely if you want to keep improving. ” And I think that really holds self-help back—the promise of easy results.

If I’ve ever managed to improve myself, it took a very long time, and it definitely wasn’t easy. And going in expecting the type of dramatic results being promised was actually pretty confusing.

When my depression or anxiety was still there months later, it felt like failing, instead of what should be expected with persistent psychological issues like anxiety and depression .

If you’re expecting it to be easy, you’re probably going to feel disappointed. You won’t even notice the improvements, probably. Because they’re very small. In my experience, it’s far more helpful to go in expecting to work hard to make gradual, realistic improvements on your overall strategy. It’s definitely possible to improve, but I don’t trust anything that promises to make it easy.

Do you feel the book has particular resonance during this pandemic when so many people are feeling alone?

As far as the resonance it has for this time, I didn’t know quarantine was going to happen when I wrote the material, but I do hope that the last chapter in particular—the one about being your own friend—could be helpful for people feeling a similar type of loneliness to what I was feeling when I wrote it. It was a deep, new kind of loneliness that I’d never felt before, and I really empathize with anybody going through something like that, whether because of quarantine, or something else, or both. Loneliness is hard, and sometimes there aren’t very many external things you can do to change it. At the very least, I hoped that talking about loneliness openly would help make it less scary.

How have people responded to your writing about hard stuff: depression, loneliness and anxiety?

The response has been very warm and supportive. People will reach out to me, saying those sections helped them feel less alone in their struggles, and then they ask how I’m doing, and if I’m O.K. It’s beautiful.

Sometimes I feel scared to be vulnerable, but I don’t think I’ve ever regretted it. I think it’s good to be vulnerable; it shows people that it’s safe to be vulnerable too. And, for the most part, I think people appreciate that. Actually, one of the comments I have saved in my special folder is somebody who said, “Thank you for going first.” I’ve probably read that one a hundred times. It helps me remember that I don’t need to feel scared.

You write for the first time about losing your younger sister Kaitlin, who died by suicide in 2013. Can you talk a little bit about her and what it meant to bring her into your book?

As children, Kaiti and I didn’t really know what to make of each other. In some ways, we were close; in others, we were rivals.

We shared a bedroom until I was 17, and we were both introverts, and we were both kind of weird and sensitive, and some days it was tense. But there were also days where we’d go to the lake to look for snakes. She’s the only person I’ve ever known who felt as enthusiastic about finding snakes as me. There aren’t a lot of little girls who like to do that, but she did. She was my snake-finding buddy.

There’s a type of understanding between siblings that you don’t get anywhere else. You grew up together. You were raised by the same people. There are quirks you share that nobody else has. It can be hard to see them, but they’re there.

When I was finishing the book, it was very painful to relive the happy memories, but also cathartic. In a way, drawing those memories for the book allowed me to feel connected to her again. Because when you’re drawing, it feels like interacting with the subject. And I was surprised by how therapeutic that was.

What advice would you give to a person who loves someone who is depressed?

As always, there’s the caveat that different people experience depression slightly differently, and what works for one person might not work for the next, but for me what has been most helpful is when somebody shows a willingness to understand, and also a willingness to just quietly be there if that’s what I need. Sometimes it feels good to talk about it; sometimes it’s too overwhelming, and it feels helpful when somebody lets me know that it’s O.K. to not feel O.K. right away. Because it isn’t always possible to feel O.K. right away—sometimes I don’t feel O.K. for a very long time—and it takes a lot of the extra stress out of the experience to know the other person understands that.

In general, understanding is good.

There are a lot of weird aspects [of depression] that are difficult to explain—like the fact that even a deeply depressed person doesn’t SEEM depressed all the time.

A couple years ago, I noticed that I was kind of restraining myself during those fleeting moments of levity, because I was self-conscious about how confusing it would be. And that’s just silly! I mean, how rare and valuable are those happy little moments, when you’re depressed? And I was trying to suppress them!

I don’t really know what somebody could say or do to help with that, but I figured it couldn’t hurt to understand that it’s a part of the experience for some folks. 💌

✨ Check out Allie’s books and her blog here.

Coping kit ⛱️.

⛑️ What To Do If You’re Worried About a Loved One’s Mental Health This important piece from the Washington Post has advice on how to spot signs that someone’s struggling even if you can’t see them in person, as well as how to help.

' You mean so much to me,' or, 'I love you.' Those are lifesaving words that only loved ones can say that are incredibly connecting and powerful for people who are feeling desperate and alone.

–John Draper, executive director of the National Suicide Prevention Lifeline

🎙 You and Me Both With Hillary Clinton: A Conversation About Mental Health In a recent episode of her podcast , Clinton talks with three people who have spoken openly about their mental health struggles: Tony Award-winner Audra McDonald, veterans advocate Jason Kander, and author Allie Brosh.

NEW to It’s Not Just You? Subscribe here to get a weekly dose of empathy in your mailbox.

A Million ❤️s Connected

This Sunday, December 13, you’ll get to meet some of our inspiring friends at Pandemic of Love when CNN features this grassroots volunteer-run aid organization in their 2020 CNN Heroes: An All-Star Tribute broadcast at 8pm ET. The timing is perfect. POL founder Shelly Tygielski (pictured above) reports that as of this week, the group has matched one million people–givers and those in need–since March 14.

It all started with Shelly’s belief that if you could find a way to match good-hearted donors directly with individuals, people would step up. And hundreds of thousands have.

And for more evidence of human kindness, check out this CBS video report about Beth Eiglarsh, a mom from Hollywood, Florida (and Pandemic of Love) patron who was paired with Sean Noriega, a former New York City school teacher who left work after being diagnosed with throat cancer. Beth helped Sean with food, finances, and more. Sean describes what her outreach meant like this:

When I use the word angel (to describe Beth), I don't use it lightly. I really do mean that word literally because this lady saved my life.

Guardians of the Year

Check out TIME’s Guardians of the Year cover story which includes Dr. Anthony Fauci and the frontline healthcare workers who’ve been battling this pandemic for almost a year.

Many of you sent me notes nominating healthcare workers, some of you named persons of the year that you know personally: a nursing home aide who has become your essential connection to a parent, a “porch angel” who dropped off groceries and meals for weeks when your whole family was sick, the person who sent you care packages when you were isolated. So to all of those persons of the year, we send our collective gratitude: You are what’s holding the country together.

MESSAGE OF THE MOMENT 🦋

The social messages brands promote are both a reflection of the zeitgeist and a driver of the culture. So it’s worth noting that several are launching overt calls for kindness this year. We sure hope that we can find empathy in our hearts without an external prompt in this time of need, but it sure can’t hurt to spread the word.

🌈 Kind Little Monsters

Lady Gaga and Oreo have partnered to promote musical messages of kindness and connection with a special line of pink and green cookies inspired by her 2020 album “Chromatica.” Starting December 15th, fans can record a personal message for a loved one on the “Sing It With Oreo” website which transforms the recording into a song to share on social.

The cookie maker is also pledging to donate to Born This Way Foundation , which Lady Gaga founded with her mom, Cynthia Germanotta, in 2012 to support youth mental health programs and promote kindness.

📗 And if you want to support Born This Way Foundation directly and support gorgeous stories of empathy and connection this holiday, gift a copy of Channel Kindness, a book of stories about creating safe spaces for LBBTQ+ youth, embracing kindness and “helping others without the expectation of anything in return.”

💐 Kindness In the Aerie

Aerie has set up a kindness hotline through Christmas that allows callers to choose different messages: kindness for yourself, for others, for the world, and online. Influential voices delivering those words of comfort include Aly Raisman , Storm Reid , and Iskra Lawrence . Iskra, an #AerieREAL Role Model, says she got involved because this turbulent year “has impacted the mental and physical health of so many people. So, being understanding of what others are going through is vital.” Aerie’s Senior Vice President of Marketing, Stacey McCormick adds: “It’s been overwhelming to experience so many people sharing kindness with themselves, others, and the world – and we hope it doesn’t end with the season, but continues 24/7, 365 days a year.”

👉To call the #AerieREAL Kind hotline dial: 1-844-KIND-365

COMFORT DOGS 🐕🐕

Our weekly acknowledgment of the creatures that help us make it through the storm.

🌟More ‘curious and about to get into mischief’, than ‘comfort’ dogs, but sweet all the same. Meet Otis & Beatrice, shared by Jeannie in Brooklyn, NY

🎈Send questions, requests, or your comfort animal pix to me at [email protected]

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• Depression: Major Depression & Unipolar Varieties

A Personal Story of Living through Depression

John Folk-Williams has lived with major depressive disorder since boyhood and finally achieved full recovery just a few years ago. As a survivor of ...Read More

A recovery story is a messy thing. It has dozens of beginnings and no final ending. Most of the conflict and drama is internal, and there’s a lot more inaction than action. The lead character hides in the shadows much of the time, so you can’t even see what’s going on.

I joined up with depression around the age of 8. There are snapshots of me in the shabby brown jacket I liked to wear. My mom took beautiful photographs, and there are lots of me in moody shadows, looking as down as could be.

She had her own depression to worry about. My typical memory of her from that time brings back a couch-bound, often napping, mother. She explained her sleep problem as a condition she called knockophasia – a term I’ve never been able to find in any dictionary. A few minutes after lying down, snap! Sound asleep. No one mentioned strange emotional problems or mental illness in those days. My parents occasionally talked about someone having a nervous breakdown as if they had died. There was no hint of a need to get help for my mother, much less for me. No one worried about me since I was a star in school, self-contained and impressive to teachers for being so mature, so adult.

Free Online Depression Test

Migraine headaches started then, and increasingly intense anxiety about school. I missed many days, felt shame as if I were faking, and obsessed over every one of my failings. I spent long hours alone in my room.

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Through my teenage years, depression went underground. Feelings were dangerous. There were too many angry and violent ones shaking the house for me to add to them. So I kept emotion under wraps, even more so than in childhood. Nothing phased me outside the house and even at home I showed almost no sign of reaction to anything, even while churning with fear and anguish.

It was in my 20s that I broke open, and streams of depression, fear, panic, obsessive love and anger flowed out. In response to a panic attack that lasted for a week, I saw a psychiatrist. In one marathon session of 3 hours he helped me put the panic together with frightening episodes from my family life. I was cured on the spot but never went back to him. It was too soon to do any more.

It took another crisis a few years later to get me back to a psychiatrist and my first experience with medication – Elavil. But I had no idea what it was. I took something in the morning to get me going and something at night to help me sleep. I took it short term, got through the crisis but continued in therapy. From there I was steadily seeing psychiatrists in various cities for the next 8 years. But no one mentioned depression.

I first saw the word applied to my condition in a letter one psychiatrist wrote to the draft board during the Vietnam era. But I wasn’t treated for that problem. Therapy in those days was still in the Freudian tradition, and it was all about family life and conflict. Depression was a springboard for going deeper. Digging up the past to understand present problems was a tremendous help, and it changed me in many ways. But depression was still there in various forms, reappearing regularly for the next couple of decades. There were wonderfully happy and successful times as well, but I had these ups and downs through marriage, children and a couple of careers.

Gradually, depression became so disruptive that my wife couldn’t take it anymore and demanded I get help. So I finally did. This was the 1990s. Prozac had arrived, and I started a tour of medication over the next dozen years that didn’t do much at all. Nor did therapy, though two psychiatrists helped me to understand the more destructive patterns in my way of living.

Depression pushed into every corner of my existence, and both work and family life became more and more difficult. The medications only seemed to deaden my feelings and make me feel detached from everyone and immune to every pressure. It was like having pain signals turned off. There was no longer any sign coming from my body or brain that something might be wrong. I felt “fine” but relationships and work still went to hell.

The strange thing was that after all these years of living with it, I didn’t know very much about depression. I thought it was entirely a problem of depressed mood and loss of the energy and motivation. As things got worse, I finally started to read about it in great depth.

I was amazed to learn the full scope of depression and how pervasive it could be throughout the mind and body. I finally had a coherent, comprehensive picture of what depression was.

That was a big step because I could at last imagine the possibility of getting better. I could see that I wasn’t worthless by nature, that there were reasons my mind had trouble focusing and that the frequent slowdown in my speech and thinking was also rooted in this illness. Perhaps the right treatment could bring about fundamental changes after all.

There were still traps ahead, though. I became obsessed with the idea of depression as a brain disease. I studied all the forms of depression, the neurobiology and endless research studies. That was a good thing to do, but after awhile I was looking more at “Depression” than the details of my own version of the illness.

I wondered how many diagnostic categories I fitted into. For sure I had one or more of the anxiety disorders. Perhaps I fit into bipolar II instead of major depressive disorder. What about dissociation? I read the research study findings as if they were announcing my fate.

It was comforting to know I had a “real” disease. Not only could I answer any naysayers about the reality of depression. I also had a weapon to fight my internalized stigma, the lingering doubt that anything was wrong with me. I used to think that maybe I really was using the illness as a way to avoid life and cover up my own weakness. Here was proof that depression wasn’t all in my imagination but in my brain chemistry.

Neurobiology was far beyond my control. I couldn’t recover by myself. Doctors had to cure me through medication or other treatments, like ECT. However, that meant my hopes were pinned on them, not on my own role in getting better.

When the treatments failed to work, I got desperate that there would never be an end to depression. Hope in the future fell apart. My life would continue to run down. Could it even lead to suicide, as it had for friends of mine?

Fortunately, as I learned more, I listened to the experts who had a much broader view of the causes of the illness. Peter Kramer’s overview of research in Against Depression made it clear to me that contributors to the illness could include genetic inheritance, family history, traumatic events and stress as well as the misfiring of multiple body systems. No one could point to a single cause or boil it down to a few neurotransmitters.

So I went back to basics and looked much more closely at the particular symptoms I faced. I tracked the details in everyday living and saw that I needed to take the lead in recovery. Medication – when it had any effect at all – played a modest role in taking the edge off the worst symptoms. That bit of relief gave me the energy and presence of mind to work on the emotional and relationship impacts, to try to straighten out the parts of my life I had some control over.

I was determined to stop the waste of life in depression. I got back into psychotherapy and tried many types of self-help as well. Many didn’t work at all, but something inside pushed me to keep trying, despite setbacks.

One of the most important efforts was writing about my experience with depression. Writing is one way I discover things, but a deep fear had blocked me from doing it for years. I can see now that the real reason I got stuck was that I had been trying to write about everything but depression. When I could finally take that on directly, writing came naturally.

Blogging turned out to be the right medium. It was manageable even when I was down. The online community of people who lived with depression gave me a form of support that I had never had before. Another decisive step was getting out of high-stress work that I had been less and less able to do effectively. Taking that constant burden away restored a deep sense of vitality.

After all this, recovery finally started to happen. It took me by surprise, and for a long time I didn’t trust that it would last. But something had changed deep down. I believed in myself again, and the inner conviction of worthlessness disappeared.

I had found a deeply satisfying purpose in writing, as well as the energy and humor to do what I wanted to do. I regained the awareness and emotional presence to be a part of my family again, instead of the hidden husband and dad.

As anyone dealing with life-long depression will tell you, setbacks happen. There’s no simple happy ending. But if you’re lucky, an inner shift occurs, and the new normal is a decent life rather than depression. Self-awareness is key to good mental health. Take our online depression quiz today.

• Major And Unipolar Depression
• Related Conditions Part I
• Historical Understanding Part I
• Neurotransmitters
• When To Seek Help
• Suicidal Ideation
• Other Articles
• Classic Symptoms
• Neuroplasticity And Endocrinology
• Measuring Depression
• St. John's Wort
• Dual Diagnosis And Symptom Severity
• Understanding Mood Episodes
• Biopsychosocial Model
• Genetics And Imaging
• Questionnaires And Tests
• The Benefit Of Exercise
• How Depression Develops
• Negative Impacts Of Depression
• Diasthesis-Stress Model
• Modes Of Treatment Part I
• Omega-3 Fatty Acids
• DSM Criteria
• Psychodynamic Theories
• Behavioral Theories
• Medications
• Mood Disorder Diagnoses
• Cognitive Theory ?EUR" Aaron Beck
• B-Vitamins And Traditional Chinese Medicine
• Symptoms Of Dysthymic Disorder
• Ellis And Bandura
• Ayurveda And Homeopathy
• More Mood Disorder Diagnoses
• TCAs And MAOIs For Children
• Self-Help Methods
• Cultural Effects
• Mood Stabalizers
• Community And Online Resources
• Social And Relational Factors
• Non-pharmacological Medical Therapies
• Additional Reading
• Lifestyle And Environmental Causes
• Evidence-Based Treatment: Psychotherapy
• Cognitive Behavioral Therapy
• CBT Continued
• Interpersonal Therapy
• Behavior Therapy
• Psychodynamic Approach
• Group, Family And Couples Counseling
• Psychotherapy
• Self Hatred
• Antidepressants
• Blunt Instruments
• Depression & Cancer
• Heart Disease
• Maintaining Relationships
• Elusiveness Of Pleasure
• Depression In Women
• Symptoms & Causes
• A Treatable Illness
• Path To Healing
• ADHD, Psychotherapy & Medication
• Anxiety & Pets
• Setting Limits
• Dysthymic Disorder
• Elliot Smith & Vulnerability Music
• Tom Cruise Vs Brook Shields On Depression
• Symptoms Of Major Depression
• Does Male Post-Partum Depression Exist?
• National Depression Screening Day
• Older Adults
• Organizations
• Post Partum Adoption Depression
• Protracted Unemployment
• Sensory Overload
• Students & College
• Free Anti-Depressant!
• Depression, Anxiety & Morality
• The Five Senses
• Long Term Effects Of Bullying
• Physical Symptoms Of Depression
• Psychotherapy, Medication Or Both?
• Unmasking Mental Illness
• Depression & Anxiety Part 2
• Wartime Experience
• The Self-Fulfilling Prophecy
• Angry All The Time
• Eating Disorder Or Overreacting?
• Classify My Mental Disorder
• OCD, Depression
• I'm Going Crazy?
• Trying To Forget
• How To Overcome Depression Caused When Boyfriend Ditched Me?
• New Boyfriend Lying About Belongings That Are His Ex Girlfriend's
• How To Help My Delusional Son?
• Is Any Of This Real?
• I Have Everything I Ever Wanted. Why Am I So Miserable?
• How Can I Convince My Suicidal MD Husband To Be Evaluated?
• Sexual Abuse, What Should I Do Now?
• Bipolar Or Depressed Or Neither?
• Feel Like Something's Wrong
• Too Much Sorrow
• Really Desperate..Please Help
• Bipolar, Depression, Grief & Anxiety
• Is This A Flashback?
• Help Us With Our Son!
• No Clue What To Do. Help?
• Am I Going Crazy?
• Do I Suffer From Depression?
• Am I Commitment-Phobic?
• I Don't Care For Anything, I Feel As Though I'm Wasting My Life.
• Anxiety Has Taken Over My Life...
• How Do I Get My 24 Year Old Son To A Counselor
• Bipolar Teen
• I Have This Issue
• Am I Depressed?
• Fear Of Choking
• In Love With A Man Who Does Not Love Me
• I Think I Have A Mental Disorder?
• Please Help Me
• OCD Or Not OCD, That's The Question
• How Can I Move Past This- A Question For Staff
• Does Romance Lead To Aggression?
• Depressed, Anxious And Dead Inside...Please Help!
• Why Do I Feel Like Everyone Is Trying To Upset Me?
• My Husbands Roller Coaster Of Proper Hygiene: Is It Depression?
• I Feel Like A Complete Waste Of A Human Life
• Am I Always Going To Feel Like This?
• Is He Changed???
• Is There Any Hope For Me, Or Am I Destined To Be Damaged?
• Falling Apart
• Helping And Watching A Friend's Recurrent Depression?
• Insanely Jealous Husband
• Can Prescription Drug Use Lead To Delusional Beharior?
• Social Anxiety, Depression And More...
• Same Views On So Much, But Can't Get Along As A Couple
• Suicidal Thoughts
• Hypothyroid 23 Year Old Girl
• It's Me Or It's My Mother?
• Is He A Narcissist?
• Help For Aging Human Service Professionals?
• If There's Nothing New, There's Nothing Good.
• Please Respond, I Need Help
• Need To Ask Someone
• Is It Okay To Give Up?
• I'm Cheated By My Girlfriend..... I Just Want To Die.....
• How Can It Help?
• Everyone Says He Is Depressed, Is He? Or Does He Really Want A Divorce??
• Help! Please!
• I Think I Need Some Help
• I Feel So Lost.
• Scared And Lonely
• Please Help Me Out
• I Never Experience Happiness
• Mystery Symptoms
• I Think I'm Depressed
• Born To Lose, Or Nurtured To Lose?
• I Am An 18 Year Old Mom Diagnosed With Severe Depression And Anxiety
• Extremely Scared: I Felt Indifferent Toward An Obsession
• Suffering With Treatment-Resistant Depression
• My Fiance May Have A Sexual, Nude Photo Addiction
• Infections And The Brain
• My Girlfriend's Family Is Ruining Our Relationship
• I Need Help And Am At The End Of My Rope
• How Can I Cope With My Husband?s Depression And Its Sexual Consequences?
• What Is The Difference Between Mental Illness And Depression?
• Do I Need Help?
• What Is It?
• Why Am I Thinking Like This?
• Why Does My Mother Hoard Everything, Including Garbage?
• Right In The Middle Of A Nervous Breakdown; What's Wrong With Me?
• Huge Disapointment With My Husband
• I Don't Really Care About Anything. What Should I Do?
• Is Post Traumatic Stress Disorder Curable?
• Is It Really A Problem?
• I Am Terrified Of Death.
• Detached: I Feel Guilty, But I Can't Help It.
• My Father, The Sociopath...
• I Feel Like A Question Mark
• Am I Not Normal!?
• Our 23 Year Old Son Refuses To Get Help For His Anxiety Attacks And Depression.
• What Is Wrong?
• Husband Abandoned Me
• D.I.D. Diagnosis, How Do I Accept This?
• I Don't Know Anymore. Please Help.
• Breaking Up With Bipolar
• Depression - Blacking Out
• My Boyfriend Saved Pictures Of His Ex-Girlfriend On His Computer.
• Restroom Phobia
• What Is Wrong With Me?
• Should I Seek Help?
• When To Leave Therapy?
• Help Me Please. What Is Going On With Me?
• I'm Afraid I'm Going Crazy
• I Don't Know What To Do
• Am I Wallowing In Depression?
• What Is Wrong With Me, Doc?
• Am I Suffering A Kind Of Psychological Problem?
• Attention Deficit And Depression
• Do I Have An Eating Disorder?
• Do You Think I Sound Depressed? I Don't Understand What Is Going On
• Is This Bi Polar?
• Depression Helps To Contribute To My Unemployment! - Paula
• Will I Ever Feel Normal?
• Cyclical Depression
• Frightening Thoughts - Fear Losing Control - Please Help!
• Anxious, Depressed, Confused, Angry....the Typical...
• Giving Up - Dad Of Three - Sep 15th 2008
• Dont Understand Me
• Exercising Violence In Dreams
• My Husband Wants To Leave Me
• Is There Help For A Person Who Has Always Been A 'little Depressed'
• Depression Treatment
• Please Help.
• Lovely, However... - Julie C. - Jul 14th 2008
• I Am Really Worried About My Mental Health (19yr Old Female)
• Do I Have Bipolar Dsorder?
• Is There Something Wrong With Me?
• Will I Ever?
• Worried About My Son
• Is There Help Out There? Lonely Mother Of Three
• Major Depressive Disorder Severe With Psychotic Features
• OCD- No Feeling
• Help!!!: Laci
• Is The Memory Of My Father Dooming My Relationship?
• Worried About Thoughts
• How Long Will I Be On Medication For Treatment Of My Depression
• My Mother Won't Go For Depression Treatment!
• Where Do I Start To Get On The Road To Recovery
• How Do I Get My Dr.s To Understand And Help Me?
• What Treatments Are Available After You've Tried The Medicines Of Last Resort?
• No One Will Help!
• A Fighting Couple
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‘I’m a NICU Nurse Who Had Postpartum Depression 3 Times—Here’s What I’ve Learned’

“I just remember sitting in my [hospital] room, and everything just felt super overwhelming, and I was very tearful," Leos recalls. "I thought to myself, ‘I need help. I can feel it already.’”

"It" was postpartum depression, or PPD, characterized by feelings of sadness, hopelessness, or anxiety that last longer than two weeks and start around the time of delivery, according to the Office on Women’s Health (OWH). Leos, 39, who lives in Midlothian, Texas, and works as a nurse in a neonatal intensive care unit (NICU), had experienced it twice before, when her two older children were born.

• Jill Zechowy, MD , physician, perinatal psychotherapist, and author of Motherhood Survival Manual: Your Prenatal Guide to Prevent Postpartum Depression and Anxiety

But even though she recognized PPD this time, it still took Leos months to feel better. Here’s what she wants everyone to know about this emotional experience.

You might feel *everything*—or nothing at all

PPD—also sometimes called perinatal depression—can occur anytime during pregnancy or in the year after, explains Jill Zechowy, MD , a physician, perinatal psychotherapist, and author of Motherhood Survival Manual: Your Prenatal Guide to Prevent Postpartum Depression and Anxiety . “It’s characterized by exhaustion, feeling overwhelmed, sometimes tearful, other times numb," Zechowy says. "These moms feel like they are failures as mothers.”

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Other new moms might experience anger, rage, or anxiety, which often shows up as disturbing, intrusive thoughts. “These can be really scary images that women have in which they imagine harm coming to the baby,” she says.

The smallest tasks, like taking leftovers out of the fridge to reheat for dinner, were overwhelming for Leos—if she had the motivation to do them at all. “I would start a task, and forget what I was doing, so my house got really crazy. I didn’t have a lot of motivation to do tasks to begin with, so once I actually got the motivation, it was even worse, because I couldn’t finish them,” she says.

She remembers cloudy moments of brain fog when she felt like she was living outside of her body, watching her family from afar without feeling the joy or love she usually felt being with them.

That was a big difference from the emotional peaks and valleys she had experienced after her first two deliveries. About eight weeks after having her first daughter, Kristina talked to her OB/GYN about how she was feeling and started a type of antidepressant called a selective serotonin reuptake inhibitor or SSRI. After her second delivery, she started the antidepressant right away. (Once you’ve had postpartum depression once, you’re more likely to have it again, Dr. Zechowy says.)

It’s more common in certain people

No one knows exactly what causes postpartum depression, and it’s probably a combination of many factors. Experts think the major hormone changes that happen so quickly after giving birth likely trigger mood changes, according to the OWH.

You’re also more likely to develop postpartum depression, per the OWH, if you have a family history of depression (even in male relatives; had an unplanned, difficult, traumatic, or premature pregnancy or delivery; don't have much support from your partner, family, or friends; or are facing other life stressors, like financial challenges or relationship problems.

Leos conceived her third child through IVF, and her daughter was born premature. Parents who go through IVF and those who deliver before full-term are both more likely to have postpartum depression symptoms , according to an August 2023 Acta Psychologica study and a January 2022 Scientific Reports study, respectively. “Everything just happened so fast for me this time, and I wasn’t expecting it at all,” Leos says of her third delivery.

Finding the right treatment can take time

What didn’t happen fast was finding an effective treatment. Leos delivered her second daughter in March 2023. She went back on the SSRI after delivery, and she says she would feel some improvement, then feel a little worse. Her OB/GYN kept increasing her dose. They added a second medication to her routine, but the same pattern—one step forward, two steps back—repeated. “I would feel a little bit better, but then I would just slide backwards," she says. "It was a roller coaster, down and up and down.”

Her OB/GYN suggested speaking with a psychiatrist. At first, Leos didn’t feel comfortable opening up to a stranger. “It was hard enough for me to open up to [my doctor], and I trusted her so much," she says. "But I realized at some point that this was beyond what she could offer to me.” She started seeing a psychiatrist in the summer of 2023. The psychiatrist adjusted the doses of her medications, tried some different options, and still couldn’t relieve Leos’s symptoms.

In December 2023, Leos remembers her psychiatrist looking at her and saying, “This is not working. We need to do something else.” Her options included electroconvulsive therapy, ketamine treatment, and hospitalization. “I couldn’t believe I had gotten to a point in my life where I could have to be in the hospital for Christmas without my kids,” she says.

She remembered hearing about a relatively new postpartum depression treatment called zuranolone on Facebook, so she asked her psychiatrist for more information. The psychiatrist hadn’t prescribed it to anyone yet—it had only been approved by the FDA for PPD treatment that August—but after looking into it more, they determined Leos would be a good candidate.

Zuranolone, sold under the brand name Zurzuvae , “is the first oral pill that the FDA has specifically approved for postpartum depression,” Dr. Zechowy says.

Previously, the only medication specifically approved for PPD was a 60-hour intravenous infusion that had to be delivered in the hospital, according to Yale Medicine .

Rather than target the neurotransmitter serotonin, zuranolone works on different feel-good receptors in the brain that depend on the hormone allopregnanolone, Dr. Zechowy explains. Allopregnanolone levels drop dramatically after giving birth. Consequently, “it works much quicker than SSRIs,” she says. “Whereas they may take two to four weeks to start becoming effective, sometimes zuranolone works as quickly as in three days.”

Plus, you only take zuranolone for 14 days, compared to the 12 months or so you’d probably be treated with SSRIs, Dr. Zechowy estimates. This makes it an especially exciting development for people with severe postpartum depression who need relief quickly, she adds.

Leos started taking zuranolone in January 2024. By day three, she could already tell she was feeling differently. “Every day, I got better and better, and then at the end, I was just like, wow, I don't feel like [I’m having] an out-of-body experience.”

Treatment, in some cases, is a life-or-death matter: “Most families are not aware of the harm of untreated postpartum depression,” Dr. Zechowy says. But perinatal mental health concerns (which includes PPD as well as postpartum anxiety and postpartum psychosis ) are the top cause of death among new moms via suicide or overdose, according to the American College of Obstetricians and Gynecologists . “I know someone who died from postpartum depression a few weeks ago,” Leos says. “It really, really shook me hard, because it could be any of us.”

There are some side effects of the PPD pill to be aware of

Leos decided to start treatment when she had five days off from work in a row, to give herself some time and space in case she experienced any side effects.

The biggest side effects of zuranolone are dizziness and sedation, Dr. Zechowy says. Because of these concerns, you shouldn’t drive within 12 hours of taking the pill (which you take every evening with a meal rich in fat to help your body absorb the medication, per the manufacturer’s website ), which simply might not work for everyone, she says.

“My main thing was dizziness, but the side effects were not as bad as I thought they would be. For me, the benefits outweigh the little side effects,” Leos says.

You shouldn’t breastfeed on zuranolone

We don’t currently know how this relatively new medication may or may not affect a newborn, so you shouldn’t breastfeed while taking it. “I pumped and dumped, and it was just for two weeks, so it wasn’t that long,” Leos says.

Still, it was challenging emotionally for her: “When I felt like such a failure, one thing I could do for my daughter was to provide milk. So the fact that I couldn’t breastfeed made me not want to take zuranolone. But I realized I could pump and dump, and for two weeks, you can do anything.”

There’s a hefty trice tag for the pill, but insurance can help

The wholesale price of Zurzuvae was announced at $15,900 by manufacturer Sage Therapeutics . They do have a financial assistance program , and anecdotally, at least, Dr. Zechowy says most insurance companies are covering the cost if your doctor gets approval from them first (called a prior authorization).

Leos didn’t have to pay that much, but she thinks it would have been worth it. “Now that I've taken it, I would gladly pay $16,000,” she says. “I’d have to take out a loan, but I would gladly pay that, because you can’t put a price tag on your life.”

You are not alone if you have PPD

One in 8 new moms experiences symptoms of PPD , per the OWH, but it can feel like you’re the only one struggling. Postpartum depression was isolating for Leos. “I didn’t want to burden anyone by telling them how I was feeling,” she says. “My best friends, my husband—they didn’t know the extent of my issues. But it’s a time [when] you need the most help and you need someone to talk to.”

Shame often keeps new parents from speaking out about how they’re feeling, Dr. Zechowy says. “Women see a significant part of their value as a human being by their role as a mother, and postpartum depression makes you feel like you're a terrible mother. You don't realize you're depressed. You just think you're not good at this.”

Leos just overcame that shame recently. “I only started talking about my experience a few months ago,” she says. There were many opportunities when someone in the health care system could have extended more support to her. For example, she says, she scored high on measurements of depression during multiple evaluations, but providers shrugged it off as normal. “I think people are just afraid to talk about it,” she says. “I started to think maybe I shouldn’t be worried about it.”

That’s emboldened her to speak up publicly and at work. “As a health care professional who works with postpartum women, I think it's important to bring up postpartum depression to them, and tell them that it's real,” she says. “In our discharge instructions, I think there's, like, one line about postpartum depression. Now I just take a lot more time to actually educate moms [about it].”

Need support for PPD? Call or text the Postpartum Support International helpline at 1-800-944-4773 or the National Maternal Mental Health Hotline at 1-833-852-6262.

• Girchenko, P., Robinson, R., Rantalainen, V.J.  et al.  Maternal postpartum depressive symptoms partially mediate the association between preterm birth and mental and behavioral disorders in children.  Sci Rep   12 , 947 (2022). https://doi.org/10.1038/s41598-022-04990-w
• Li, Chuan-Chen et al. “Factors associated with postpartum depressive symptoms among women who conceived with infertility treatment.”  Acta psychologica  vol. 238 (2023): 103987. doi:10.1016/j.actpsy.2023.103987

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7 Depression Research Paper Topic Ideas

In psychology classes, it's common for students to write a depression research paper. Researching depression may be beneficial if you have a personal interest in this topic and want to learn more, or if you're simply passionate about this mental health issue. However, since depression is a very complex subject, it offers many possible topics to focus on, which may leave you wondering where to begin.

If this is how you feel, here are a few research titles about depression to help inspire your topic choice. You can use these suggestions as actual research titles about depression, or you can use them to lead you to other more in-depth topics that you can look into further for your depression research paper.

What Is Depression?

Everyone experiences times when they feel a little bit blue or sad. This is a normal part of being human. Depression, however, is a medical condition that is quite different from everyday moodiness.

Your depression research paper may explore the basics, or it might delve deeper into the  definition of clinical depression  or the  difference between clinical depression and sadness .

What Research Says About the Psychology of Depression

Studies suggest that there are biological, psychological, and social aspects to depression, giving you many different areas to consider for your research title about depression.

Types of Depression

There are several different types of depression  that are dependent on how an individual's depression symptoms manifest themselves. Depression symptoms may vary in severity or in what is causing them. For instance, major depressive disorder (MDD) may have no identifiable cause, while postpartum depression is typically linked to pregnancy and childbirth.

Depressive symptoms may also be part of an illness called bipolar disorder. This includes fluctuations between depressive episodes and a state of extreme elation called mania. Bipolar disorder is a topic that offers many research opportunities, from its definition and its causes to associated risks, symptoms, and treatment.

Causes of Depression

The possible causes of depression are many and not yet well understood. However, it most likely results from an interplay of genetic vulnerability  and environmental factors. Your depression research paper could explore one or more of these causes and reference the latest research on the topic.

For instance, how does an imbalance in brain chemistry or poor nutrition relate to depression? Is there a relationship between the stressful, busier lives of today's society and the rise of depression? How can grief or a major medical condition lead to overwhelming sadness and depression?

Who Is at Risk for Depression?

This is a good research question about depression as certain risk factors may make a person more prone to developing this mental health condition, such as a family history of depression, adverse childhood experiences, stress , illness, and gender . This is not a complete list of all risk factors, however, it's a good place to start.

The growing rate of depression in children, teenagers, and young adults is an interesting subtopic you can focus on as well. Whether you dive into the reasons behind the increase in rates of depression or discuss the treatment options that are safe for young people, there is a lot of research available in this area and many unanswered questions to consider.

Depression Signs and Symptoms

The signs of depression are those outward manifestations of the illness that a doctor can observe when they examine a patient. For example, a lack of emotional responsiveness is a visible sign. On the other hand, symptoms are subjective things about the illness that only the patient can observe, such as feelings of guilt or sadness.

An illness such as depression is often invisible to the outside observer. That is why it is very important for patients to make an accurate accounting of all of their symptoms so their doctor can diagnose them properly. In your depression research paper, you may explore these "invisible" symptoms of depression in adults or explore how depression symptoms can be different in children .

How Is Depression Diagnosed?

This is another good depression research topic because, in some ways, the diagnosis of depression is more of an art than a science. Doctors must generally rely upon the patient's set of symptoms and what they can observe about them during their examination to make a diagnosis. 

While there are certain  laboratory tests that can be performed to rule out other medical illnesses as a cause of depression, there is not yet a definitive test for depression itself.

If you'd like to pursue this topic, you may want to start with the Diagnostic and Statistical Manual of Mental Disorders (DSM). The fifth edition, known as DSM-5, offers a very detailed explanation that guides doctors to a diagnosis. You can also compare the current model of diagnosing depression to historical methods of diagnosis—how have these updates improved the way depression is treated?

Treatment Options for Depression

The first choice for depression treatment is generally an antidepressant medication. Selective serotonin reuptake inhibitors (SSRIs) are the most popular choice because they can be quite effective and tend to have fewer side effects than other types of antidepressants.

Psychotherapy, or talk therapy, is another effective and common choice. It is especially efficacious when combined with antidepressant therapy. Certain other treatments, such as electroconvulsive therapy (ECT) or vagus nerve stimulation (VNS), are most commonly used for patients who do not respond to more common forms of treatment.

Focusing on one of these treatments is an option for your depression research paper. Comparing and contrasting several different types of treatment can also make a good research title about depression.

A Word From Verywell

The topic of depression really can take you down many different roads. When making your final decision on which to pursue in your depression research paper, it's often helpful to start by listing a few areas that pique your interest.

From there, consider doing a little preliminary research. You may come across something that grabs your attention like a new study, a controversial topic you didn't know about, or something that hits a personal note. This will help you narrow your focus, giving you your final research title about depression.

Remes O, Mendes JF, Templeton P. Biological, psychological, and social determinants of depression: A review of recent literature . Brain Sci . 2021;11(12):1633. doi:10.3390/brainsci11121633

National Institute of Mental Health. Depression .

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition . American Psychiatric Association.

National Institute of Mental Health. Mental health medications .

Ferri, F. F. (2019). Ferri's Clinical Advisor 2020 E-Book: 5 Books in 1 . Netherlands: Elsevier Health Sciences.

By Nancy Schimelpfening Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be.  

What’s It Like Being Depressed? | Interview With A Previous Dynamic You Client

‘What’s it like being Depressed?’  This is often a question many people want to get an answer to  – but understandably feel uncomfortable to ask.  Following a Course of Cognitive Behavioural Therapy (CBT) at our Clinic we asked ‘Derek’ to answer some questions for us…

Whilst Depression is different for each person, there are a number of symptoms that are very common as part of this disorder .  We’re calling Depression a disorder because it is important to recognise that it is a psychological condition that should be taken seriously – and is much more than simply ‘feeling a bit low’.

To help give an idea what Depression can be like, we asked a previous client to answer some questions for us, and here are the answers he gave…

Q: What’s It Like? / How Did You Know You Were Depressed?

A: “I didn’t really know that I was depressed at first.  My marriage had just ended and I was having a hard time, and so I just thought that it was normal to feel down and upset.  The problem was it just sort of spiralled and get worse rather than better.  I didn’t ever seem to get a rest from feeling upset, or able to stop thinking about how bad my life was going.  It seemed like things weren’t going to get any better and that i’d blown all of my chances.  I stopped doing more things in my life because there didn’t seem any point.

It sounds strange to say it now, some people talk about black clouds, or black dogs – but it wasn’t like that for me.  I just felt like I was trapped by something I couldn’t see, and that I couldn’t get out.  The only way I could get a break from it was by being asleep.  I would lay in bed in the mornings at weekends and hope that I could get back to sleep, the problem was I never could.  So I ended up laying in bed for hours with my eyes closed hoping to switch off, but with my mind going mad with nasty thoughts.  If you ask me ‘whats it like being depressed’, that was the worst bit for me – the relentless low and hopeless feelings.”

Q: Did You Ever Feel Suicidal?

A: “Yes I did.  I had lots of thoughts about how I could end my life.  I never really felt like I could be brave enough to do any of them. I’m so grateful for that now, as my life is so much better and pretty much back to normal again.  I have hope again, and a future that is better than I would’ve ever imaged.  It never seemed like that would happen at the time though.  I guess that’s what being depressed does to everyone, sucks away their hope.  I would honestly say to anyone that is thinking about suicide, don’t do it.  Life will get better at some point, just hang in there.”

Q: Did People Take You Seriously?

A: “I think so.  I was lucky compared to some people.  People were worried about me, although I didn’t see that at the time.  It seemed like people weren’t doing enough for me and I was upset that people didn’t understand what I was going through.  Depression can make you selfish I guess, but you don’t mean to be.

I was lucky, I had a supportive family and that my work understood.  They gave me time off, and my family paid for me to have private therapy with Dynamic You.  I always felt like people were listening to me, but that they didn’t really know what to do with me or what to say to me.  It’s nice now that things are back to normal again.  I’m even able to talk to my ex without getting the horrible feelings back.  Now that must be progress!”

Q: Did People Change Around You?

A: “Not that I noticed.  Although people have since told me that they felt like they were walking on egg shells around me as I was grumpier than usual.  I wasn’t aware of that at the time.  I think it’s just as hard for people around you to know what to do.  People are worried about saying the wrong thing or offending you.

Q: What Made You Get Psychotherapy For Depression?

A: “I knew I needed something, and the antidepressants didn’t seem to be working.  My GP recommended a course of Cognitive Behavioural Therapy but told me there were long waits on the NHS.

Once I had decided that I wanted to try psychotherapy I didn’t want to wait to get started.  What I really wanted was someone to make everything better for me again, and take away all the problems I was facing.  Therapy didn’t give me this – but perhaps that was being a bit to over optimistic!  What it did give me was a new perspective and sense of hope for the future.”

Q: How Are You Doing Now?

A: “I’m doing really well.  I can’t thank my family and my Therapist at Dynamic You enough.”

Q: What Advice Would You Give Someone Reading This Interview?

A: “The best advice I can give is to get treatment as soon as possible.  I don’t know how things would have gone if I hadn’t got treatment, but I know they wouldn’t be as good as they are now.

I know that I wouldn’t have done anything silly deep-down, but I think I would have just stumbled around for a lot longer.  As it is, I don’t feel depressed any more and I have have rebuilt my life again.  I’m still taking antidepressants, as I’ve been advised that it’s best to stay on them for a while.  But I don’t feel scared at the idea of stopping them when i’m told to because I have a whole lot of techniques to use from therapy if I need.

Even if you’re not depressed I think everyone should have therapy.  It’s amazing that life doesn’t come with an instruction book sometimes.  We all need to know how our minds work, and in some ways i’m glad I know what it’s like being depressed now, because it gave me the chance to figure things out properly for the future and to understand my brain a bit better.”

If you want to find out more about what it’s like being depressed, or to read about the common symptoms of Depression Click Here .

You can find out about other people our Therapy Clinics have helped by clicking here .

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The Psychiatric Interview

Table of contents, general tips, subspecialty, the psychiatric review of systems, obsessions and compulsions, medications, substance use history, past medical history, family history, personality traits/disorders, legal/forensic history, closing the interview, mental status examination (mse), the rule of parsimony.

The Psychiatric Interview involves a balance of being empathetic, asking the right questions, and thinking about the diagnostic criteria carefully for psychiatric disorders. Remember, everyone has a different way of interviewing, but every question you ask should have a purpose . Are you trying to elicit symptoms? Understand someone's life history? Understand their safety risks? Just as a good surgeon makes no unnecessary incisions on the patient during a surgery, a good psychiatrist should ask no unnecessary questions during the interview. This does not mean that your interview be devoid of substance or empathy, but that you make every question count . Below is a template to guide you.

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• Ask neutral questions early (e.g. - age, workplace, medical history, medications)
• Ask “threatening/challenging” questions later (e.g. - psychotic symptoms, suicide/homicidal thoughts, substance use, trauma, cognitive testing questions)
• Be careful of using leading questions and piggybacking multiple symptoms along. (e.g. - “How's your sleep, appetite, and mood?”; ask each individual item separately)
• Occam's Razor should be in the back of your mind.
• Open-ended questions are questions that cannot be answered with a simple “yes” or “no” response (e.g. - “Tell me about your childhood.”)
• Closed-ended questions can be answered from multiple choices or a “yes” or “no” response (e.g. - “On a scale of 1 to 10, how would you rate your mood?”)

Emergency Room Interviewing Tips

• They may tell you “It's not OK!” (because it really isn't “OK” for them right now), or tell you “No, you don't understand!” (because you really don't actually understand everything that is happening. How could you? You just met them today!)
• Watch out for these verbal “tics”!
• e.g. - “I can see you are very upset/very angry/pissed off, etc…”
• e.g. - “I can't even pretend to understand what you're going through right now, but I will do my best to listen and try to understand.”
• “Why here, and why now?” (the reason they came to the ER or reason for the crisis event)
• “What can we do for you? What were you hoping we could do for you?”
• e.g. - “Not making a decision is also a decision in and of itself.”
• Show empathy!
• Identify your patient's strengths and coping skills throughout the interview

If assessing a child, adolescent, or older adult, the interview and assessment will be significantly different. See the pages above.

Ask the pertinent social history upfront: this allows you to frame the interview and understand your patient's social situation.

• Relationship status and children (if any)
• Disability/welfare status
• Occupation/Education
• Living situation (where? with whom?)
• Family/siblings
• Health care providers: GP, psychiatrist, specialists, etc.

History of Presenting Illness

• Start with close ended questions, do not ask leading questions. Make them direct!
• Who brought you here? Who sent you here?
• Allow your patients to tell you the story. Doctors have a bad habit of interrupting patients within the first few minutes of meeting a patient. [1]
• Anything further in the past should be considered as past psychiatric history

Always Establish the Chronology of Events

• “How do you feel now?”, “How do you feel compared to your well self?”, “When did you last feel 'normal/well'?”
• Always compare the patient's current symptoms to their baseline
• Are there any acute stressors presently?
• What are their coping strategies?
• Key questions on a psychiatric review of systems includes asking questions about mood (both depression and mania ), sleep , anxiety , psychosis , obsessions and compulsions , dissociative symptoms , trauma history , body image disturbances , eating disorders , and somatic / pain disorders .
• It will be difficult to get through all these areas in a one-time assessment, and the clinician should use their clinical judgment to determine which questions will be the most helpful and high yield.
• An example of a relatively comprehensive psychiatric review of systems is detailed below, but is by no means exhaustive. Some individuals early on may find using a checklist helpful to keep themselves organized.
• “Tell me about your mood right now,” “How's your mood right now?”
• On a scale of 0 to 10 (0 = worst you've ever felt, and 10 = best mood you ever had)
• When someone says they are “depressed,” it is important to clarify what they mean by that, don't just take it at face value
• If someone says they've “always been depressed,” try to get them to describe what their earliest memory of being depressed was like

Substance-induced mood/anxiety disorder?

“Now I'm going to ask you about some other symptoms people might feel when they're depressed.”:

• “Tell me about your sleep”
• Ask about sleep hygiene (screen time)
• How long are you asleep?
• What time do you fall asleep?
• What time do you get up?
• Are there night time awakenings?
• Are you told you snore at night? (think about sleep apnea , which can cause depressive symptoms)
• Do you ever experience nightmares? (could be a sleep disorder or a trauma disorder )
• Interest (Anhedonia)
• ADHD screen may be applicable here
• How much weight loss?
• What is their ideal weight?
• What specifically makes this ideal?
• Are they pre-occupied with their weight
• Current weight and highest weight
• Compensatory behaviour: medications, purging, laxatives, diuretics
• Psychomotor Slowing
• Suicide (leave this for later, unless your patient brings it up)

Always ask about anxiety and depression at the same time since these symptoms often overlap and are “co-morbid.” Key questions to ask include:

• Find your worry is difficult to control?
• Do you easily blanking out or have difficulty concentrating?
• Easily fatigued?
• Sleep changes (difficulty falling or staying asleep, or restless, unsatisfying sleep)?
• Feel keyed up, on edge, or restless?
• Feel irritable, or others comment on it?
• Experience muscle tension when you are worried?
• Would you describe yourself as a worrier?

“Now I'm going to ask you about some symptoms when people feel the opposite of depressed.”

• “Found if easy to jump from one idea to another?” (more of a physical observation in the patient)
• Have your friends or family recently commented on this?
• Ever get the feeling you have superpowers, or invincible?
• “Racing thoughts in your head?” (more of the patient's subjective experience)
• “Have you been doing a lot more at work? Sexual indiscretion when you normally wouldn't? Having sexual relations with strangers?”
• “Decreased to the point where you don't have to sleep for days?”, more specifically, are not sleeping because you have so much energy ?
• “Talking more rapidly?”

Key questions to ask about bipolar symptoms and course of illness:

• Do you spend most of your time feeling depressed or manic?
• Do you tend to get psychotic symptoms when you have depressive or manic symptoms? (think: either depression with psychotic features , or mania with psychotic features)
• Was there a period of time (>2 weeks) where you did not feel depressed/manic, but still had psychotic symptoms? (think schizoaffective disorder )
• When was your first manic/depressive episode? (The index event is important, this informs you: what is the natural history of the illness in the person? Do they tend to have a depressive or manic presentation?)

In patients with a history of multiple manic and depressive episodes, it can often be overwhelming and not practical to ask about the course of each specific episode. It is useful to obtain in broad strokes the following details instead:

Key Features of a Good Bipolar Disorder History

• “Do you ever feel things are not real?
• “Do you worry that people might be against you or after you?”
• “Do the voices ever command you do to things?”
• “Do you ever things other people don't see?”
• “Are the voices outside or inside your head?” (auditory hallucinations are more likely to be heard “outside,” and often patients will look for the voice)
• “Do you ever feel that thoughts are being put into your head?” (thought insertion)
• “Do you ever feel that thoughts are being taken out of your head?” (thought withdrawal)
• “Do you ever feel that your thoughts are being broadcasting so that other people know what you are thinking?” (thought broadcasting)
• “Do you feel like there are special messages for you?”
• Ask about hallucinations types, are they: auditory, visual, tactile, or olfactory? - this may indicate brain pathology or lesions!

Substance-induced psychosis?

Most individuals with OCD will have both obsessions and compulsions. High sensitivity screening questions and a good OCD history includes the following:

• e.g. - worries about dirt/germs, or thoughts of bad things happening
• e.g. - repeatedly washing hands, cleaning, checking doors or work over and over, rearranging things to get it just right , or repeating thoughts in your mind to feel better?
• e.g. - interfering with school, work, or seeing friends?

The Relationship Between Obsessions and Compulsions

• Compulsions are usually performed in response to an obsession (e.g. - obsession about contamination → compulsion of hand washing rituals; obsession about a situation being incorrect → compulsion of repeating rituals until it feels “just right”)
• For individuals with OCD, compulsions reduce the distress triggered by the obsession, or prevent a feared event from occurring (e.g. - getting sick, hurting someone)
• It is important to note that compulsions are not connected in a realistic way to the feared event (e.g. - arranging items in a certain colour to prevent harm to a loved one) or are significantly excessive (e.g. - washing hands for 30 minutes at a time due to fears of contamination)
• Compulsions that are performed are not pleasurable! Rather, they allow the individual to experience relief from their anxiety or distress

Asking the question

• “Some people might think of suicide when their mood is low, has this ever crossed your mind?”
• “You're going through the loss of a loved one, has your own death or suicide ever crossed your mind?
• Always ask about the index suicide attempt (when, how, why?)
• Are there any self-harm behaviours that might put their safety at risk? Could this lead to an “inadvertent suicide”?
• Did they carry out their suicide attempt(s) with the expressed intent to die? (Sometimes a “suicide attempt” is not actually an attempt, but an accidental overdose - it is important to clarify this with your patient)

Current safety

• Is there any plan?
• Is there access to the means of death? (firearms, medications, poisons, etc.)
• Do they plan on doing this immediately?
• What are the chronic, acute, and imminent risk factors that might lead to suicide?
• Are there any threats to others due to psychotic symptoms?
• Are there any threats to specific individuals?
• “If you were to leave the hospital now, would you want to hurt anyone?”
• “If you saw [person they wanted to hurt] on the street, what would you do? Would you defend yourself? Would you want to hurt/kill them?”
• Are there any symptoms that cause dangerous driving? If patients have suicidal idea, homicidal ideation, mania, or psychosis, this is a critical safety question to ask
• Has their license ever been revoked?
• What medications are they on now?
• Have they been on any psychiatric medications? Now? In the past? What doses?
• Patients often forget about this, and it is important to prompt them. Certain supplements (e.g. - St. John's wort ) can have significant drug-drug interactions.
• Do they have any allergies to medications? Any specific reactions to psychiatric medications?
• What age? How many packs per day? Ever use nicotine replacement therapy?
• What age? What kind? IV/PO? Naloxone?
• What age? How much? History of blackouts? Have you ever been a binge drinker? Alcohol withdrawal? Seizures?
• “Ever feel you need to cut down your drinking?”
• “Have people annoyed you by criticizing your drinking?”
• “Have you ever felt bad or guilty about your drinking?”
• “Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover ( eye-opener )?”
• What age? How much? What specific effects from the cannabis do they like or not like? Do they get paranoia?
• What age? How much? What effects?
• How much caffeine do they use? What time of day? How many cups?

Substance-induced Psychiatric Symptoms?

Various medical conditions can relate to psychiatric symptoms, and can also have medication interactions. In brief, you should always ask:

• Any history of concussions or head injuries ?
• Any history of seizures ?
• Thyroid disease or disorders ?
• History of surgeries

Past Psychiatric History

• How many life-time hospital admissions?
• How many total depressive episodes?
• How many total manic episodes?
• How many total psychotic episodes?
• By staying general, but detailed enough to get broad strokes of a person's history, you can avoid getting bogged down in too much detail.
• Have they ever had ECT or neurostimulation?
• If they aren't sure, you can specifically ask the patient if they observed any unusual behaviours or symptoms in that family member
• Any family members die by suicide (or unexplained deaths)?
• Any family members with problematic alcohol or substance use?
• Any family members hospitalized for psychiatric reasons?
• Any family members with neurodegenerative disorders and dementias (for geriatric patients)

Social History

• Location raised
• Any issues with development/birth?
• Were you raised by your parents?
• Are your parents still together?
• Parent's occupation and finances
• Relationship with mother and father?
• Relationship with your siblings?
• Would you say you generally had a happy childhood? (individuals with a generally unhappy childhood are more likely to be dysthymic)
• What was school like for you?
• How would you describe yourself as a child?
• Bullying at school?
• Do you have any religious affiliation?
• “How did you do academically?”, “What is your highest level of education?”
• “Do you live by yourself/with others?”, “House, condo, etc.?”
• “What kind of jobs did you have?”
• Friends? Family? Co-workers?

While obtaining your social history, this is a good time to touch on any possible history of trauma.

• It is good to have a non-threatening opener, such as: “Stressful life experiences can affect your health, and it can be helpful for us as healthcare providers to understand this. You can skip these questions if you don't want to answer them, and they are non-mandatory.”
• “Have you ever experienced anything in your life that you would consider traumatic?,”
• Or more point-blank, “Have you ever experienced any physical, emotional, or sexual abuse?”

This is a good time to screen for things like borderline personality disorder :

• Ask about self-esteem, sense of self, impulsivity
• “Are you by nature an impulsive person?”
• “Do you feel that you have a poor sense of self?”
• “Is it hard for you when people in your life leave you?”
• “Do you frequently feel empty inside?”
• “Do you ever harm yourself such as cutting or burning?”
• Remember, you cannot diagnose someone with a personality disorder while they are having a primary mental disorder going on (e.g. - depression, psychosis, mania, etc.)
• Being able to tease out personality disorders can help you differentiate between diagnoses (i.e. - cluster B traits vs. bipolar disorder)
• “Any issues with the law? Or being in jail?”
• Past arrests, incarceration, court dates, murder, assault, violence?
• “Did you have any thoughts on how we might be able to help you today?”
• “Did we go through the main concerns that you hoped to talk about today?”
• Thank the patient for their time and sharing a “snippet” of their life with you today

During the interview, you should pay attention to the mental status examination (MSE). The MSE is a systematic way of describing a patient's mental state at the time you were doing a psychiatric assessment.

Diagnosis and Biopsychosocial Formulation

Now that you have finished gathering information, the next steps will be to establish a diagnosis and to formulate the patient.

Even though the DSM II was published in 1968 (!) the following excerpt is sage advice even (and especially) today.

A Tip From the DSM-II...

• Systematic Psychiatric Evaluation: A Step-by-Step Guide to Applying The Perspectives of Psychiatry
• Essentials of Psychiatric Diagnosis, Revised Edition: Responding to the Challenge of DSM-5® Revised Edition

For Clinicians

• 14 Tips for the Diagnostic Interview of Mental Disorders - Dr. Allen Frances
• Maria Yang: The Social History
• R.S. Manley. Psychiatric Interview, History, and Mental Status Examination. Chapter 7.1
• The Hub (Psychiatry)
• Psychiatry: a Resource Guide for Residents and Researchers

Overcoming Depression in a College Essay?

So I am 17 years old preparing to send in applications to my colleges. I have struggled with depression and self harm for most of my life. But I recovered in 8th grade due to the support of a friend. The thesis statement for this personal essay is, I believe one person truly can change anything. It is talking about my struggles with depression as well as my journey out of it. My parents are suggesting that I write about something different which is genuinely hurtful given that this is a part of me and something that made me into the man I am today. If I could get some feedback as to wether this is a good idea or not as well as possible ways to format an essay of this sort or even someone willing to proof read it I would greatly appreciate it.

I would not write about depression, unless you’re trying to get your supportive friend into college.

I am trying to think about what you could write under that topic that would convince me you’d be a good roommate or tell me what you’d contribute to the college community. Very, very difficult to do.

I don’t that it a good college essay topic, try to look at the bright side and search for a new topic that you may find interesting aside from depression.

I understand why this is important to you.

However, it’s not typically the type of narrative that will positively add to your application.

If you were at a job interview and the interviewer asked “why should we hire you”, would this be the first thing you share?

Typically, your essay is the opportunity to share how you will be a positive contributor to campus life and academics.

The point of the essay is to let them know something about you that they won’t be able to get from your application or your letters of recommendation. Since it’s an essay, the rule is “show, don’t tell”. That essay would definitely be considered “telling”.

Aside from that, you want to write something that will make them want to have you as their student. Unfortunately, as somebody who struggles with depression, and has done so for a few decades, I am truly sorry to tell you that it is not something that can be cured. It can be controlled, and can be overcome, not eliminated, and that’s something that AOs likely also know. For them, the fact that you are prone to depression makes you a risky proposition. So that is the last thing that you want them to know.

Find a topic that will allow your best traits to shine through, and have you come across as a person that they’d like to have around.

Struggled “most of my life” or “recovered in 8th grade?” Sure, 8>4. But they’re looking at you as a hs senior and generally prefer who you are currently or the recent enough past.

You don’t need a thesis statement. That’s hs. But if you want to show you can change, you do need active examples (show,) what you do, how that impacts others. Of course, depends on the tier of colleges.

I have to agree with your parents on this one. The college essay is not meant to be a confessional or a soul bearing exercise.

The purpose of the college essay is to: 1) tell admissions officers something positive about yourself that can’t be found elsewhere in the application and 2) to give admission officers a reason to want you on campus. IMO your proposed essay does not accomplish either. In fact discussing mental health issues can be a red flag for admissions officers.

It is great that you have overcome depression and it is amazing that you have such a wonderful and impactful friend. It will always be an important part of your story/your life. But that does not make it a good college essay topic.

If your goal is to be accepted by a college or university, then it would not be wise to write about your depression and thoughts of self harm.

Nevertheless, this is a very valuable writing topic to share with your parents. Write the essay & share it only with your parents & trained therapist.

Write about the man you are today and not the boy you were.

Totally agree with others. You are selling yourself and depression isn’t a selling point. Admissions officers see it as a red flag because they know it can come back. Don’t give them a reason to say no.

Home / Essay Samples / Health / Depression / Exploring the Depths of Depression: An Argumentative View

Exploring the Depths of Depression: An Argumentative View

• Category: Health
• Topic: Depression , Mental Illness , Suicide

Pages: 1 (658 words)

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