Depression and mental health among GLBT people

Everyone gets sad sometimes, and sometimes it feels worse than at other times. Sometimes people feel depressed or sad because something stressful has happened in their lives--like losing a job or the death of a loved one. Even a good thing can make a person feel overwhelmed if it is stressful enough. And sometimes people get depressed for no obvious reason.

Millions of Americans, both gay and straight, transgender and non-transgender, have emotional or psychological problems of some sort during their lives. While we know that homosexuality, bisexuality, and transgender identity are not mental illnesses, the stresses caused by society's negative messages, condemnation, and violence can sometimes result in depression and other types of emotional difficulties for GLBT persons.

Clinical depression is a medical illness that attacks both the mind and the body. It may be far more complex an illness than most people recognize. Depression can cause significant chemical changes to the brain that may make it difficult for many people to overcome it without some time of professional help or treatment.

Depression is not the same as feeling blue or sad--those feelings are a normal part of life. In clinical depression people feel bad for prolonged periods of time--weeks or months. People who are depressed often find it difficult to concentrate. Sometimes they feel like they are on an emotional roller-coaster, sometimes they have trouble getting sad or anxious thoughts out of their minds, and sometimes they just have no energy at all.

Depressed people sometimes have significant weight changes, either up or down. They may have difficulty sleeping, especially in the early morning. Some depressed people sleep more than usual. Sexual interest may decrease.

Untreated, depression can last for months or even years. It may resolve by itself, but it often reoccurs. With treatment, those who suffer from depression often report significant relief within 4-6 weeks.

Is clinical depression treatable?

Clinical depression is readily treatable with counseling and medication. Many people suffer needlessly from depression because they don't seek treatment. They may feel that depression is a personal weakness, or try to cope with their symptoms alone.

If you are feeling depressed, and have been for over a month, you should consider seeking professional help from a gay-positive (or trans-supportive) therapist, doctor, psychiatrist, or other health care provider. There are plenty of mental and other health professionals who will support you and guide you towards being a happy and healthy GLBT person-you deserve nothing less. If you are looking for a gay-supportive counselor, ask friends for referrals or call a local GLBT-friendly mental health agency.

A study performed by the National Institutes of Mental Health showed that after 16 weeks of psychotherapy, 55% of those with mild to moderate depression reported significant improvement. Different people react in different ways to various types of counseling, but cognitive therapy--in which you learn to recognize and replace depressive thinking--can be particularly effective for people experiencing depression.

When there is a chemical component to depression, antidepressant medication can help to correct the chemical imbalance (low levels of brain serotonin and norepinephrine). People with moderate to severe depression are most likely to benefit and improve from the use of medication. Many different types of antidepressants have been developed-if one doesn't work for you, another one probably will. Some studies have shown that combinations of antidepressant drugs and good psychotherapy may be the best approach.

Depression and suicide

Sometimes people become so depressed that they think about harming or killing themselves. These thoughts and actions can be "passive"--like not wanting to wake up in the morning or wishing to disappear, as well as "active"--like taking pills, cutting oneself or shooting oneself. When suicidal thoughts or acts are present, it's a good indication that the person may be struggling with a very serious depression.

If you are thinking about hurting yourself or have laid out a suicide plan, please get help immediately. Call a friend, your doctor or your local crisis telephone service. You are not alone and although it may be hard to imagine right now, these feelings will pass and you will be glad you did seek help. If you're in King County and want to speak with someone right away, call the Crisis Clinic at 206-461-3222 any time of the day or night.

If you have a friend or loved one who is thinking about suicide, talk to them about it openly and help them get some professional help as quickly as possible. Asking about suicide does not make it more likely that a person will harm themselves--often people find it a great relief to finally have someone to talk to.

Tips for handling depression

Try to accept your depression as an illness. You cannot will the depression away.
Try to do things that you enjoy--visit friends, get a massage, take a class--to get your mind off what may be contributing to the depression and to focus on things that help you feel better.
Delay any big decisions or changes that involve work, love or money until you feel better.
It's common to be forgetful when you're depressed, stressed out or anxious. Take notes and make lists. Your memory will improve when you feel better.
Waking through the night is very common. It's better to get out of bed until you feel sleepy again. Repeated awakening in the early morning without being able to return to sleep easily is a sign that medical evaluation is needed.
Mornings are often the worst time. The day usually gets better towards evening.
Avoid being home alone for long periods--the depressive thoughts can get worse when no one is around.
Get outside at least once a day for a walk. Light to moderate exercise of any kind can be very helpful to your recovery.
Don't try to "medicate" yourself with alcohol, marijuana or other drugs. These drugs may actually make you more depressed than you were to begin with.

What do if someone you love is depressed

It can be difficult to be around a friend who is depressed. You may feel helpless and sometimes angry, particularly if the person is irritable and doesn't respond when you reach out. Keep reminding yourself that the person is ill, and doesn't mean to be hurtful or unresponsive.

You can't relieve clinical depression with love alone any more than you can cure heart disease or diabetes with just love. People who are depressed need professional help, and some require medication.

On the other hand, social support improves treatment results in many serious illnesses including depression. Reach out to your depressed friend so that he or she knows that you care. Call. Send affectionate notes. Invite the person to dinner, movies, ball games, parties, and other events. But keep your expectations low. Even if your friend doesn't respond, you can be sure that he or she appreciates your attempts.

Who is at risk for clinical depression?

Clinical depression is similar to heart disease and cancer in that everyone is potentially at risk for each. If you have a family history of one of these illnesses, your susceptibility increases. This explains why some people develop a clinical depression only after a large, stressful event, while others develop clinical depression seemingly out of the blue.

Young adults (18-25) are more prone to depression than people in midlife-perhaps because of the particular stressors of separating from one's family and learning to live on one's own. Elderly people also have higher rates of depression than people in midlife.

People who abuse alcohol may become depressed--and excessive use of alcohol often indicates that a person is "self-medicating" a depression. But alcohol and related drugs like valium and barbiturates are themselves depressants, and just make problems worse.

Depression screening questionnaires

This screen questionnaire is not designed to provide an actual diagnosis of depression. For that, you will need a complete clinical evaluation by a psychiatrist or other health care professional.

1.	I am unable to do the things I used to do.
2.	I feel hopeless about the future.
3.	I can't make decisions.
4.	I no longer enjoy the things I used to find fun.
5.	I am losing or gaining weight.
6.	I get tired for no reason.
7.	I am sleeping too much, or too little.
8.	I feel worthless and unhappy.
9.	I become irritable or anxious.
10.	I think about dying or killing myself.

If you answered yes to 5 or more of these questions, and you have felt this way everyday for several weeks, there is a good chance you are suffering from depression and should see a psychiatrist, a therapist, or other health care professional.

If you answered yes to question 10, you should seek help immediately, regardless of your answer to any other questions.

Click here for another online depression screening questionaire.

Other types of emotional and mental health problems

Individuals in the GLBT community also may experience a variety of other types of mental illnesses. Lesbians, gay men, and bisexual and transgender individuals are no more or less likely to have serious mental illnesses than heterosexuals and non-transgender people.

Mental illnesses take a variety of forms. Some, like schizophrenia, may involve disruptions to the way we think and symptoms that include hearing voices or seeing things that aren't there. Other mental illnesses, like depression, involve changes in the way we feel and/or behave.

Our society still attaches significant stigma to mental illnesses - much in the way we used to do with cancer and, more recently, with AIDS. This stigma often leads people to try to hide a mental illness, preventing them from seeking the assistance that can help them feel better. For GLBT individuals, the multiple stigma of being a sexual minority as well as a person struggling with a mental illness may be extremely challenging, and make day-to-day existence difficult.

The good news is that help is available. It's always a good idea to speak with your primary care doctor or mental health counselor about how you are feeling. Discuss concerns you or they may have about your mental health, just as you would discuss any other type of illness. If you don't have a doctor or counselor, help may be available from your local mental health system.

In King County, 9% of the adults receiving care from the county's mental health system have disclosed to their providers that they are members of the GLBT community. Care that is sensitive to the needs of GLBT persons is available.

Click here to find GLBT-friendly mental health resources.

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