We all feel blue or down at times. Perhaps we've been under the weather, or experienced a rejection or are having financial difficulties. During these periods we may accomplish less than usual and may suffer multiple minor aches and pains. We may be more accident-prone. But within hours, days, or at most a week or two, these feelings change and we're back to normal.

But what if these feelings persist? Typically we first try to ignore them, hoping we'll snap out of it with a little more time. Sometimes we tell ourselves we're just being lazy. How do we know if we've crossed the line from feeling blue and blah to being depressed?

Depression is more common than you might imagine. Perhaps your image of a depressed person is someone who can't get out of bed. But frequently depression is disguised, especially in its less severe forms. It may appear as physical symptoms, including fatigue, headaches, stiffness, backaches, sleep disturbance, or digestive problems. These pains are real, but will often go away if the depression is treated.

If you've recently experienced a major loss in your life of course you will grieve. You may still want to talk with a professional for support but this does not necessarily mean you're depressed. But if you can't point to life events that are causing you distress, yet you continue to feel sad, it is more likely that you are depressed.

It is also likely that you are depressed if you've become stuck in your grieving or have had one crisis after another. Your thoughts may have become habitually negative and your actual body chemistry may have changed. The longer you allow this state to continue, the more severe it probably will become and the more difficult it may be to treat.

You may be depressed if you are experiencing many of the symptoms listed below. Not everyone who is depressed experiences every symptom. Some people experience a few, some many. Also, the severity of symptoms varies with individuals.

1. Irritability or moodiness throughout most of the day.

2. Significantly lessened interest and pleasure in usual activities, often including sex.

3. Persistent sad, anxious, or empty feelings

4. Appetite changes or weight changes.

5. Sleeping too much or not enough.

6. Body movements (gestures, speech, gait) either agitated or slowed
down.

7. Fatigue or loss of energy.

8. Feeling worthless, helpless, or excessively or inappropriately guilty.

9. Indecisiveness or problems thinking, concentrating, or remembering.

10. Persistent physical symptoms that do not respond to treatment, such as headaches, chronic pain, digestive problems.

11. Recurrent thoughts of death, suicidal thoughts (with or without a plan) or a suicide attempt.

What causes depression? Sometimes depression runs in families, indicating that a biological vulnerability can be inherited. People with serious depression often have disruptions in the chemical molecules, called neurotransmitters, that carry messages between nerve cells in the brain. Recent research has shown a powerful link between adequate levels of these neurotransmitters, especially serotonin, and feelings of well-being.

If you see yourself in this list, please call your physician or a therapist at once. If you identify with some but not most of the symptoms, you may be experiencing a mild or moderate depression. It's possible you've lived with this chronic low level depression so long it seems normal to you.

People often ask if they should take medication for their depression. Certainly it is an option, and there are many effective medications available. Often, the relief that comes from talking with a professional produces a significant improvement in mood and no medication is needed. Other times, it is literally a lifesaver. Most importantly, know that depression can usually be successfully treated and the sooner you get help, the sooner you will feel better.