Hidden Signs of Depression by Alberto Souza, MSN, APRN, FNP-C

Studies show about 1 out of every 6 adults will have depression at some time in their life. This means that you probably know someone who is depressed or may become depressed at some point. We often think of a depressed person as someone who is sad or melancholy. However, there are other signs of depression that can be a little more difficult to detect.

 

Trouble Sleeping

If you notice a change in a loved one’s sleeping habits pay close attention as this could be a sign of depression. Oftentimes depression leads to trouble sleeping and lack of sleep can also lead to depression.

Quick to Anger
When a person is depressed even everyday challenges can seem more difficult or even impossible to manage which often leads to increased anger and irritability. This can be especially true for adolescents and children.


Losing Interest
When someone is suffering from depression you may notice a lack of interest in past times he or she typically enjoys. “People suffering from clinical depression lose interest in favorite hobbies, friends, work — even food. It’s as if the brain’s pleasure circuits shut down or short out.”


Appetite Changes
Gary Kennedy, MD, director of geriatric psychiatry at Montefiore Medical Center in Bronx, New York cautions that a loss of appetite can be a sign of depression or even a sign of relapse back into depression. Dr. Kennedy also points out that others have trouble with overeating when they are depressed.


Low Self-Esteem

Depression often leaves people feeling down about themselves. Depression can lead to feelings of self-doubt and a negative attitude.

 

What to do
If you suspect you or someone you love may be suffering from depression talk about it, encourage him or her to get professional help and once he or she does be supportive. Remember that at times symptoms of depression need to be treated just like any other medical condition.

Sources

Healthtalk.org

helpguide.org

Psychology Today

About the Author:  Alberto has worked in healthcare for over 10 years. He began as a CNA and then worked as a registered nurse until completing his Master’s Degree in Nursing.  Alberto has been been working as a Nurse Practitioner since April of 2013.  In addition to his work as a Nurse Practitioner, he also teaches online classes for the Dixie State University Nursing Program.  He is currently working at the St. George Center For Couples & Families.

Telling Your Kids About Divorce

Making the decision to divorce is hard enough when thinking about only the spouses involved, add kids to the mix and things get ten times more difficult. If you are going through a divorce, most likely you are concerned about how your decision to separate will affect your children, and how are you going to tell them? As parents we are constantly trying to protect our children from any pain and suffering, the reality is that the news of your parents’ divorcing, no matter how carefully delivered, is going to cause some kind of pain, hurt, or confusion in the eyes of your child.  Although you can’t control how you or your child will feel during this stressful time in your lives, you can make the choice to commit to seeking out effective ways to handle and offer a positive healthy source of support for your children. Committing to this will allow them to adjust to the divorce in a positive way, and in their own way as you lovingly guide them through the process.

TIPS  

  • If possible the news of the divorce should come from both Mom and Dad together as a family.  During this conversation stress the fact that even though family life is going to look very different, you will both continue to love them.
  • Tell the children that the divorce has nothing to do with anything that any of the children may have done or not done. Reassure them that they are not the cause of the divorce.
  • Children thrive on structure, especially during transition periods. Keep a daily routine with school, activities, and their regular everyday life. Keeping as much consistency as possible helps the children to feel more secure.
  • Having some kind of a plan of what life might now look like for them can be very beneficial. It is comforting for them to know where they will be going to school, where they will be sleeping, and how often they will see mom or dad. Nothing is permanent in this arrangement but offering them some sort of idea of how their lives will and won’t change will again help them to feel secure.  
  • Address your children’s concerns. Encourage them to talk, scream, cry or celebrate. Help them to feel safe in expressing their feelings.
  • Lastly make sure that they are told how much you both love them and how that will never change.

Studies show that children do best and have fewer long term emotional, social or academic problems, when parents can establish a healthy, respectful, co-parenting relationship. Transitioning into a new type of relationship and putting aside the hurt and anger that are associated with the broken marriage can be extremely difficult for many parents to accomplish. But through patience with each other and hard work it can be done. Divorce changes families but it does not end your commitment to your children. Make sure you take the time to find the solutions that work best for your family to ensure a positive outcome for you and your children.

**If you or your children are struggling to deal with the life transitions involved with divorce, seek out professional assistance for individual or family therapy. The therapist can assist in encouraging better communication, and helping all families member to properly heal and process the trauma of divorce.

 

Brandi Hess, MA, LAMFT

Brandi Hess has a passion for helping people to work through life’s difficulties, assisting them in finding joy, and the strength to reach their full potential. Brandi strives to ensure that she understands each of her clients’ unique needs. She provides therapy and counseling sessions tailored specifically to obtain her clients’ goals, in an individual or family setting. She offers a kind, honest, and straight-forward approach in therapy, allowing for trusting relationships to be built. She specializes in couples and family distress, pre/post-divorce, and adolescent treatment. One of Brandi’s many strengths is being able to connect with adolescents by creating a therapeutic environment where the adolescent feels safe and willing to start the process of change. Brandi works with a variety of concerns such as depression/anxiety, women’s issues, and trauma. Brandi received her Bachelors of Science in Human Development and Family Studies at the University of Utah, and her Master’s degree in Marriage & Family Therapy from Argosy University.

Pornography Addiction: An Epidemic

Pornography is a big business. Americans spent 97 billion dollars on pornography over the past five years. The monetary cost of this epidemic is only a part of the real cost of this problem in our country. Over the past decade, increasing attention has been given to the damaging effects of pornography on the brain and, by extension, the lives of individuals and families. The accessibility of pornographic material and the multitude of technologic means by which it comes into our lives has brought this issue increasingly into the spotlight. In fact, you may be reading this because pornography has impacted you, personally, or someone you love.  

There has been controversy in the psychiatric literature about whether those who struggle with pornography are “addicted.” Whether or not it is formally designated in the professional literature as an addictive disorder, it certainly has been shown to affect the brain and the lives of its users in ways consistent with other addictive disorders. As with any addiction, an understanding of the process is key. Let’s start with how the brain responds to pornography. Our brains are designed to catalog our experiences with the end goal of preserving life and eliminating threats to our safety. Essentially, our brains are effective at remembering what feels good and what doesn’t. While this process is complex, a basic understanding of a few key brain chemicals is critical. 

The brain responds to pornography by releasing a powerful chemical called dopamine. Dopamine is released whenever we have pleasurable experiences. The release of dopamine and another powerful chemical called epinephrine (adrenaline) floods the brain in connection with pornography. With repeated exposure, a neural pathway in the brain is created that links arousal and associated neuro-chemicals dopamine and adrenaline with pornography use. As pornography exposure and dopamine release increases, dopamine receptors are eliminated. This “flooding” of the brain creates habituation or tolerance, resulting in the need for even greater stimulus (more explicit and “hard-core” pornography, novelty and intensity) to achieve the same effect.  

Dr. Donald L. Hilton, Jr. MD, a neurosurgeon at the University of Texas, has written extensively about the effects of pornography on the brain. His research and other reviews conclude that the effects of pornography on the brain are comparable to potent drugs, such as cocaine. He also explains that when the body orgasms, the brain produces a particular neurotransmitter called “oxytocin” which creates bonding. Oxytocin is also secreted in the brains of babies and moms during breastfeeding. So we are literally bonding to pornography (a digital image) when we reach climax. In an article published in the Harvard Crimson, Dr. Hilton states that “pornography emasculates men—they depend on porn to get sexually excited and can no longer get off by having sex with their women alone. What happens when you are addicted to porn is that you crave it. Real sex even becomes a poor substitute for porn, and you lose interest.” ¹ 

A final neurophysiologic effect of pornography is the damage created to the impulse control center of the brain, the pre-frontal cortex. With constant flooding of the brain with dopamine and epinephrine, there is a reduction in size and control of this area. Essentially, the ability to self-regulate and exercise impulse control is reduced until, ultimately, the addiction drives appetites, desires, and behaviors. As individuals fall into the grip of this addiction, they often experience other effects, such as isolation, depression, anxiety, sexual dysfunction, and relationship distress, among others – all of which spiral the individual away from resources that can lift and help them toward recovery and healing.  

As awareness of this issue increases, so do resources aimed at educating and assisting those affected by pornography addiction. A relatively new campaign called “Fight The New Drug” (www.fightthenewdrug.org) is an excellent resource for those seeking more information regarding the impact of pornography. There are also many religious/spiritually-based programs available², many of which are based on the twelve-step program utilized by Alcoholics Anonymous (AA).  

Pornography Counseling

Pornography addiction is becoming more prevalent in our society. Organizations like Fight the New Drug do a great job of educating the public on the harmful effects of pornography. What do you do if you struggle and can’t seem to find a way out? For many, the way out seems elusive and unobtainable. It’s difficult to find how when you have tried so many things, only to have this problem keep coming back. Many that come into counseling have already been before and are discouraged that they just can’t ‘get over it’. Knowing how to use the power or education and relationships is part of the answer. A good therapist can help you access both in your efforts to let go of this addiction. At the Center for Couples and Families we specialize in relationship therapy in regard to pornography use. Knowing how to communicate with your loved ones about this difficulty is an important part of the process.

An Ethic to Live: Building Barriers to Suicide Around Ourselves & Those We Love

In cities throughout the world, notable high buildings and bridges increasingly have additional fencing built atop of them with the specific purpose of preventing suicides. Suicide fences tend to work because research has shown that suicidal actions are frequently impulsive, hence such fences serve to forestall that impulse and buy individuals precious time to further think about their decisions. In studies of suicide fences, it appears that individuals don’t leave such barriers to go look for another bridge or tall building to end their lives from, but instead return to the business of living for yet another day.  

Presently suicide is the leading cause of death among young people ages 10-17 here in Utah, and over the last decade, it’s also doubled amongst adults in our state. As concerned friends, neighbors, and parents, how do we help our community build more barriers to suicide; protecting and empowering those we love? Over the next year, I’ll be writing a series of articles in answer to this question; offering my perspective as both a therapist, who has stood on sacred ground in helping others walk back from suicidal thinking, and as one who’s felt and ultimately rejected the dark pull to end my life amidst heavy times.   

Perhaps you’ve already noted that there’s no way to build suicide fences everywhere or to somehow block all of the endless ways in which someone might consider ending their life. Sound public policies on prevention and physical barriers like suicide fences are only some of the important ways to help. So in addition to these forms of prevention, the focus of my writing will be on how to build barriers to suicide directly into the thinking and values of individuals, and into the culture of our community as a whole. In this first article, I want to introduce how we help foster an ethic to live within ourselves and in others as a key barrier to suicide.  

An ethic to live means valuing our lives and holding a commitment within ourselves to continue living — even when we’re unsure of how we’ll cope or move forward. In my experience, helpful conversations about consciously building an ethic to live, begin by first taking care to turn our attention to the reality that to live is to be vulnerable to an array of difficult life experiences, with the potential to evoke within us the thought to end one’s life to escape them. Throughout human history, individuals and peoples have had to confront extremely painful and unjust challenges which have overwhelmed their sense of being able to continue on, and it’s important to acknowledge that when we confront such considerable pain, it is the most human thing in the world to want relief from it. This is real; excruciating human suffering beyond one’s current sense of how to reduce or stop it is real, and in these concentrations of pain, we may find ourselves having suicidal thoughts.  

When we acknowledge and honor that such excruciating life experiences do show up for many of us, it’s then that we can locate where we need to begin building internal fences to prevent suicide. It’s here that we recognize the need to develop a strong ethic to live even though there are times that we might not yet fully know how we’ll cope or be able to see brighter ways forward. It’s also here that we find the need to define as individuals what makes life worth living with specificity to our own life experiences, as well as the need to find a listener who we can turn to and voice what’s going on inside of us. 

As you navigate life’s difficulties, no matter how hard things may get, make the commitment now to live and identify your personal reasons to do so. Additionally, identify suicidal thoughts as a  sign to find a listener who you feel safe enough to talk to. It’s worth thinking about right now who it is you might feel comfortable turning to during your hardest times. By doing so, you’ll begin to build your own internal fence between you and suicide as well as have greater insight as to how to help others you care about to do the same.  

* If you or someone you care about is currently having thoughts of ending their life, caring help is available 24/7 by texting 741741 from anywhere in the USA or you can call 1-800-273-8255 to speak directly with a Counselor from the National Suicide Prevention Lifeline. 

Bio: Laura Skaggs Dulin holds a master’s degree in Marriage and Family Therapy from San Diego State University. She currently sees clients at the Spanish Fork Center for Couples and Families and at Encircle LGBT Youth and Family Resource Center in Provo.  

A New Start. A New Journey. A New You. How the right therapy, and the right therapist can help get you there by David Nutter, MA, LAMFT

New starts in life often happen when people decide to engage therapy. Whenever I meet new clients as individuals, couples, or even families, I ask them what their goals are in therapy. For some, they have not been asked about what they need, want, or even prefer in their lives for a long time. For others, it often feels that they have never been heard at all, let alone asked. What happens when you go to therapy? What type of model and style of therapy will the person you see provide? What is their level of formal training, how well attuned are they to meet your needs and do they rely on any other resources other than their self-perceived competency? Understanding how much someone knows about your particular issue(s) is a critical step in selecting the type of therapist and style of therapy you will engage.

For example, as I write this article I am thinking of the many different styles of therapy available. I can immediately think of 11 different styles: structural family therapy, strategic therapy, the Milan systemic approach, the Mental Research Institute (MRI) approach, Satir’s communication approach, symbolic-experiential family therapy, intergenerational family therapy, collaborative therapy, narrative therapy, cognitive behavioral therapy and solution-focused therapy. That’s a lot of different styles of therapy, all with empirical research associated with their model and experts in each field.

Added to this list of styles of therapy are the therapists themselves. Who are you going to see and what you are likely to experience is largely dependent on the type of education they have and the experience they have with others. There is a vast difference in the education requirements to become a life coach, mental health counselor or a marriage and family therapist (MFT). There are differences in approaches and emphasis, even within the same style/model of therapy. You and the particular issues you bring to therapy may be weighing on you. The therapist fortunate enough to have you as a client should work as hard on your issues as you do.

There are resources such as books, workbooks, films, music and other sources that might resonate with you that are not particularly useful or preferred by others. You have decided to make a new start and that new start needs the support of the developing relationship of trust you are building with your therapist of choice. That relationship is essential for discussing what you want to achieve and the ways you plan to address the changes or goals you want for yourself and your relationships. Your new journey starts with a decision about what you want to experience in the future. Often this gets accomplished by a review of the past and current life experiences you have survived or thrived from. The therapist caring deeply about your experiences and your strengths will celebrate what you have achieved and where you are going. Aspects that you bring to the therapy effort are elements of the way you might describe yourself—the many facets of who you are. When people describe their experiences in therapy, I hope they include feeling heard, challenged, respected, validated, encouraged and celebrated. Their experience should feel welcomed like a friend, with a serious focus in a nurturing manner. Sometimes people cry, reflect and reconsider critical directions or attitudes they have adopted. Sometimes they laugh and release tension in a light-hearted way. New beginnings are often encouraged by a therapist going the extra mile along side of you, so you can keep going more miles, confidently forward. Welcome to your new start.

 

About the Author:

David Nutter is an Associate Marriage and Family Therapist at the St. George Center For Couples & Families. His career experience includes military service, management and executive positions and international business consulting. He received his undergraduate degree from BYU and his Masters in Marriage and Family Therapy from Northcentral University, a COAMFTE approved program. David was inducted into two honor societies for academic and clinical excellence and is enrolled in NCU’s PhD/ MFT program. During his Master’s program he was mentored by Steve Allred, with a broad range of client ages and issues. He served as the SGPD Chaplain (board certified) to reduce the impact to personnel and citizens from significant trauma experiences. He is adjunct faculty at DSU. He has lived in every U.S. time zone and abroad, and appreciates diversity. David is married to his “girlfriend” Diane. Together, they call their 7 children, their spouses/partners and 5 grandchildren their immediate family.

Why Should Couples Consistently Set New Year’s Resolutions Together? By Dr. Matt Eschler, Ph.D, LMFT

I have counseled couples for twenty-five years. Panicking, anxiously pacing, wringing hands, couples have wandered into my office, hoping to find some peace in their relationships. In the counseling arena we explore some very principled foundation ingredients that, when mixed together, produce peaceful, passionate relationships.

There are three fundamental ingredients that all of us need to exercise for a shot at a sound relationship. My challenge to you is to sit with your lover and assess the following three principles, and set specific goals to learn a little more, stand a little more firm, and increase your skills in these three areas:

The first foundation principle is friendship. Friendship is unilateral. Increase your friendship with your lover every couple of hours. You do this by sharing information, being trustworthy, and being transparent—without conditions.

The second principle that relationships will not survive without is influence. You must accept your lover’s influence. Men seem to have a slightly more difficult time with this, but both partners will benefit from allowing influence. Think about a time when there was disagreement in direction of relationship or activity. Did you allow your lover to have influence? Did you argue until one of you gave in? Was their healthy negotiation until a mutually satisfying result occurred? The hope is always influence and no competition. Get a little better at this in 2018!

Finally, the third principle is generating a governing purpose for your marriage. This is the North Star that holds you both accountable to a result that is desirable and cherished. If you are seeking the same purpose, you won’t go after hostile results. For example, my wife and I want to travel the world. If I sneak out and spend our travel money on a new truck and lots of clothes, we won’t have resources available to travel. That causes issues. If I save and we put our travel fund together and watch it grow together, we will eventually accomplish our common goal.

I invite you all to accept this challenge: In 2018 be a little bit better in all three of these areas. Sit with your lover and map out a specific strategy to accomplish these three goals to improve your relationship.

 

About the Author: Matt lives in St. George, Utah where he and his wife Chris are enjoying their life with each other. Since their kids have grown and moved out perusing their dreams Matt and Chris travel the world. They want to visit 200 countries before the are done. Matt and Chris are active in their community and enjoy working out, training for marathons, and spending time participating in numerous activities with their adult children.  Matt has received his PhD in Psychology. He is focused on the arena of resolving personal conflicts and improving interpersonal relationships. In addition to his Doctorate Degree Matt has earned a Masters in Marriage and Family Therapy, studied Criminal Justice and received a category I licensure with Peace Officer Standard of Training along with a degree in the Arts of Business Management. Matt is a professor at Dixie State University and hopes to be part of the positive growth of Southern Utah.

Forced Apologies

My four-year-old daughter placed herself in the middle of our living room to play with blocks. She was so engrossed with building a wooden castle that she didn’t notice her two-year-old sister walking towards her with her right arm stretched far back to slap her older sister across the head. When that slap came, my older daughter went from happy to surprise to anger and then lots of tears. She ran towards me seeking justice. “Mommy, she hit me!” My younger daughter remained still, looking innocent. I immediately walked over to her with my older daughter in hand and said, “Hands are not for hitting. Say sorry for hitting please.”  I’m sure many parents can relate to this scenario. Teaching our children the skills for making amends is an important life skill and is not so much about saying the words “I’m sorry”.  

There is a belief amongst some parents that enforcing premature apologies on children is not effective. Their reasoning is that premature apologies teach children to lie and encourage insincerity. It also creates shame and embarrassment. Other studies show that young children have the ability to be empathetic even before they can speak; therefore, parents should encourage apologies (Smith, Chen, Harris; 2010). As I reflected on my research and my knowledge as a Marriage and Family Therapist, I recognized several things we can do as parents to create productive apologies: 

  1. Keep yourself in check: It’s frustrating to see your children fight, especially when it happens at inconvenient times. However, it’s important to remain calm and model for your children how to handle frustration.   
  2. Be immediate when possible: When you see an incident occur between your children, address it. The best time for learning and growth is when the incident is still fresh in their minds. However, when there are time constraints and the issue cannot be addressed right away, it is important to tell your children when and where it will be addressed. Be consistent when using the alternative and follow through.  
  3. Ask instead of tell: Avoid lecturing. Ask questions instead. “Tell me what happened?” “What were you feeling when you hit your sister?” Validate the expressed emotion and help them to understand that it is okay to feel frustration and sadness; however, it is not okay to hit or throw things. Help them to also make the connection between emotion and action. “Look at her face, how do you think she’s feeling right now?” Asking these types of questions enhances empathy. 
  4. Problem Solve: Ask questions about what they think they should do when they feel frustrated or sad. Help them to come up with solutions.  Ask questions about how they can make things better with their sibling/s. 
  5. Have them practice a do-over: When your child identifies the solution, have them practice it with the other sibling/s. Praise them for their efforts at the end.    

What is more important than the phrase “I’m sorry” is what children take away from the experience. We can facilitate and enhance learning opportunities by not focusing on the phrase “I’m sorry” but instead more on what can be learned from this situation and how can we improve.  

Looking for Happiness and Finding Addiction

Our community is the epitome of mainstream America. We have deeply rooted family values, safe streets, moral standards, and most families stand guarded against outside influences that threaten our happiness. Recently, however, Utah achieved the 7th highest drug overdose rate in the nation. How can a community named Happy Valley have some of the highest rates of adult mental illness and teenage suicide in the country? 

Treating addiction is clearly a necessity. However, explaining these alarming and confusing statistics may also come down to understanding some myths, or assumptions, about happiness.  

Myth No. 1: I Should Be Happy All the Time 

Some aspects of our local community amplify and reinforce the well-intended message that “good people” or “my kid” should not or would not encounter pain. At times, we may even feel entitled to getting our way and therefore feel betrayed when we stress and we encounter unwanted but normal life struggles. These challenges show up as: loneliness, divorce, work stress, relationship issues, domestic violence, bullying, prejudice, low self-esteem, and chronic pain to mention a few.  

Myth No. 2: If I’m Not Happy, Something is Wrong with Me 

For decades, mental health symptoms have been twisted and misunderstood to the point that painful or overwhelming thoughts and feelings are now presumed to be products of weak, faulty, and unworthy minds. Labels like ‘Anxious’, or ‘Addict’ are now used so frequently and in such negative ways it distracts us from the real issue at hand. Those labels not only build a wall but also mask the reality that we all struggle in similar ways. Combine these objectifying terms with a competitive culture this myth grows more powerful and exponential.  

Myth No. 3: For a Better Life, I Must Get Rid Of Negative Feelings  

Every single one of us experiences self-judgment, fear, and shame of not measuring up. It can be overwhelming and discouraging. Unfortunately, we live in a culture that promotes numbing and hiding as the solution to any pain or discomfort.   

Anger, over-working, blaming, over-booking schedules, and isolation has been dependable sources of distraction for years. Some argue how safe and how little impact these behaviors have on themselves and others. Ironically, they assume that dependent or ‘addictive’ thinking and behaviors are only appropriate if describing illicit drugs and alcohol. Recently, more camouflaged options like sugar, caffeine, over the counter medication, smoking, power drinks, and trendy diets have become legal and justified ways to remedy unwanted thoughts or deal with social pressures. All of these behaviors, and others, are designed to alter reality, enhance social performance, and reduce stress. Unbeknownst to us, we end up trading one form of addiction for another.  

Everyone considers himself or herself an unwilling and/or unaware accomplice and each would avoid the road of undue suffering if possible. Here are three practical take home ideas that can help you start breaking yourself free from the shackles of these myths and identify and strengthen your core values so you can stay connected with reality.  

  1. Take time and energy to notice core values that you have and may share with others. Write down and/or share thoughts, feelings, and memories that help identify and strengthen your core values. Yoga, meditation, and other quiet activities will improve focus and self-awareness. 
  2. Compare less. Look for opportunities to learn about and accept the uniqueness of others. Admitting and accepting our weakness and vulnerability to others actually creates meaningful emotional and social bonds.  
  3. React less. Take a deep breath and refocus values that you can practice today.  

All of us long for acceptance, empathy, and connection from others but sometimes get stuck in the attractive web of addictive behaviors. If help is needed, reach out to others or professionals. Enjoy the search for happiness in the everyday pursuit of values, not distractions.  

Seasonal Affective Disorder – SAD

Every now and then, most of us feel down or blue – this is different than depression. Situational sadness comes and goes with whatever is getting us down. For example, if you don’t get recognized for something you worked hard at, you will probably feel sad. After time, your sadness will start to disappear. It isn’t as sad over time. This is situational. Depression, on the other hand, seems to last beyond these events. Even when something potentially sad has come and gone and if there is seemingly no reason to feel sad, you still might feel sad. This can especially be true in the winter. The days are shorter and colder. This causes most of us to stop moving as much, and to stay inside. We then lack exercise and sunlight. On top of that, with the Halloween, Thanksgiving, Christmas and New Year’s, we tend to eat food that isn’t as healthy. We eat more sugar. This all contributes to feeling sad when we don’t seem to have anything to be sad about. Seasonal Affective Disorder (SAD) is what happens to many people during the winter months. Most people don’t realize they have this type of problem, they just think that they are down or blue. It is more than just having the ‘winter blues’. It impedes you in your daily life and interferes with your functioning. Recognizing that you have SAD will help you know what to do to overcome and let go of it. Some of the symptoms include: feeling sad, losing interest once enjoyed, change in appetite, change in sleep (usually sleeping more), loss of energy, restless activity, feeling worthless or guilty, trouble making decisions, and thoughts of suicide or death. If you think you might have this type of depression talk with a therapist today.