“I’m not good at anything.” “I’m just not worth anything.” “I’m always sad.” “I’m constantly tired, even when I get enough sleep.”

These kinds of statements and thoughts can be more important than meets the eye. Persistent sadness, a lack of energy, and several other symptoms can be signs of depression.

As a physician, about 30 percent of patients during my 10 years of private practice suffered with various mental health diagnoses, which affect people of all genders, socioeconomic statuses and ages. For this article, we will consider “Jane”—a composite of former patients suffering from depression.

Jane has been having thoughts of depression off and on for years, yet she has been persistently suffering from them over several months. She hides it as much as possible. This is primarily because of the social stigma associated with depression. A common reaction from others is: “What’s wrong with you?! Just pick yourself up and move along.”

It is typical for those with symptoms of depression to try to hide it. From friends. From family. From spouses. Even from doctors.

Jane is someone you know. A family member perhaps? She could also be you. Did you know most people experience at least mild depression sometime during their life? Yet those who have not personally experienced depression often have difficulty understanding those who do.

Experts say that about 20 percent—1 in 5—of the U.S. population experience major symptoms of depression at any point in time.

This statistic alone means that we all likely know at least one person who has some of the persistent, nagging thoughts and feelings of depression.

Depression can go from self-doubt to self-mutilation or all the way to self-murder. Depressed people can get so used to telling themselves of all their problems, it becomes addicting. It feels normal—even good—to dwell on how miserable their lives are!

While this article aims to help those who are personally struggling, the primary focus is on those who are not currently affected—but need to understand it to be helpful to those who are. You may not realize it, but there is at least one “Jane” in your life.

What Exactly Is Depression?

Jane has now been persistently sad for several months. She believes this is without a “real reason.” It is difficult to explain to others, and she is embarrassed. Every time she thinks about how she feels or attempts to discuss it, she tears up and sometimes outright cries. It hurts deep in her heart. A lot. More than any physical pain she has ever had.

She feels alone, worn out, tired and sleepy. She has gained 15 pounds of extra weight and cannot stick to a weight reduction diet for more than a few hours. She wonders if life is even worth living any more.

The Mayo Clinic website states the textbook definition of clinical depression: “Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think, and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn’t worth living.”

What Causes It?

Jane is smart. She has read up on depression. She found that alcohol can cause it, so she stopped drinking. And although she knows that other things like illicit drug use and even some prescription drugs, such as narcotics are often associated with similar symptoms, she has never had a problem with these things.

Sighing, she thinks, “At least if I did struggle with chemical dependence, there would be a reason I feel bad and I could try to fix it, or doctors could help me.”

The natural grieving process can sometimes be confused with depression. Grief is a normal response to personal loss such as losing a job, a loved one’s death, a miscarriage, or other losses. Depression is something more permanent.

WebMD confirms this: “When you lose someone or something dear to you, it’s natural to feel pain and grief. The grief process is normal, and most people go through it. But when grief takes over your life and you begin to feel hopeless, helpless, and worthless, then it’s time to talk to your doctor about telling the difference between normal grief and depression.”

But passing grief does not apply to Jane, which discourages her. She is reluctant to confide in any type of health care professional. Despairing, she thinks, “Nothing is really wrong with me, so they can’t help me anyway.”

However, we can and should encourage Jane and those like her to involve a physician in the evaluation of possible depression. Underlying medical problems can increase the risk of developing depression or, in some cases, can be the cause of depression. Here are a few:

• Brain disorders such as Parkinson’s disease

• Following major medical events such as heart surgery or a stroke

• Certain metabolic conditions

A physician can perform an evaluation and recommend appropriate, individualized treatment options. This is important to prevent depression from getting worse. So, someone like Jane should be encouraged to get help as soon as possible.

However, for people with a diagnosis of depression, these conditions are the exception, not the rule. This means that most people who are depressed do not have a medical condition as the cause of their depression.

That is what happened to Jane. The evaluation was “normal.” The doctor did not think laboratory evaluation was even needed but did it on her insistence. The results showed everything was normal.

But she is not normal. Everything about her behavior shows she is depressed.

Mood and Sleep

Jane remains sad. Virtually all the time. On the now rare occasion when she does not feel sad, she is never happy. She is only blah—at best neutral. Despite this, she says she is getting by.

According to Family Practice Notebook, an online reference tool used by physicians who specialize in family medicine, a “depressed mood” is one of the most important criteria used to diagnose major depression. Different from the intermittent sadness and short-lived discouragement people can feel from the struggles of life, a depressed mood lasts for many days and, without intervention, can go on for weeks, months and years.

There is often no discernable cause of this disorder. Having unremitting depressed mood for two weeks or longer without a major life event like the death of a loved one or a job loss should prompt more intense evaluation.

Depression affects mood but not all mood disorders cause depression. Medical science has long known that the hormones associated with some women’s menstrual cycles can bring mood fluctuations—some so severe they require professional medical treatment. But this is not necessarily tied to depression.

Jane falls asleep through the day, which she attributes to poor sleep at night. “Insomnia,” she thinks.

Sleep disturbance, often interrupted sleep from early morning wakening, is another symptom of clinical depression. While occasional awakening without an ability to return to sleep occurs for many other reasons, persistent insomnia often accompanies depression.

Some experience the opposite—excessive tiredness resulting in a need for much more sleep.

It can be difficult for individuals to determine the cause of their sleeping problems. Is it due to factors such as stress? Or unremitting sleep disturbance over time due to possible depression? Therefore, it is again crucial to seek professional evaluation.

Interest, Worthlessness and Fatigue

Jane is not interested in much of anything. She used to be an avid walker, and she enjoyed going out to dinner with friends at restaurants.

But not now. For months she has just wanted to sit at home and flip through television channels. And many times, she just stares at the ceiling without much thought. Just lying there—for hours.

This persistent, decreased interest in her usual activities is another important symptom of depression. It is normal to have a reduced interest in activities from time to time, but not day after day.

Jane also feels guilty about her weight—her diet—and letting family down. “If I could just quit it!” she thinks.

Feelings of guilt or worthlessness are not always a sign of clinical depression. But, if accompanied by other symptoms, these feelings can be from depression—especially if they are strong and unrelenting.

Jane’s tiredness is debilitating at times. She calls in to work sick a few days every month. And work is starting to question her being absent. But some days she cannot hide it, and employers and co-workers just think it is fatigue.

For others who see someone going through this, it can be difficult to know how to help. But realize that simply listening and encouraging such people to get professional help goes a long way.

Concentration, Appetite and Motor Skills

You notice Jane has had difficulty finding her words at times and she often forgets what others just said. This difficulty concentrating exhibits as cloudy thinking and feeling foggy mentally. Her ongoing inability to focus is noticeable.

Also, her clothes are tighter, more wrinkled—signaling a change in appetite that has led to weight gain. Like many with clinical depression, she is eating more “comfort food.” This can create or complicate other illnesses.

Unlike Jane, some lose the desire to eat and begin to lose a significant amount of weight. This is especially problematic for normal or already underweight individuals.

Jane just sits looking at you without much movement. She looks tired.

While some people act agitated with depression, it is more common for affected individuals to show slowed movements and speech, termed “psychomotor retardation.” This results in unusual social interactions and can cause others to avoid depressed individuals.

But this is when they need human contact the most.

Suicide

Jane is so discouraged, she thinks the world might be better off without her. Fortunately, she is not seriously thinking about suicide. However, if you know of someone who has suicidal intent—is developing a plan or has already developed a plan to commit suicide—get immediate professional help. This means right now—refer to the contact information contained in this article.

In Jane’s situation, like many others, suicidal thoughts occur in what experts term “suicidal ideation.” This is a preoccupation with one’s own death, dying or even just a preoccupation with being dead.

There is a common misconception that talking about suicide with a person considering it somehow encourages them to go through with it. Realize that talking with a depressed person about suicidal thoughts does not necessarily lead to an increased risk of suicide. It can help a depressed person for a friend to listen through such thoughts, and then refer that person to a professional.

Helping Someone Cope

Jane is now well on her way to resolving her depression. You have noticed improvement following the treatment and counseling you have encouraged her to receive and maintain. Support from friends and family has been instrumental.

While there is no one-size-fits-all approach, there are beneficial actions we can encourage depression sufferers to implement as we encourage them to seek professional help.

First, remember that telling someone to “just get over it” is discouraging and can make them feel even worse. Never say that to anyone.

Instead, refer to this list on coping with depression adapted from the United Kingdom’s National Health Service:

• Stay in touch. Do not withdraw from life. Socializing can improve your mood. Keeping in touch with friends and family means you have someone to talk to when you feel low.

• Be more active. Take up some form of exercise. There is evidence that exercise can help lift your mood. If you have not exercised for a while, start gently by walking for 20 minutes every day.

• Face your fears. Do not avoid the things you find difficult. When people feel low or anxious, they sometimes avoid talking to other people. Some people can lose their confidence in going out, driving or traveling. If this starts to happen, facing up to these situations will help them become easier.

• Do not drink too much alcohol. For some people, alcohol can become a problem. You may drink more than usual as a way of coping with or hiding your emotions, or just to fill time. But alcohol will not help you solve your problems and could also make you feel more depressed.

• Try to eat a healthy diet. Some people do not feel like eating when they are depressed and are at risk of becoming underweight. Others find comfort in food and can put on excess weight.

• Have a routine. When people feel down, they can get into poor sleep patterns, staying up late and sleeping during the day. Try to get up at your normal time and stick to your routine as much as possible. Not having a routine can affect your eating. Try to carry on cooking and eating regular meals.

Do your best to encourage the Janes in your life who you believe or know are suffering from depression. Ultimately, they have to learn to help themselves, but the guidance and encouragement of a friend goes a long way in showing that they are worth something, they are good at something, and the world is a better place with them in it.