WARNING

When I am an old woman I shall wear purple
With a red hat which doesn't go, and doesn't suit me.
And I shall spend my pension on brandy and summer gloves
And satin sandals, and say we've no money for butter.
I shall sit down on the pavement when I'm tired
And gobble up samples in shops and press alarm bells
And run my stick along the public railings
And make up for the sobriety of my youth.
I shall go out in my slippers in the rain
And pick flowers in other people's gardens
And learn to spit.

You can wear terrible shirts and grow more fat
And eat three pounds of sausages at a go
Or only bread and pickle for a week
And hoard pens and pencils and beermats and things in boxes.

But now we must have clothes that keep us dry
And pay our rent and not swear in the street
And set a good example for the children.
We must have friends to dinner and read the papers.

But maybe I ought to practice a little now?
So people who know me are not too shocked and surprised
When suddenly I am old, and start to wear purple. 

PHENOMENAL WOMAN -- POEM

Pretty women wonder where my secret lies.
I'm not cute or built to suit a fashion model's size
But when I start to tell them,
They think I'm telling lies.
I say,
It's in the reach of my arms
The span of my hips,
The stride of my step,
The curl of my lips.
I'm a woman
Phenomenally.
Phenomenal woman,
That's me.

I walk into a room
Just as cool as you please,
And to a man,
The fellows stand or
Fall down on their knees.
Then they swarm around me,
A hive of honey bees.
I say,
It's the fire in my eyes,
And the flash of my teeth,
The swing in my waist,
And the joy in my feet.
I'm a woman
Phenomenally.
Phenomenal woman,
That's me.

Men themselves have wondered
What they see in me.
They try so much
But they can't touch
My inner mystery.
When I try to show them
They say they still can't see.
I say,
It's in the arch of my back,
The sun of my smile,
The ride of my breasts,
The grace of my style.
I'm a woman

Phenomenally.
Phenomenal woman,
That's me.

Now you understand
Just why my head's not bowed.
I don't shout or jump about
Or have to talk real loud.
When you see me passing
It ought to make you proud.
I say,
It's in the click of my heels,
The bend of my hair,
the palm of my hand,
The need of my care,
'Cause I'm a woman
Phenomenally.
Phenomenal woman,
That's me. 

TEEN DEPRESSION (FOR PARENTS)

Teenage depression isn’t just bad moods and occasional melancholy. Depression is a serious problem that impacts every aspect of a teen’s life. Left untreated, teen depression can lead to problems at home and school, drug abuse, self-loathing—even irreversible tragedy such as homicidal violence or suicide.

Fortunately, teenage depression can be treated, and as a concerned parent, teacher, or friend, there are many things you can do to help. You can start by learning the symptoms of depression and expressing concern when you spot warning signs. Talking about the problem and offering support can go a long way toward getting your teenager back on track.

Understanding teen depression

There are as many misconceptions about teen depression as there are about teenagers in general. Yes, the teen years are tough, but most teens balance the requisite angst with good friendships, success in school or outside activities, and the development of a strong sense of self.

Occasional bad moods or acting out is to be expected, but depression is something different. Depression can destroy the very essence of a teenager’s personality, causing an overwhelming sense of sadness, despair, or anger.

Whether the incidence of teen depression is actually increasing, or we’re just becoming more aware of it, the fact remains that depression strikes teenagers far more often than most people think. And although depression is highly treatable, experts say only 1 in 5 depressed teens receive help.
Unlike adults, who have the ability to seek assistance on their own, teenagers usually must rely on parents, teachers, or other caregivers to recognize their suffering and get them the treatment they need. So if you have an adolescent in your life, it’s important to learn what teen depression looks like and what to do if you spot the warning signs.

Signs and symptoms of teen depression

Teenagers face a host of pressures, from the changes of puberty to questions about who they are and where they fit in. The natural transition from child to adult can also bring parental conflict as teens start to assert their independence. With all this drama, it isn’t always easy to differentiate between depression and normal teenage moodiness. Making things even more complicated, teens with depression do not necessarily appear sad, nor do they always withdraw from others. For some depressed teens, symptoms of irritability, aggression, and rage are more prominent.

Signs and symptoms of depression in teens

Sadness or hopelessness Irritability, anger, or hostility Tearfulness or frequent crying Withdrawal from friends and family Loss of interest in activities Changes in eating and sleeping habits

Restlessness and agitation Feelings of worthlessness and guilt Lack of enthusiasm and motivation Fatigue or lack of energy Difficulty concentrating Thoughts of death or suicide

If you’re unsure if an adolescent in your life is depressed or just “being a teenager,” consider how long the symptoms have been present, how severe they are, and how different the teen is acting from his or her usual self. While some “growing pains” are to be expected as teenagers grapple with the challenges of growing up, dramatic, long-lasting changes in personality, mood, or behavior are red flags of a deeper problem.

Effects of teen depression

The negative effects of teenage depression go far beyond a melancholy mood. Many rebellious and unhealthy behaviors or attitudes in teenagers are actually indications of depression. The following are some the ways in which teens “act out” or “act in” in an attempt to cope with their emotional pain:

• Problems at school. Depression can cause low energy and concentration difficulties. At school, this may lead to poor attendance, a drop in grades, or frustration with schoolwork in a formerly good student.
• Running away. Many depressed teens run away from home or talk about running away. Such attempts are usually a cry for help.
• Drug and alcohol abuse. Teens may use alcohol or drugs in an attempt to “self-medicate” their depression. Unfortunately, substance abuse only makes things worse.
• Low self-esteem. Depression can trigger and intensify feelings of ugliness, shame, failure, and unworthiness.
• Internet addiction. Teens may go online to escape from their problems. But excessive computer use only increases their isolation and makes them more depressed.
• Reckless behavior. Depressed teens may engage in dangerous or high-risk behaviors, such as reckless driving, out-of-control drinking, and unsafe sex.
• Violence. Some depressed teens (usually boys who are the victims of bullying) become violent. As in the case of the Columbine school massacre, self-hatred and a wish to die can erupt into violence and homicidal rage.

Teen depression is also associated with a number of other mental health problems, including eating disorders and self-injury.

Suicide warning signs in teenagers

Teens who are seriously depressed often think, speak, or make "attention-getting" attempts at suicide. An alarming and increasing number of teenagers attempt and succeed at suicide, so suicidal thoughts or behaviors should always be taken very seriously.

For the overwhelming majority of suicidal teens, depression or another psychological disorder plays a primary role. In depressed teens who also abuse alcohol or drugs, the risk of suicide is even greater.
Because of the very real danger of suicide, teenagers who are depressed should be watched closely for any signs of suicidal thoughts or behavior.

Suicide warning signs in depressed teens

• Talking or joking about committing suicide.
• Saying things like, “I’d be better off dead,” “I wish I could disappear forever,” or “There’s no way out.”
• Speaking positively about death or romanticizing dying (“If I died, people might love me more”).
• Writing stories and poems about death, dying, or suicide.
• Engaging in reckless behavior or having a lot of accidents resulting in injury.
• Giving away prized possessions.
• Saying goodbye to friends and family as if for good.
• Seeking out weapons, pills, or other ways to kill themselves.

Encouraging a depressed teen to open up

If you suspect that a teenager in your life is suffering from depression, speak up right away. Even if you’re unsure that depression is the issue, the troublesome behaviors and emotions you’re seeing in your teenager are signs of a problem.

Whether or not that problem turns out to be depression, it still needs to be addressed—the sooner the better. In a loving and non-judgmental way, share your concerns with your teenager. Let him or her know what specific signs of depression you’ve noticed and why they worry you. Then encourage your child to share what he or she is going through.

Your teen may be reluctant to open up. He or she may be ashamed, afraid of being misunderstood. Alternatively, depressed teens may simply have a hard time expressing what they’re feeling.

If your teen claims nothing is wrong, but has no explanation for what is causing the depressed behavior, you should trust your instincts. Remember that denial is a strong emotion. Furthermore, teenagers may not believe that what they’re experiencing is the result of depression.

Getting treatment for teen depression

Depression is very damaging when left untreated, so don’t wait and hope that the symptoms will go away. If you see depression’s warning signs, seek professional help.

Make an immediate appointment for your teen to see the family physician for a depression screening. Be prepared to give your doctor specific information about your teen’s depression symptoms, including how long they’ve been present, how much they’re affecting your child’s daily life, and any patterns you’ve noticed. The doctor should also be told about any close relatives who have ever been diagnosed with depression or another mental health disorder. As part of the depression screening, the doctor will give your teenager a complete physical exam and take blood samples to check for medical causes of your child’s symptoms.

Seek out a depression specialist

If there are no health problems that are causing your teenager’s depression, ask your doctor to refer you to a psychologist or psychiatrist who specializes in children and adolescents. Depression in teens can be tricky, particularly when it comes to treatment options such as medication. A mental health professional with advanced training and a strong background treating adolescents is the best bet for your teenager’s best care.

When choosing a specialist, always get your child’s input. Teenagers are dependent on you for making many of their health decisions, so listen to what they’re telling you. No one therapist is a miracle worker and no one treatment works for everyone. If your child feels uncomfortable or is just not ’connecting’ with the psychologist or psychiatrist, ask for a referral to another provider that may be better suited to your teenager.

Don’t rely on medication alone

Expect a discussion with the specialist you’ve chosen about treatment possibilities for your son or daughter. There are a number of treatment options for depression in teenagers, including one-on-one talk therapy, group or family therapy, and medication.

Talk therapy is often a good initial treatment for mild to moderate cases of depression. Over the course of therapy, your teen’s depression may resolve. If it doesn’t, medication may be warranted. However, antidepressants should only be used as part of a broader treatment plan.

Unfortunately, some parents feel pushed into choosing antidepressant medication over other treatments that may be cost-prohibitive or time-intensive. However, unless your child is considered to be high risk for suicide (in which case medication and/or constant observation may be necessary), you have time to carefully weigh your options before committing to any one treatment.

Risks of teenage antidepressant use

In severe cases of depression, medication may help ease symptoms. However, antidepressants aren’t always the best treatment option. They come with risks and side effects of their own, including a number of safety concerns specific to children and young adults. It’s important to weigh the benefits against the risks before starting your teen on medication.

Antidepressants and the teenage brain

Antidepressants were designed and tested on adults, so their impact on the youthful, developing brain is not yet completely understood. Some researchers are concerned that the use of drugs such as Prozac in children and teens might interfere with normal brain development. The human brain is developing rapidly in young adults, and exposure to antidepressants may impact that development—particularly the way the brain manages stress and regulates emotions.

Antidepressant suicide warning for teens

Antidepressant medications may increase the risk of suicidal thinking and behavior in some teenagers. All antidepressants are required by the U.S. Food and Drug Administration (FDA) to carry a “black box” warning label about this risk in children, adolescents, and young adults up to the age of 24. The risk of suicide is highest during the first two months of antidepressant treatment.

Certain young adults are at an even greater risk for suicide when taking antidepressants, including teens with bipolar disorder, a family history of bipolar disorder, or a history of previous suicide attempts.

Teenagers on antidepressants should be closely monitored for any sign that the depression is getting worse. Warning signs include new or worsening symptoms of agitation, irritability, or anger. Unusual changes in behavior are also red flags.

According to FDA guidelines, after starting an antidepressant or changing the dose, your teenager should see their doctor:

• Once a week for four weeks
• Every 2 weeks for the next month
• At the end of their 12th week taking the drug
• More often if problems or questions arise

Supporting a teen through depression treatment

As the depressed teenager in your life goes through treatment, the most important thing you can do is to let him or her know that you’re there to listen and offer support. Now more than ever, your teenager needs to know that he or she is valued, accepted, and cared for.

• Be understanding. Living with a depressed teenager can be difficult and draining. At times, you may experience exhaustion, rejection, despair, aggravation, or any other number of negative emotions. During this trying time, it’s important to remember that your child is not being difficult on purpose. Your teen is suffering, so do your best to be patient and understanding.
• Encourage physical activity. Encourage your teenager to stay active. Exercise can go a long way toward relieving the symptoms of depression, so find ways to incorporate it into your teenager’s day. Something as simple as walking the dog or going on a bike ride can be beneficial.
• Encourage social activity. Isolation only makes depression worse, so encourage your teenager to see friends and praise efforts to socialize. Offer to take your teen out with friends or suggest social activities that might be of interest, such as sports, after-school clubs, or an art class.
• Stay involved in treatment. Make sure your teenager is following all treatment instructions and going to therapy. It’s especially important that your child takes any prescribed medication as instructed. Track changes in your teen’s condition, and call the doctor if depression symptoms seem to be getting worse.
• Learn about depression. Just like you would if your child had a disease you knew very little about, read up on depression so that you can be your own “expert.” The more you know, the better equipped you’ll be to help your depressed teen. Encourage your teenager to learn more about depression as well. Reading up on their condition can help depressed teens realize that they’re not alone and give them a better understanding of what they’re going through.

The road to your depressed teenager’s recovery may be bumpy, so be patient. Rejoice in small victories and prepare for the occasional setback. Most importantly, don’t judge yourself or compare your family to others. As long as you’re doing your best to get your teen the necessary help, you’re doing your job.

Taking care of the whole family when one child is depressed

As a parent dealing with teen depression, you may find yourself focusing all your energy and attention on your depressed child. Meanwhile, you may be neglecting your own needs and the needs of other family members. While helping your depressed child should be a top priority, it’s important to keep your whole family strong and healthy during this difficult time.

• Take care of yourself – In order to help a depressed teen, you need to stay healthy and positive yourself, so don’t ignore your own needs. The stress of the situation can affect your own moods and emotions, so cultivate your well–being by eating right, getting enough sleep, and making time for things you enjoy.
• Reach out for support – Get the emotional support you need. Reach out to friends, join a support group, or see a therapist of your own. It’s okay to feel overwhelmed, frustrated, helpless, or angry. The important thing is to talk about how your teen’s depression is affecting you, rather than bottling up your emotions.
• Be open with the family – Don’t tiptoe around the issue of teen depression in an attempt to “protect” the other children. Kids know when something is wrong. When left in the dark, their imaginations will often jump to far worse conclusions. Be open about what is going on and invite your children to ask questions and share their feelings.
• Remember the siblings – Depression in one child can cause stress or anxiety in other family members, so make sure “healthy” children are not ignored. Siblings may need special individual attention or professional help of their own to handle their feelings about the situation.
• Avoid the blame game – It can be easy to blame yourself or another family member for your teen’s depression, but it only adds to an already stressful situation. Furthermore, depression is normally caused by a number of factors, so it’s unlikely—except in the case of abuse or neglect—that any loved one is “responsible.”

DEPRESSION

Depression makes you feel helpless and hopeless, but there’s a lot you can do to change how you feel. With help and support, you can overcome depression and get your life back.

The key to recovery is to start small and take things one day at a time. Learning about depression—including its symptoms, causes, and treatments—is a good place to start.

Understanding Depression

SIGNS, SYMPTOMS, CAUSES, AND HELP

Feeling down from time to time is a normal part of life. But when emptiness and despair take hold and won't go away, it may be depression. More than just the temporary "blues," the lows of depression make it tough to function and enjoy life like you once did. Hobbies and friends don’t interest you like they used to; you’re exhausted all the time; and just getting through the day can be overwhelming. When you’re depressed, things may feel hopeless, but with help and support youcan get better. But first, you need to understand depression. Learning about depression—including its signs, symptoms, causes, and treatment—is the first step to overcoming the problem.

What is depression?

We all go through ups and downs in our mood. Sadness is a normal reaction to life’s struggles, setbacks, and disappointments. Many people use the word “depression” to explain these kinds of feelings, but depression is much more than just sadness.

Some people describe depression as “living in a black hole” or having a feeling of impending doom. However, some depressed people don't feel sad at all—they may feel lifeless, empty, and apathetic, or men in particular may even feel angry, aggressive, and restless.

Whatever the symptoms, depression is different from normal sadness in that it engulfs your day-to-day life, interfering with your ability to work, study, eat, sleep, and have fun. The feelings of helplessness, hopelessness, and worthlessness are intense and unrelenting, with little, if any, relief.

Are you depressed?

If you identify with several of the following signs and symptoms, and they just won’t go away, you may be suffering from clinical depression.

• you can’t sleep or you sleep too much
• you can’t concentrate or find that previously easy tasks are now difficult
• you feel hopeless and helpless
• you can’t control your negative thoughts, no matter how much you try
• you have lost your appetite or you can’t stop eating
• you are much more irritable, short-tempered, or aggressive than usual
• you’re consuming more alcohol than normal or engaging in other reckless behavior
• you have thoughts that life is not worth living (Seek help immediately if this is the case)

Signs and symptoms of depression

Depression varies from person to person, but there are some common signs and symptoms. It’s important to remember that these symptoms can be part of life’s normal lows. But the more symptoms you have, the stronger they are, and the longer they’ve lasted—the more likely it is that you’re dealing with depression. When these symptoms are overwhelming and disabling, that's when it's time to seek help.

Common signs and symptoms of depression

• Feelings of helplessness and hopelessness. A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation.
• Loss of interest in daily activities.  No interest in former hobbies, pastimes, social activities, or sex. You’ve lost your ability to feel joy and pleasure.
• Appetite or weight changes. Significant weight loss or weight gain—a change of more than 5% of body weight in a month.
• Sleep changes. Either insomnia, especially waking in the early hours of the morning, or oversleeping (also known as hypersomnia).
• Anger or irritability. Feeling agitated, restless, or even violent. Your tolerance level is low, your temper short, and everything and everyone gets on your nerves.
• Loss of energy. Feeling fatigued, sluggish, and physically drained. Your whole body may feel heavy, and even small tasks are exhausting or take longer to complete.
• Self-loathing. Strong feelings of worthlessness or guilt. You harshly criticize yourself for perceived faults and mistakes.
• Reckless behavior. You engage in escapist behavior such as substance abuse, compulsive gambling, reckless driving, or dangerous sports.
• Concentration problems. Trouble focusing, making decisions, or remembering things.
• Unexplained aches and pains. An increase in physical complaints such as headaches, back pain, aching muscles, and stomach pain.

Depression and suicide

Depression is a major risk factor for suicide. The deep despair and hopelessness that goes along with depression can make suicide feel like the only way to escape the pain. Thoughts of death or suicide are a serious symptom of depression, so take any suicidal talk or behavior seriously. It's not just a warning sign that the person is thinking about suicide: it's a cry for help.

Warning signs of suicide include:

• Talking about killing or harming one’s self
• Expressing strong feelings of hopelessness or being trapped
• An unusual preoccupation with death or dying
• Acting recklessly, as if they have a death wish (e.g. speeding through red lights)

• Calling or visiting people to say goodbye
• Getting affairs in order (giving away prized possessions, tying up loose ends)
• Saying things like “Everyone would be better off without me” or “I want out”
• A sudden switch from being extremely depressed to acting calm and happy

If you think a friend or family member is considering suicide, express your concern and seek professional help immediately. Talking openly about suicidal thoughts and feelings can save a life.

The faces of depression

Depression often looks different in men and women, and in young people and older adults. An awareness of these differences helps ensure that the problem is recognized and treated.

Depression in men

Depression is a loaded word in our culture. Many associate it, however wrongly, with a sign of weakness and excessive emotion. This is especially true with men. Depressed men are less likely than women to acknowledge feelings of self-loathing and hopelessness. Instead, they tend to complain about fatigue, irritability, sleep problems, and loss of interest in work and hobbies. Other signs and symptoms of depression in men include anger, aggression, violence, reckless behavior, and substance abuse. Even though depression rates for women are twice as high as those in men, men are a higher suicide risk, especially older men.

To learn more, see Depression in Men: Understanding and Dealing with Male Depression.

Depression in women

Rates of depression in women are twice as high as they are in men. This is due in part to hormonal factors, particularly when it comes to premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), postpartum depression, and perimenopausal depression. As for signs and symptoms, women are more likely than men to experience pronounced feelings of guilt, sleep excessively, overeat, and gain weight. Women are also more likely to suffer from seasonal affective disorder.

To learn more, see Depression in Women: Causes, Symptoms, and Treatment.

Depression in teens

While some depressed teens appear sad, others do not. In fact, irritability—rather than depression—is frequently the predominant symptom in depressed adolescents and teens. A depressed teenager may be hostile, grumpy, or easily lose his or her temper. Unexplained aches and pains are also common symptoms of depression in young people.

Left untreated, teen depression can lead to problems at home and school, drug abuse, self-loathing—even irreversible tragedy such as homicidal violence or suicide. But with help, teenage depression is highly treatable.

To learn more, see Teen Depression: A Guide for Parents and Teachers.

Depression in older adults

The difficult changes that many older adults face—such as bereavement, loss of independence, and health problems—can lead to depression, especially in those without a strong support system. However, depression is not a normal part of aging. Older adults tend to complain more about the physical rather than the emotional signs and symptoms of depression, and so the problem often goes unrecognized. Depression in older adults is associated with poor health, a high mortality rate, and an increased risk of suicide, so diagnosis and treatment are extremely important.

Types of depression

Depression comes in many shapes and forms. The different types of depression have unique symptoms, causes, and effects. Knowing what type of depression you have can help you manage your symptoms and get the most effective treatment.

Major depression

Major depression is characterized by the inability to enjoy life and experience pleasure. The symptoms are constant, ranging from moderate to severe. Left untreated, major depression typically lasts for about six months. Some people experience just a single depressive episode in their lifetime, but more commonly, major depression is a recurring disorder. However, there are many things you can do to support your mood and reduce the risk of recurrence.

Atypical Depression

Atypical depression is a common subtype of major depression. It features a specific symptom pattern, including a temporary mood lift in response to positive events. You may feel better after receiving good news or while out with friends. However, this boost in mood is fleeting. Other symptoms of atypical depression include weight gain, increased appetite, sleeping excessively, a heavy feeling in the arms and legs, and sensitivity to rejection. Atypical depression responds better to some therapies and medications than others, so identifying this subtype can be particularly helpful.

Dysthymia (recurrent, mild depression)

Dysthmia is a type of chronic “low-grade” depression. More days than not, you feel mildly or moderately depressed, although you may have brief periods of normal mood. The symptoms of dysthymia are not as strong as the symptoms of major depression, but they last a long time (at least two years). These chronic symptoms make it very difficult to live life to the fullest or to remember better times. Some people also experience major depressive episodes on top of dysthymia, a condition known as “double depression.” If you suffer from dysthymia, you may feel like you’ve always been depressed. Or you may think that your continuous low mood is “just the way you are.” However, dysthymia can be treated, even if your symptoms have gone unrecognized or untreated for years.

Seasonal affective disorder (SAD)

There’s a reason why so many movies and books portray rainy days and stormy weather as gloomy. Some people get depressed in the fall or winter, when overcast days are frequent and sunlight is limited. This type of depression is called seasonal affective disorder (SAD). Seasonal affective disorder is more common in northern climates and in younger people. Like depression, seasonal affective disorder is treatable. Light therapy, a treatment that involves exposure to bright artificial light, often helps relieve symptoms.

Depression causes and risk factors

Some illnesses have a specific medical cause, making treatment straightforward. If you have diabetes, you take insulin. If you have appendicitis, you have surgery. But depression is more complicated. Depression is not just the result of a chemical imbalance in the brain, and is not simply cured with medication. Experts believe that depression is caused by a combination of biological, psychological, and social factors. In other words, your lifestyle choices, relationships, and coping skills matter just as much—if not more so—than genetics. However, certain risk factors make you more vulnerable to depression.

Causes and risk factors for depression

• Loneliness
• Lack of social support
• Recent stressful life experiences
• Family history of depression
• Marital or relationship problems

• Financial strain
• Early childhood trauma or abuse
• Alcohol or drug abuse
• Unemployment or underemployment
• Health problems or chronic pain