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They say I’m supposed to take time out for myself, do something that brings me joy. But nothing brings me joy. I can go to a garden. My intellect knows it is beautiful. But it is like smelling a flower behind glass. The beauty brings me no joy. I can’t connect with it...” --from a mother’s journal, continued below


Depression is sadness on steroids. Sadness that takes on a life of its own. Depression can become a death spiral. A person who is depressed has feelings of shame and worthlessness, fatigue or lethargy or brain fog. These all leave the person unable to cope with reality or function in life and carry out daily tasks. The failures that follow--large and small, real and perceived--confirm the individual’s fears of inadequacy, shame, or worthlessnes–so the spiral continues.


Depression is more than just sadness. Sometimes it doesn’t even feel like sadness. Signs of depression can include:

  • Feeling sad, empty, hopeless

  • Loss of interest or pleasure in things that one normally enjoys

  • Irritability, frustration, anger that is easily aroused

  • Changes to sleep--from insomnia to excessive sleepiness

  • Changes to eating--from lack of appetite to inability to quit eating

  • Fatigue, lack of energy, moving slowly

  • Restlessness, anxiety

  • Lack of focus, absentmindedness, difficulty with memory

  • Difficulty making decisions or taking action

  • Feeling overwhelmed even by simple tasks

  • Physical pains or aches with no apparent medical cause

  • Persistent feelings of failure, regret, shame, worthlessness

  • Frequent thoughts of death, imagining death or suicide


If you have several of these symptoms most of the time for at least two weeks, and they interfere with your basic daily activities, relationships, and/or job, you probably meet the official DSM-5 criteria for a diagnosis of depression.


How to stop the depression death spiral?

Medication: SSRI medications are helpful to many people. They can limit how low you feel at low times. They can give your brain a biochemical boost that restores enough energy and focus to allow you to do what you need to recover. If SSRI’s don’t work, other types of medication are available. A family doctor, urgent care, or psychiatrist can get you started and manage prescription antidepressant medication.


Psychotherapy: Cognitive Behavior Therapy (CBT) helps you stop the spiral by changing your thought patterns. Dialectical Behavior Therapy (DBT) uses techniques of mindfulness to help you manage strong emotions and learn coping skills. Plenty of other types of therapy are available. If the first type of therapy you try, or the first therapist you see don’t help, try another.  Tips for Finding a Therapist


Medication and therapy together can be an especially effective combination. The medication gives you the ability to engage with therapy and learn from it. From the Depression and Bipolar Support Alliance:There is a traditional belief that depression following a stressful or traumatic event is more “psychological” than “biological,” in which case psychotherapy would be recommended over medication. But the evidence does not support that belief: both psychotherapy and medication are effective for the treatment of depression, whether it follows a specific event or not.” Greg Simon, MD, MPH


Baby steps of competence: Start by setting micro-goals. Each one that you achieve can help you go on to the next. The goals could be as small as reaching for your phone from the bed. Then sitting up in bed. Then standing on your feet. Then taking a shower. Then getting a cup of coffee. Maybe once you get that far, you will find you have the strength to do more. Maybe getting that far will use up all the energy you have for the day. Either way, you have done something.


Self-Care: Keeping up with basic hygiene, nutrition, exercise, and healthy living can give a boost of competence. It can also prevent poor physical health from deepening the spiral.


Accept that it’s OK to be sad: Some people feel shame about being depressed, which only makes the depression worse. It is normal to feel sad and even depressed when you have a significant loss or trauma--and sibling sexual trauma brings both. Feeling depressed does not mean you are weak, or defective, or that you are to blame for how you feel.


Look for support: There are ways to connect with others who have been affected by sibling sexual trauma. If you have supportive friends or family, this is the time to let them help you. If you don’t have humans you can connect with, pets can be great comforters.


A mother’s journal, continued “...I knew that, as broken as my family relationships already were, my depression was just making them worse, and the longer I was depressed the worse they would become. I felt like I was nothing but a drag on the family, that everything I tried just made the situation worse. I wished I could just quietly disappear from their lives so I wouldn’t cause them any more pain. But I had seen enough of life to know that was impossible. So, instead of washing down a bottle of sleep medicine with a bottle of wine, I decided to call the doctor and ask for an antidepressant. It didn’t work right away. Things got worse before they got better. But eventually the antidepressant gave me just enough energy to gain the first few footholds to start climbing out of my pit.


Additional Resources

Healing Toolkit

American Psychiatric Association: What Is Depression?

National Institute of Mental Health: Depression Major Depressive Disorder

Health Promotion Agency of New Zealand: start your Small Steps journey How to Cope with Trauma-Induced Depression

Oxbow Academy Teen Sexual Behavior Program: Building Self-Esteem, A Self-Help Guide

Building Self-Esteem: A Self-Help Guide - Sexual Behavioral Problems Program at Oxbow Academy

What Is Depression?

NIMH » Depression

Depression (major depressive disorder) - Symptoms and causes - Mayo Clinic

Trauma | Depression and Anxiety

Can you explain the difference between situational depression and clinical depression? - Depression and Bipolar Support Alliance

How to Cope With & Process Trauma-Induced Depression

Benefits of Sequentially Adding Cognitive-Behavioral Therapy or Antidepressant Medication for Adults With Nonremitting Depression | American Journal of Psychiatry

Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis

Depression Definition and DSM-5 Diagnostic Criteria (

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