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Understanding Depression in a Friend or Family Member

· Depression is a serious condition. Don’t underestimate the seriousness of depression. Depression drains a person’s energy, optimism, and motivation. Your depressed loved one can’t just “snap out of it” by sheer force of will.

· The symptoms of depression aren’t personal. Depression makes it difficult for a person to connect on a deep emotional level with anyone, even the people he or she loves most. In addition, depressed people often say hurtful things and lash out in anger. Remember that this is the depression talking, not your loved one, so try not to take it personally.

· Hiding the problem won’t make it go away. Don’t be an enabler. It doesn’t help anyone involved if you are making excuses, covering up the problem, or lying for a friend or family member who is depressed. In fact, this may keep the depressed person from seeking treatment.

· You can’t “fix” someone else’s depression. Don’t try to rescue your loved one from depression. It’s not up to you to fix the problem, nor can you. You’re not to blame for your loved one’s depression or responsible for his or her happiness (or lack thereof). Ultimately, recovery is in the hands of the depressed person.

Signs that your friend or family member may be depressed

· He or she doesn’t seem to care about anything anymore.

· He or she is uncharacteristically sad, irritable, short-tempered, critical, or moody.

· He or she has lost interest in work, sex, hobbies, and other pleasurable activities.

· He or she talks about feeling “helpless” or “hopeless.”

· He or she expresses a bleak or negative outlook on life.

· He or she frequently complains of aches and pains such as headaches, stomach problems, and back pain.

· He or she complains of feeling tired and drained all the time.

· He or she has withdrawn from friends, family, and other social activities.

· He or she is either sleeping less than usual or oversleeping.

· He or she is eating either more or less than usual, and has recently gained or lost weight.

· He or she has become indecisive, forgetful, disorganized, and “out of it.”

· He or she is drinking more or abusing drugs, including prescription sleeping pills and painkillers.

How to talk to a loved one about depression

Sometimes it is hard to know what to say when speaking to a loved one about depression. You might fear that if you bring up your worries he or she will get angry, feel insulted, or ignore your concerns. You may be unsure what questions to ask or how to be supportive.

If you don’t know where to start, the following suggestions may help. But remember that being a compassionate listener is much more important than giving advice. Encourage the depressed person to talk about his or her feelings, and be willing to listen without judgment. And don’t expect a single conversation to be the end of it. Depressed people tend to withdraw from others and isolate themselves. You may need to express your concern and willingness to listen over and over again. Be gentle, yet persistent.

Ways to start the conversation:

· I have been feeling concerned about you lately.

· Recently, I have noticed some differences in you and wondered how you are doing.

· I wanted to check in with you because you have seemed pretty down lately.

Questions you can ask:

· When did you begin feeling like this?

· Did something happen that made you start feeling this way?

· How can I best support you right now?

· Do you ever feel so bad that you don’t want to be anymore?

· Have you thought about getting help?

Remember, being supportive involves offering encouragement and hope. Very often, this is a matter of talking to the person in language that he or she will understand and respond to while in a depressed mind frame.

What you can say that helps:

· You are not alone in this. I’m here for you.

· You may not believe it now, but the way you’re feeling will change.

· I may not be able to understand exactly how you feel, but I care about you and want to help.

· When you want to give up, tell yourself you will hold of for just one more day, hour, minute — whatever you can manage.

· You are important to me. Your life is important to me.

· Tell me what I can do now to help you.

Avoid saying:

· It’s all in your head.

· We all go through times like this.

· Look on the bright side.

· You have so much to live for why do you want to die?

· I can’t do anything about your situation.

· Just snap out of it.

· What’s wrong with you?

· Shouldn’t you be better by now.

Source: http://www.helpguide.org/mental/living_depressed_person.htm (abridged)

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How to Help a Friend who’s Depressed

Depression is a difficult experience to deal with and the support of a friend can be invaluable. It can shine a ray of hope, make you feel you’re not alone, and help to bolster your faltering self-esteem. However, a healthy balanced friendship has some healthy boundaries, too, and knowing what those are can make us more effective friends. For example:

1. There are times when we need guidance or some tips from others as we want to learn new skills, or to change and grow. For example, if it’s a poor assignment grade, or we keep losing friends then a friend who knows us well can sometimes share what they’ve observed. But before you dive in and give unwelcome advice, make sure your friend’s receptive and will take it the right way! Don’t just blurt out your opinion without being asked.

2. Related to this, ask your friend what they need, or what they’d like from you – as they may not even know, and this will help focus their thinking. You can then decide if you can give them what they need (like practical help or some tips for studying). If they can’t answer your question, you may end up being used - and become a dumping ground for their negativity. This is clearly detrimental for both of you.   

3. If you’re asked to share your thoughts, do it tentatively … Like “This worked for me … but we’re all different …” Or, ask her what has worked, and what hasn’t worked, before – as we often have the answers … It’s just hard to face the truth!

4. Whereas it’s good to listen and to be understanding, we also need to know when it’s time to withdraw. For example, if your friend is always negative and never seems to change then you may, inadvertently, be helping keep her stuck (by always being there, so she doesn’t have to change). Yet at the end of the day, we each choose the life we’ll live … We can stay a helpless victim or we can take up the reins, and assume control of our lives and destiny.

5. True friendship is based on meeting both parties’ needs. And though at times we will give more if a friend has a real need, if one person’s always taking then the friendship is unhealthy. That is, you’re not their personal therapist or human dumping ground. You need to recognise what’s happening and put up boundaries – like limiting the time you make available to them. To find solutions to their problems and move on with their life, your friend needs the skills of a detached professional …. And that is very different from being a good friend.       

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11 Common Errors in Thinking

According to Cognitive Behavioural Therapy, we often feel anxious, upset and annoyed because of certain errors in our thinking. These are faulty ways of looking at life which are automatic - and also very common. However, if we identify and change our way of thinking then our feelings are reactions will be much healthier. These errors in thinking include the following:

1. All –or – Nothing Thinking: Where the person evaluates themselves, others, situations and the world in extreme categories. It doesn’t allow for grey areas in thinking.  “I’m a terrible parent.”

2. Overgeneralizing: Thinking that because a bad experience happened once, then that’s the way it’s always going to be. For example, “I know I’ll fail my driving test. I’ve already failed it three times”.

3. Discounting the Positives: Ignoring the positive aspects of a situation and saying that they don’t count. For example, generally getting  good marks in school – but not praising yourself for that. One paper gets some negative feedback and you tell yourself you’re a useless student. The positive results are ignored.

4. Jumping to Conclusions -This has two aspects to it: mind reading and fortune telling.

(i) Mind reading is thinking you know what others are thinking without any evidence. For example, a person with social anxiety assumes her colleagues think she’s useless at her job.

(ii) Fortune telling is predicting that the future will turn out badly. For example, going for a routine mammogram and concluding that you have cancer.

5. Magnifying / Minimising: Evaluating the importance of a negative event, or the lack of evidence of a positive event, in a distorted manner. (Blowing things out of proportion.) For example, concluding that your sister doesn’t like you anymore because she forgot to send a  birthday card.

6. Emotional Reasoning: Believing that something must be true because it feels true. For example, when your boyfriend is an hour late in arriving for a film, you conclude that he isn’t interested in you. You discount the fact that, maybe, the bus was late, or he was delayed at work.

7. Labelling: Using a label (bad mother, idiot) to describe a behaviour - and then taking on board everything associated with that label. Seeing things is global terms. For example, a friend says or does something thoughtless. You label then them as “a terrible friend” and now you interpret anything they say in a hostile and negative way.

8. Personalization and blame: Where a person totally blames themselves for something that’s gone wrong when it is not their fault. For example, a soccer team member thinks she’s “put the coach in a bad mood” because she missed a goal. She discounts the fact that the coach may have been annoyed before the game started. The opposite is to totally blame another for something. For example, a wife may blame her husband for the break up of their marriage and not admit that she had any part in it.

9. Catastrophizing: (Similar to fortune telling) Dwelling on the worst possible outcome. For example, an employee had to do a presentation. He became obsessed with thoughts of performing badly, letting the company down, losing his job, then losing his home and family.

10. Making “should” or “must” statements:  Where the person has a fixed idea of how they, others or life should be. These become “rigid demands”. When they person is disappointed (as will inevitably happen) they become very upset and overestimate how bad this will be for them. For example, a student berates themselves for only getting 89% in an exam – when they wanted all their results to be in the 90s.

11. Selective abstraction: Dwelling on one negative detail instead of seeing the bigger picture. For example, a girl gets a haircut and 8 of her friends say they love it. One person says they preferred her old style. The girl thinks about that for hours and hours and wonders if she should have changed her hairstyle.

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Beating Anxiety

There are some easy tools that anyone can use to cope with their feelings of anxiety. They include:

1. Learning more about anxiety: This will help you to understand what is happen when you start to feel increasingly anxious. First, remember that we all feel anxious at times. It can help us to prepare for and cope with hard tasks – such as sitting an exam or teaching a class. However, it leads to problems when the danger isn’t real yet our body is signalling a high state of alert.  

2. Learning strategies that help us relax: The two most common strategies for relaxing and unwinding are calming down our breathing and muscle relaxation. The former involves taking slow, gentle breaths (breathing in through the nose, pausing for a few seconds, then breathing out slowly through the mouth, again). The latter involves learning how to tense and relax the different muscles - and then repeating this until our stress levels fall.

3. Actively challenging our anxious thoughts: When we’re anxious and tense we often see the world as a threatening and hostile place. This usually reflects faulty, negative thinking where we jump to conclusions or expect the worse to happen. This is out of proportion, exaggerated thinking which is unrealistic – and makes us feel uptight. A strategy for helping is replacing faulty thinking with a more realistic and accurate approach. This necessitates us challenging our automatic thinking so we see things in a clearer, less distressing way. Of course, it takes practise and effort to shift our change anxious thinking – but it’s worth the effort in the end

4. Facing our fears: One of the best ways of dealing with our fears is exposing ourselves to what makes us feel afraid. For example, if you avoid being with people as this leaves you feeling anxious then the best way forward is to simply face your fear.  You could make a list that goes from “least to most scary” - and then reward yourself each time you move a level up the list.


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Exploring Mood Disorders

There are two main types of mood disorder: major depressive disorder (also known as unipolar or clinical depression), and bipolar depression (formerly known as manic depression). The distinguishing feature separating these disorders is the presence or absence of manic episodes. Specifically, if the person has manic episodes they are diagnosed with bipolar depression.

Major Depressive Disorder (MDD) includes a number of different categories:

1. Atypical depression: This is characterized by extremes (such as experiencing alternating episodes of excessive sleep with insomnia), significant weight gain due to comfort eating, a feeling of heaviness in the limbs, and social impairment. The person usually feels hypersensitive in social situations as they expect to be rejected by others.

2. Melancholic depression: This is the most frequently diagnosed form of MDD. Here, sufferers lose all interest in relationships and the normal activities of life. Hence, they withdraw from others and isolate themselves. They may have trouble sleeping and they tend to waken early. Generally speaking, a depressed mood and other negative symptoms (debilitating guilt feelings, a pervasive sense of hopelessness, psychomotor retardation and so on) are most pronounced in the morning.

3. Psychotic depression: This is where a depressive episode is accompanied by psychotic symptoms such as delusions. Occasionally, the person may experience hallucinations.

4. Catatonic depression: This is a rare and severe form of major depression. During catatonic episodes, the individual is mute and immobile (in a stupor) – although some may exhibit bizarre movements.

Note: Catatonic symptoms can also occur in schizophrenia.

5. Postpartum depression: This refers to the intense and disabling depression that may follow giving birth. It is more disruptive and lasts for longer than postpartum blues.

6. Seasonal affective disorder: In SAD, depressive episodes are triggered in the autumn or winter and end in the spring. Diagnosis is dependent upon having at least two episodes in colder months - with none at other times of the year - over a two-year period or longer. It is more common in young people and women.

7. Dysthymia: This is battling a chronic low mood daily for at least two years. Symptoms are less severe than in other forms of depression.

8. Recurrent brief depression: This is distinguished from major depressive disorder by differences in duration. Depressive episodes occur once a month, and last for less than 2 weeks. Episodes must span at least one year and, for females, must be independent of their menstrual cycle.

9. Minor depressive disorder: This is where the individual experiences at least two characteristics symptoms of depression for two weeks.

Bipolar disorder (formerly known as manic depression) refers to having alternating periods of mania and depression. In some cases, the disorder is cyclical; alternatively, the person may experience mixed states. Some individuals may also experience psychotic symptoms. As with MDD, this disorder includes several categories:

1. Bipolar I: This is where the individual experiences a history of one or more manic or mixed episodes. A depressive episode is not required for this diagnosis (although it is often present too).

2. Bipolar II: Here, the individual experiences recurrent intermittent hypomanic and depressive episodes.

3. Cyclothymia: This is similar to Bipolar II in that the person experiences recurrent hypomanic and dysthymic episodes - but no full manic or major depressive episodes.

Manic symptoms include: increased energy, activity, and restlessness; euphoric mood; highly distractible; concentration difficulties and racing thoughts; jumps from one idea to another; talks very quickly; needs little sleep; increased sexual drive; goes on spending sprees; demonstrates poor judgment; unrealistic beliefs in one’s abilities and powers; extreme irritability; provocative, intrusive, or aggressive behaviour; may abuse substances; denies there is a problem.

Depressive symptoms include: lasting sad, anxious, or empty mood; feelings of hopelessness or pessimism; feelings of guilt, worthlessness, or helplessness; cannot derive pleasure from life or relationships; decreased energy; a feeling of fatigue; difficulty concentrating, remembering or making decisions; restlessness or irritability; insomnia – or excessive sleeping; change in appetite; unintended weight loss or gain; chronic pain which is unrelated to illness or injury; thoughts of death /attempted suicide.

Genetics, biology, environmental factors and faulty thinking all play a role in the development of mood disorders. Treatment is usually a combination of drugs and counselling, especially CBT.

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How to Stop Worrying

1. Prepare for the worst but hope for the best. In reality, few of our worries actually become a reality. However, if you prepare in advance for things going wrong, you’ll have strategies available to cope and survive.

2.  Write a list of everything you think you need to do, and then tick them off as you work through the list. That will help you feel more organised, and much more in control.

3. Do something to distract yourself – so your anxious thoughts don’t grow bigger in your mind.

4. Share your feelings with someone who understands and cares. They’ll offer you support – and you’ll gain perspective, too.

5. Confront the problem head often. It’s often the uncertainty that worries us the most – so face up to your worries – and take the steps you can.

6. Choose to do something that help you to calm you – like listening to your ipod or chilling with a friend.

7. Choose to be thankful. There are so many things to be grateful for. Compose a list of those, and you’ll find your worries fade. 

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Symptoms of Teenage Depression

1. Being overwhelmed by deep feelings of sadness or hopelessness.

2. Lack of energy; feeling sluggish and lethargic. Alternatively, feeling restless and agitated.

3. Having no interest in, and deriving no pleasure from, activities they previously enjoyed.

4. Experiencing feelings of anxiety and panic.

5. Feeling as if they are in turmoil; feeling worried and irritable all the time. He or she may brood over things, or suddenly lash out in anger (because of their feelings of distress.)

6. Having difficulty organizing, concentrating or remembering things (where this wasn’t previously the case.)

7. Having a negative view of life and the world. Feeling pessimistic.

8. Being overwhelmed by feelings of worthlessness, shame and guilt. Often he or she will feel stupid, ugly, or like a total failure.

9. Marked changes in appetite or weight.

10. Experiencing sleep problems (Having difficulty falling asleep, staying asleep or sleeping too much.)

11. Isolating themselves; avoiding and withdrawing from friends and family.

12. Self-mutilation and suicidal thoughts.

For more information see: http://www.yalemedicalgroup.org/stw/Page.asp?PageID=STW000727

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Facts on Depression

1. Being diagnosed with depression doesn’t mean you are crazy, weak, or a failure.

2. Often depression runs in families.

3. There is a link between low self-esteem and depression.

4. Experiencing a significant loss, or coping with an ongoing stressful situation, are both common causes of depression.

5. Negative thought patterns and core beliefs can contribute to negative moods and feelings of depression. They can also make it more difficult to fight and cope with depression.

6.  Although depression can be devastating to both sufferers and their families, the good news is that depression generally responds to treatment. For example, there is a large body of literature confirming the effectiveness of both CBT and antidepressant medications.

7. There is also some evidence indicating that natural remedies (such as St. John’s Wort) may be helpful for mild to moderate depression.

8. It is worth experimenting with different forms of treatment as individuals who don’t respond well to one approach often respond well to another approach.  

9. Evidence indicates that regular exercise has a positive effect on mood, and can help when you’re fighting depression. (Some have argued that it is comparable to the benefits of antidepressant medications).

10. Many people have found that journaling is helpful for expressing their thoughts and feelings … and then dealing with these in a more objective way.

11. People who are battling depression should limit their consumption of alcohol, sedatives and caffeine as these can worsen their mood and interfere with their ability to cope.

12. Always talk to a trusted friend, family member, doctor or counsellor about suicidal thoughts. No matter how alone and desperate you feel, there is always someone who genuinely cares and who will support you through this time.

For more information on research findings see: http://www.anxietyandstress.com/copingwithdepression.html

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Some Symptoms of Depression

- An inability to function normally in everyday life

- Lethargy, fatigue, and the feeling that doing things takes too much energy

- Persistent sadness, including fits of crying (either uncontrollably or being set off easily)

- Feelings of anxiety or emptiness

- Feelings of worthlessness, self-blame and low self esteem

- Sleeping a lot more or less than usual, or experiencing insomnia

- Compulsive overeating, or a loss of appetite

- Finding thinking or concentrating difficult, “foggy” thinking; inability to make clear decisions; forgetfulness

- Pessimism; feeling that life is hopeless, pointless and futile

- Numbness/ an inability to feel anything at all

- Aches and pains, digestive problems, headaches

- Generally feeling irritable and restless

- Being troubled by suicidal thoughts/ thoughts of dying.

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Some Facts on Depression

1. Sadness is not the same as depression. Depression has an additional component of helplessness and hopelessness which persists for weeks – and sometimes months and years.

2. Depression is not the same for everyone. Different people experience different feelings, and different intensities of emotions. Some experience no emotions at all; they feel as if their emotions are dead.   

3. Depression can manifest as physical pain (such as headaches and backaches). Also, sometimes  chronic pain is due to insomnia, a common symptom of depression.

4.  It can take several  weeks for prescription medication to take effect.

5. Medication alone is rarely effective. It is best combined with talking therapies, such as CBT.

6. There is often a genetic component to depression. This is exacerbated by stress and negative life events.  

7. You can’t tell is a person is depressed simply by looking at them.

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How to Deal with Anxiety

1. Reduce your intake of caffeine. Caffeine, chocolate and sugar are known to increase anxiety levels. They can also make you feel on edge and interfere with healthy sleep patterns.

2. Meditate. Focus on one thing - your breathing at this moment. Inhale very slowly then exhale very slowly. Repeat this until you feel yourself relaxing.

3. Work on enhancing your self esteem. Often, people who suffer from anxiety are actually suffering from low self esteem. If this describes you, then get some paper and a pen, and make a long list of all your good points and strengths. Maybe you’re athletic or intelligent, creative, empathic or a caring, loyal friend. These are a central part of who you are. Don’t minimise them - as they’re cucial qualities.

4. Find a sounding board. Everybody needs to vent from time to time … as just expressing your feelings can reduce anxiety. And if you don’t have someone that you feel that you can trust, then write down your feelings, as that gets them off your chest.

5. Exercise. This can lower your blood pressure, and improve how you feel. It also releases some endorphins in the brain – which has a natural soothing and calming effect.

6. Distract yourself. Your thoughts can play havoc with your peace of mind. So find a way to interrupt and change your old thought patterns. For example, playing sport requires focus, as does doing as assignment, or listening to a friend, or even working in your blog.

7. Be kind to yourself and treat yourself well. When was the last time you did something fun? That is, something just for you, where you felt special and prized? You deserve to be respected, loved and treated well – so do that for yourself – don’t wait for somebody else.

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How to cope with panic attacks

1. Recognise that panic attacks are a mind state and not a physical risk. A panic attack can be a very frightening and uncomfortable experience. However, it doesn’t indicate a real physical risk – even although it feels that way.

2. Try to grasp that you are not alone. Panic attacks are relatively common. They’re an anxiety disorder that many other people share.

3. Understand what panic is. Panic is excess adrenaline running through your body when it is confronted with a possible life-threatening situation. It can also be triggered by something that reminds you of a threatening event in your past. Feelings of panic can be very scary, but the feelings are related to your past – not to a threat in the present. Even although you feel terrified, you are not in any real danger.

4. Go and see a doctor or counsellor. Sometimes people find anti-anxiety medication helps them cope with panic attacks. However, identifying the psychological root – and then getting help in dealing with that – is the most effective treatment approach.

5. Let others close to you know that you suffer from panic attacks. People who have never experienced a panic attack may find it hard to understand what you are going through. However, you can help them with this by sharing your difficult experiences with them. In fact, many people want to help those they love – but they don’t know what to say or do. Thus, if you can be more open with them, then they can reach out and offer you support.

6. Don’t avoid those situations which have led to a panic attack in the past. Avoidance will only ‘reinforce’ the disorder … So the more you avoid the dreaded situation the more panic the avoided situation generates. Should a panic attack occur, don’t attempt to fight the feelings. Instead, allow the feelings to wash over you … and then drain away. Focus on staying in the present moment.

7. Focus on slowing your breathing down. This help to ensure that your brain is receiving the appropriate amount of oxygen. That will help reduce your anxiety levels, and the panic attack will dissipate and end.

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Some Tips for Coping with Anxiety

1. Check your nutrition. Sometimes high levels of anxiety are caused by a magnesium or potassium deficiency.

2. Pay attention to your caffeine levels. Coffee, tea and chocolate all contain reasonable levels of caffeine. This can make you jittery, or increase your feelings of anxiety.

3. Try meditation and mindfulness. These help to keep you focused on the here and now, to slow your heartbeat and breathing down, as well as helping to relax your mind.

4.  Work on maintain a healthy self-esteem. Many people who feel anxious, stressed or depressed are actually suffering from low self-esteem.

5. Find a trusted sounding board, and vent your feelings to them – but make sure it’s someone who understands and cares.

6. Exercise – This releases endorphins, those feel-good hormones, which help reduce our feelings of anxiety.

7. Distract yourself. Take your mind off your worries by doing other things that require concentration, and a focused state of mind.

8. Treat yourself. Give yourself a mood lifter by hanging out with friends, buying something that you love, or doing something that is fun.   

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What are the Symptoms of Depression?

Depression shows itself in many different ways. People don’t always realise what’s going on because their problems seem to be physical, not mental. They tell themselves they’re simply under the weather or feeling tired. But if you tick off five or more of the following symptoms, it’s likely you’re depressed:

· being restless and agitated

· waking up early, having difficulty sleeping, or sleeping more

· feeling tired and lacking energy; doing less and less

· using more tobacco, alcohol or other drugs than usual

· not eating properly and losing or putting on weight

· crying a lot

· difficulty remembering things

· physical aches and pains with no physical cause

· feeling low-spirited for much of the time, every day

· being unusually irritable or impatient

· getting no pleasure out of life or what you usually enjoy

· losing interest in your sex life

· finding it hard to concentrate or make decisions

· blaming yourself and feeling unnecessarily guilty about things

· lacking self-confidence and self-esteem

· being preoccupied with negative thoughts

· feeling numb, empty and despairing

· feeling helpless

· distancing yourself from others; not asking for support

· taking a bleak, pessimistic view of the future

· experiencing a sense of unreality

· self-harming

· thinking about suicide.

Source: http://www.mind.org.uk/help/diagnoses_and_conditions/depression

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