An expert talks about depression…what it is, how to recognize it, how to get help

By Judie Jacobson

On Monday, August 11, actor and comedian Robin Williams shocked the world by committing suicide in his home in northern California. According to reports, though the star’s family and friends were caught completely off-guard – none had any indication that Williams was planning to end his life – many were aware of his ongoing battle with depression.

And so, a national conversation has begun. The circumstances of Williams’ death have brought to the forefront the issue of clinical depression.

To help shed light on the issue of depression, the Ledger turned to Janice Rothstein, who has served as clinical director of Jewish Family Service of Greater Hartford since 2001. Rothstein holds a Masters degree in education, counseling and special education.  She spoke with the Ledger about what depression is and how to help yourself or a loved one suffering from its effects.

Q: Can you define depression? What is the difference between depression and feeling low?

A: The DSM – the Diagnostic and Statistical Manual of Mental Disorders — is the standard classification of mental disorders that is used by mental health professionals, and it has established the criteria for depression. There are five out of nine symptoms you would have to have to be considered clinically depressed, and these are symptoms that you may recognize in yourself or others may observe in you:

(1) depressed mood – for example, being tearful or feeling sad;
(2) significantly decreased pleasure or interest in activities which you used to give you pleasure;
(3) significant fluctuation in weight, without attempting to gain or lose weight, or a decrease or increase in appetite;
(4) diminished ability to think, concentrate or make decisions;
(5) change in sleep pattern – whether it’s sleeping too much or not sleeping at all;
(6) fatigue or loss of energy;
(7) feeling of apathy or agitation;
(8) excessive or inappropriate guilt feelings or a feeling of worthlessness;
(9) recurrent thoughts of death or suicide.

These are all things that would constitute a change in the way someone has presented in the past; whether it’s your sleep, your appetite, fatigue, irritability, etc.; someone who didn’t exhibit these symptoms before and is now experiencing many of them, and has been experiencing them for a period of two weeks or more.

All these things impact not only the individual, but the individual’s family as well, and his or her relationships with family. Likewise, it could impact a person’s performance and relationships at school or at work.

People observing a person who suffers from these symptoms may say, “snap out of it” – but this is not something you’re snapping out of. There are other issues that mimic depression, in that they share some of the same symptoms – for example, substance abuse, bereavement, certain medical illnesses – but the feeling of living in a black hole, the feeling of emptiness, of significant sadness that lasts for many days, this is clinical depression.

Q: Can clinical depression pass on its own or is help needed to work through depression?

A: Typically, depression does not pass on its own. We’re talking about something that’s different from being down or feeling sad. Everybody feels sad now and then, but there’s a different quality to it. It’s all-consuming and it needs to be treated.

Q: Is this a genetic condition? Can it be passed down in families?

A: It can be. There can be a predisposition to depression.

Q: Do depression and substance abuse go hand in hand? And, if so, which is likely to have come first?

A: That’s a very good question and it would be hard to tease out. But it would be important to treat both. Some people may feel depressed and may use substances to numb the pain.

Q: Is there a misconception about depression that deters people from seeking help?

A: There certainly has been. In the past, people have not viewed depression as an illness, and that’s unfortunate. It has kept people from talking freely. If there is any good that comes out of this or similar instances, hopefully it will allow people to talk more openly about their depression. Because depression is a brain disorder – it’s a physical disorder like any other, much like diabetes or high blood pressure or cancer.

With Robin Williams’ death, [the public] is now looking at this and talking about it, and the media is focusing on it and talking about; so, perhaps we’re normalizing feelings and beginning to view depression as what it is: not as a behavioral issue, but as a brain disorder.

Q: Is there a clear point in the trajectory of depression when one crosses the line into attempting suicide? 

A: It’s very individualized. There is a power to depression and an impulsiveness to suicide.

People who have a completed suicide are not thinking clearly. At that moment they can’t solve problems; they’re not able to consider the consequences. They’re not thinking about dying, they’re thinking about ending the pain. Depression and feeling suicidal really impairs reality, so that you’re not thinking about leaving your loved ones or anything else, you’re thinking about getting rid of the pain at that moment.

People who are intent on killing themselves – people who attempt suicide and are not successful the first time – often will try again.

Q: Are there some people who are at a higher risk for depression?

A: There are. And if we look at the groups who are at a higher risk, we can see how someone like Robin Williams clearly falls into that higher risk category. The group at higher risk is middle-aged Caucasian men, often with a serious medical condition, as well as a chronic depression and history of substance use. Those are the demographics.

Unfortunately, men also are traditionally less likely to seek help than women, and men utilize friendships in a different way than women do. They’re less likely to disclose their struggles to friends.

Q: The teenage years seem to be a time of increased risk for suicide. Are teens more prone to depression?

A: Absolutely. Social media – specifically, Facebook – have made the world a vastly different place than it was years ago. At JFS, we see preteens and teens who are coming in because they’re significantly depressed, and what led to that depression is often somebody posting something about them on Facebook. There are a lot of issues of poor self-esteem and low self-worth connected to the use of social media. As a result, we see an increase in depression in kids that is manifested in cutting behaviors, eating disorders, and the like. A lot of it is centered around what’s happening with all the social media junk.

Nobody is immune to depression – whether it does have a genetic underpinning or environmental stressors – as we’ve seen with Robin Wiliams, fame and power don’t make you immune to this tragic ending.

Q: What should one do if they recognize they are experiencing clinical depression?

A: Get yourself psychiatric help, psychotherapy and medication. There are some newer treatments now that are very successful. Also, do not give up hope. That’s important for family members to remember as well. Family members can also get help, perhaps in a support group. Families can also stage interventions, either using the guidance of a professional or on their own; the family sits together and tells the person of their concerns. If they can, they get the person to a hospital or to talk to a doctor, if the person is not yet in treatment.

There are also suicide hotlines; depression hotlines; calling 911 or 211, which is a United Way hotline for suicide depression. Many places have programs for depression, as well as substance abuse: They include, in the Hartford area, the Institute of the Living, Saint Francis Hospital, John Dempsey Hospital, and others. All of these have programs for depression and substance abuse.

JFS as well as other area outpatient mental health clinics do work with individuals, children and adults, with mood disorders and depression, and we have two psychiatrists on staff to treat depression and we provide psychiatric assessment and medication management.

People should be aware that the Mental Health Parity and Addiction Equity Act of 2008 requires company insurance plans to treat mental illness and substance abuse problems the same as physical illness, such as heart disease or cancer. Likewise, the 2010 Affordable Care Act has extended that same protection to the individual insurance market allowing adults up to the age of 26 to stay on their parents health insurance, so that people could access services.

I think the more that people are talking about this will help raise awareness, and that’s a good thing. And hopefully remove some of the stigma that exists and has existed for so long.

Comments? judiej@jewishledger.com.

The Warning Signs of Suicide With Depression
Depression carries a high risk of suicide. Anybody who expresses suicidal thoughts or intentions should be taken very seriously. If someone you know is demonstrating any of the warning signs of suicide with depression listed below, either call your local suicide hot line, contact a mental health professional right away, or go to the emergency room for immediate treatment.

Call: 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255) — or the deaf hotline at 1-800-799-4TTY (1-800-799-4889).

Warning signs of suicide with depression include:
• A sudden switch from being very sad to being very calm or appearing to be happy
• Always talking or thinking about death
• Clinical depression (deep sadness, loss of interest, trouble sleeping and eating) that gets worse
• Having a “death wish,” tempting fate by taking risks that could lead to death, such as driving through red lights
• Losing interest in things one used to care about
• Making comments about being hopeless, helpless, or worthless
• Putting affairs in order, tying up loose ends, changing a will
• Saying things like “It would be better if I wasn’t here” or “I want out”
• Talking about suicide (killing one’s self)
• Visiting or calling people one cares about

Getting Help
There are eight Jewish Family Service (JFS) agencies throughout the state, all of which offer counseling and other services for those suffering from depression. Listed below are the towns in which they are located along with contact information:

Danbury – (203) 794-1818
Fairfield – (203) 366-5438
Greenwich – (203) 622-1881
New Haven – (203) 389-5599
Southbury – (203) 267-3177
Stamford – (203) 921-4161
West Hartford – (860) 236-1927
Westport – (203) 454-4992

Some other resources:
Depression and Bipolar Support Alliance – Greenwich Chapter: A weekly support group. For information visit www.dbsagreenwichct.com.

Peer-run Depression and Bipolar Support Alliance Group:

A support group that meets 6-8 p.m. every Thursday. located at St. Vincent’s Behavioral Health Services, 47 Long Lots Rd., Westport.
Contact: (203) 779-5253, branforddbsa@gmail.com.