Q: I am hoping you can help me. Over the past few months I have been feeling very tired, pretty much all the time. I have a difficult time getting out of bed in the morning and during the day do not have much energy. Recently I canceled plans with friends only to spend the entire weekend in my bed with no motivation to do anything. No matter how much I sleep I am still very tired. I recently told a friend and he said I might be “depressed.” I hear this word all the time but I really do not know what it means. How does one know if they are “depressed” and how do they get their energy back?

Signed, Tired Out

Dear Tired Out,

Fatigue is definitely a symptom of depression and ironically, it can be the only (conscious) symptom. But it is also a symptom of many other things as well. Problems with underactive thyroid, anemia, infections and viruses and other medical problems can be underlying the extreme fatigue that you describe.

The first thing you should do is to get a physical examination along with a routine blood panel. It’s important that you rule out a medical problem before assuming that you have depression.

Having said that, do you know what your friend is seeing in you that you may not be able to see in yourself? What is it about you that makes your friend think that you are depressed? As human beings, we have a range of consciousness when it comes to self awareness. Some of us are very introspective while others are more externally focused and have not developed skills at introspection. Sometimes, we have deliberately worked out a defense mechanism so that we don’t notice our own feelings. This is particularly true if we were raised in an environment where it wasn’t really safe to pay attention to feelings. One feeling that often goes unnoticed is anger and this can be a problem because anger turned inward, against ourselves, is one of the single greatest causes of depression.

So, let’s start with some questions. Are you feeling sad or blue? Do you think your mood is depressed, even if just slightly? Do you feel like yourself? Or do you feel kind of vacant and uncertain of yourself? Are you still interested in the things that have always excited you or been important to you? Or have you kind of lost interest in things that used to matter? How is your appetite? Are you eating more or eating less? Have you gained or lost weight? Are you moody or irritable and impatient with others? What about sexual appetite? Has it changed; have you lost it or maybe, even though you are tired, you feel more of a need for sexual stimulation? How is your concentration? Depression often makes concentration very difficult. Work will often suffer because we cannot concentrate or as you mentioned, the motivation to do things just seems to be missing. Sometimes, it is simply really difficult to make decisions.

Have you found yourself crying unexpectedly or without understanding why? Do you feel that your life has meaning; that it is worth living? Or do you sometimes think you would be better off if you were not alive? Do you have suicidal thoughts or sometimes find yourself wishing that you would not wake up in the morning?

These are all the classic signs of depression. All of us have some days that are better than others and we all have times when we feel depressed about something or another. But feeling depressed from time to time is much different than being depressed. If you answered yes to even a few of these questions, you may well be depressed.

If you want to try to overcome this on your own, start by talking with someone you trust. Look at any recent losses or big disappointments you may have had. Ask yourself who or what you might be angry at. Process your grief or anger. Write about it, talk about it. Diet and exercise can play a big role as well. It’s very hard to be active and depressed at the same time.

If you do not feel better soon, you should seek professional help. Untreated, depression can go from bad to worse. Fortunately, there are a number of very good treatment options. Today there are excellent medications if you need one but they are not always necessary. Mental health professionals have developed a number of proven techniques to cure depression and are well trained to help you. The talking cure does work.

Quality of life matters. Depression hurts the one who has it and the people who love them as well.

Dr. JoAnne Barge is a licensed psychologist whose office is Brentwood. E-mail your questions to NewShrink@gmail.com or visit us at www.newshrink.com.

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