Help with depression

snommintj
snommintj Member Posts: 601
edited March 2014 in Colorectal Cancer #1
Since my most recent cancer symptoms my wife seems to have fallen into depression. She's had to cope with issues and problems she's never encountered before. I know the last 18 months has been hard on her. She was diagnosed with depression many years ago and had a slight bout of postpartum. Now she seems to be getting worse. I'm not asking for treatment ideas. I need some body to help me understand what is going on. I recognize that it is a chemical imbalance. What I can't seem to understand is if you know it's a chemical imbalance, then you know your feelings aren't real or as intense as you feel. Does the imbalance interfere with your ability to recognize this and/or does it prevent you from overcoming those feelings. This is something that I truly don't understand.

Comments

  • Shannonlw7
    Shannonlw7 Member Posts: 27
    hope this helps
    i was diagnosed about eight years ago with depression and it wasnt that my feeling werent real, it was the intense factor..like everything was too hard to handle..and after my meds took affect, i felt soo much better, i still had the feelings and problems but i at least felt like i had control over them again. so i do believe that the imbalance does interfere with you being able to be rational over anything..but they did help.. and eventually i did ween myself off the meds and ive been doing good ever since..i hope this helps you out some..
  • This comment has been removed by the Moderator
  • PhillieG
    PhillieG Member Posts: 4,866 Member
    The Short Answer
    Yes, I believe it does interfere with your ability to recognize it. Unless you experience it I doubt you will understand it.
    -phil
  • usakat
    usakat Member Posts: 610 Member
    The Blues....
    Hello John,

    With all that you have been going through, I'm sorry to hear your wife is struggling too. I know for certain that it is not uncommon for caregivers, spouses/partners and others connected to the cancer patient to fall into depression. For some, and I know I felt this while my mom was going through her fourth cancer, and I know she felt it when I was going through mine, a huge and overwhelming sense of helplessness. As a caregiver/spouse/partner/family member/friend, to love someone so much and to see them suffer, and knowing there is little that they can actually actively do to help is very difficult. I think this is source that this type of depression springs from.

    You mention that your wife's condition is a chemical imbalance? What makes you think so? Is she on medication to help re-balance those ever so important brain chemicals? If she indeed does have a brain chemistry issue, then your situation would of course only exacerbate the depression, especially if she is not on medication. I don't believe that she can "think" her way out of it, meaning if she does indeed have brain chemistry issues that she can logically and rationally rationalize her way through this without some help. I don't think depression and brain chemistry work that way. And even if she does have a brain chemistry problem, it does not mean her feelings or thoughts are not real...they are very real. She loves you and is worried about you...and I'm sure worried about herself and your children.

    If she has not been properly diagnosed with a brain chemical imbalance by a Psychiatrist, then I would first guess that she is suffering a situational depression and understandably so. Short term meds can help with this, but more so, talking it out with someone. Journal writing has always helped me sort through difficult times - you might suggest it.

    If she is indeed severely depressed and it is adversely affecting her life and her/your family's life, then she should get help....the sooner the better.

    I hope this gives you something to think about - I hope this helps....

    Keeping you and your family in my thoughts and prayers....
  • usakat
    usakat Member Posts: 610 Member
    usakat said:

    The Blues....
    Hello John,

    With all that you have been going through, I'm sorry to hear your wife is struggling too. I know for certain that it is not uncommon for caregivers, spouses/partners and others connected to the cancer patient to fall into depression. For some, and I know I felt this while my mom was going through her fourth cancer, and I know she felt it when I was going through mine, a huge and overwhelming sense of helplessness. As a caregiver/spouse/partner/family member/friend, to love someone so much and to see them suffer, and knowing there is little that they can actually actively do to help is very difficult. I think this is source that this type of depression springs from.

    You mention that your wife's condition is a chemical imbalance? What makes you think so? Is she on medication to help re-balance those ever so important brain chemicals? If she indeed does have a brain chemistry issue, then your situation would of course only exacerbate the depression, especially if she is not on medication. I don't believe that she can "think" her way out of it, meaning if she does indeed have brain chemistry issues that she can logically and rationally rationalize her way through this without some help. I don't think depression and brain chemistry work that way. And even if she does have a brain chemistry problem, it does not mean her feelings or thoughts are not real...they are very real. She loves you and is worried about you...and I'm sure worried about herself and your children.

    If she has not been properly diagnosed with a brain chemical imbalance by a Psychiatrist, then I would first guess that she is suffering a situational depression and understandably so. Short term meds can help with this, but more so, talking it out with someone. Journal writing has always helped me sort through difficult times - you might suggest it.

    If she is indeed severely depressed and it is adversely affecting her life and her/your family's life, then she should get help....the sooner the better.

    I hope this gives you something to think about - I hope this helps....

    Keeping you and your family in my thoughts and prayers....

    One more thought...
    Have you thought about inviting her to look at or join the Caregivers forum her at CSN? If you don't want to share CSN, you could suggest she look at colonclub.com or mycrcconnections.com

    Both are good and welcome caregivers/spouses...
  • Buzzard
    Buzzard Member Posts: 3,043 Member
    usakat said:

    One more thought...
    Have you thought about inviting her to look at or join the Caregivers forum her at CSN? If you don't want to share CSN, you could suggest she look at colonclub.com or mycrcconnections.com

    Both are good and welcome caregivers/spouses...

    Brain Functions..........
    John.....I have been through this and am going through it now with my wife and I both.....

    The brain has neuro-transmitters that allow it to make particular chemicals that involuntarily make you smile , cry , laugh etc... If you are in a depressed mode for a longer than normal period the brain neuro transmitters shut down..They automatically sense that you no longer need them so they quit working making the chemicals that allow you to be happy once again... There are anti-depressants IE. Prozac, Flourextine, etc that actually wake these neuro-transmitters up and start them actually produce these chemicals again....It actually starts as just being depressed but in an ordeal like we go through the longevity of it causes the transmitters to actually shutdown thus causing the depression and no way to come out of it until medication is involved.

    One more note along these lines......I started out on 10mg Flourextine for depression and then went to 20 mg / day and I am fine now, but along with this type of anti-depressant comes something I didn't know about...

    Compazine, which is a nausea aid works off of the same brain neuro-transmitters that the Flourextine initiates, in essense if your transmitters have shut down Compazine will not work for you, That is one of the reasons for my early nausea problems. Zofran is absorbed through the stomach lining thus the transmitters never came into play so that started to work better than Compazine.

    Anyway back on the subject at hand, my wife and I both are on anti-depressants me on Flourextine at 20mg/day and she is on Lexipro at 10mg/day....It takes the medication usually 1-2 weeks to start noticing anything...but it will help..It allows you to quit dwelling on the things that cause the depression and allows you to smile again,literally.

    We are both either fine or so messed up that we think we are...either way it works for us both...I hope this helps..My wife was having the same deep depression as yours seems to be and its understandable.....Good Luck bud and I hope this helps....My wife would be more than glad to talk to you or your wife about her feelings if you or her ever need to. You could pm me if it is ever necessary....Good Luck.....
  • angelsbaby
    angelsbaby Member Posts: 1,165 Member
    Buzzard said:

    Brain Functions..........
    John.....I have been through this and am going through it now with my wife and I both.....

    The brain has neuro-transmitters that allow it to make particular chemicals that involuntarily make you smile , cry , laugh etc... If you are in a depressed mode for a longer than normal period the brain neuro transmitters shut down..They automatically sense that you no longer need them so they quit working making the chemicals that allow you to be happy once again... There are anti-depressants IE. Prozac, Flourextine, etc that actually wake these neuro-transmitters up and start them actually produce these chemicals again....It actually starts as just being depressed but in an ordeal like we go through the longevity of it causes the transmitters to actually shutdown thus causing the depression and no way to come out of it until medication is involved.

    One more note along these lines......I started out on 10mg Flourextine for depression and then went to 20 mg / day and I am fine now, but along with this type of anti-depressant comes something I didn't know about...

    Compazine, which is a nausea aid works off of the same brain neuro-transmitters that the Flourextine initiates, in essense if your transmitters have shut down Compazine will not work for you, That is one of the reasons for my early nausea problems. Zofran is absorbed through the stomach lining thus the transmitters never came into play so that started to work better than Compazine.

    Anyway back on the subject at hand, my wife and I both are on anti-depressants me on Flourextine at 20mg/day and she is on Lexipro at 10mg/day....It takes the medication usually 1-2 weeks to start noticing anything...but it will help..It allows you to quit dwelling on the things that cause the depression and allows you to smile again,literally.

    We are both either fine or so messed up that we think we are...either way it works for us both...I hope this helps..My wife was having the same deep depression as yours seems to be and its understandable.....Good Luck bud and I hope this helps....My wife would be more than glad to talk to you or your wife about her feelings if you or her ever need to. You could pm me if it is ever necessary....Good Luck.....

    MENTAL HEALTH
    SHE NEEDS TO SEE A MENTAL HEALTH PROFESSIONAL THEY SHOULD NO WHAT TO DO , i SHOULD BE DEPRESSED ABOUT ANGEL BUT JUST SAD i JUST CAN;T GET TO SAD OR I WILL SEEK HELP TO. i HOPE SHE WILL FEEL BETTER SOON. THE WHOLE CANCER THING IS SO OVERWHELMING FOR US AND WE TEND TO WORRY SO MUCH ABOUT THINGS.

    MICHELLE
  • Betsydoglover
    Betsydoglover Member Posts: 1,248 Member
    Your wife's depression
    Hi John -

    Many years ago I suffered from panic attacks - not depression, but the conditions are related and often the same drugs help. I KNEW intellectually that I was not dying of a heart attack, but that didn't make it less scary or help me cope any more. I was utterly terrified and scared of dying during a panic attack. I suspect this is similar to depression.

    A psychiatrist who specializes in psycho-pharmacology treated me with Paxil, then Celexa, plus as needed Xanax. It changed my life and after about 2 years I was able to wean off the meds and have been fine ever since. In my case the reasons my anxiety manifested itself the way it did were not rocket science - my father had his first heart attack when I was 5 and I grew up watching him clutch his chest, pop nitros and always assumed I would die young from heart disease. Regardless, talk therapy, as my psych said, would give me lots of additional insight, but probably wouldn't reduce the panic attacks. But meds, plus periodic short visits with the psych, worked wonders.

    My point is that anxiety / depression may seem very simple to solve - just realize it's not real and get better - but that doesn't usually work. One might think that if I was susceptible to panic attacks that a Stage IV cancer diagnosis would have brought it on. But - no not at all. Often these things are chemically based. And often if the right dose of drugs can help, just the fact that you are feeling better increases the chances that you will stay better.

    If your wife hasn't seen a psychiatrist, I strongly suggest she does. Most primary care physicians, while they may prescribe psychotropic drugs, are not especially skilled in doing so.

    Take care,
    Betsy
  • ADKer
    ADKer Member Posts: 147

    Your wife's depression
    Hi John -

    Many years ago I suffered from panic attacks - not depression, but the conditions are related and often the same drugs help. I KNEW intellectually that I was not dying of a heart attack, but that didn't make it less scary or help me cope any more. I was utterly terrified and scared of dying during a panic attack. I suspect this is similar to depression.

    A psychiatrist who specializes in psycho-pharmacology treated me with Paxil, then Celexa, plus as needed Xanax. It changed my life and after about 2 years I was able to wean off the meds and have been fine ever since. In my case the reasons my anxiety manifested itself the way it did were not rocket science - my father had his first heart attack when I was 5 and I grew up watching him clutch his chest, pop nitros and always assumed I would die young from heart disease. Regardless, talk therapy, as my psych said, would give me lots of additional insight, but probably wouldn't reduce the panic attacks. But meds, plus periodic short visits with the psych, worked wonders.

    My point is that anxiety / depression may seem very simple to solve - just realize it's not real and get better - but that doesn't usually work. One might think that if I was susceptible to panic attacks that a Stage IV cancer diagnosis would have brought it on. But - no not at all. Often these things are chemically based. And often if the right dose of drugs can help, just the fact that you are feeling better increases the chances that you will stay better.

    If your wife hasn't seen a psychiatrist, I strongly suggest she does. Most primary care physicians, while they may prescribe psychotropic drugs, are not especially skilled in doing so.

    Take care,
    Betsy

    Seek a professional opinion
    I want to echo the advice to seek professional help. I was in the position of caregiver to someone in a crisis situation over 20 years ago. The impact on me was mild post-traumatic stress syndrome. While depression may be what your wife is dealing with, it is also possible that something else is going on which hopefully a mental health professional could diagnosis accurately.
  • kmygil
    kmygil Member Posts: 876 Member
    Yes and No
    Arrggghhh. Having suffered from depression a few times in my life I have come to recognize the early symptoms of a downward spiral. This does not mean that my excellent denial system didn't work; I refused to acknowledge it the last time, even though I was practically living in my closet crying when I wasn't out trying to kill myself & other people in my car. It got to feel quite usual to have suicidal ideations 24/7. Somewhere in my head, I knew that this was the worst bout yet, but it sort of felt like watching a movie about someone else, because when not depressed, I am a very upbeat and optimistic person (oxymoron, right?) So. It took a visit from my younger sister (all 3 of us siblings have inherited not only the colon cancer gene, but depressive genetics) to slap me into reality. She hadn't been here for 2 hours before she cornered me and said, "Get some help, NOW!"

    So yes, the feelings are very real, and yes, you can recognize it for what it is without it being real. Trying to cope with it on your own is like trying to sprint through a swamp--impossible. I managed to get through the first 3 bad depressions, each lasting about 3-4 years, on my own. This time I got treatment. Thank God for that, because 2 months after tx started, I was dx'd with the cancer. I don't believe that I would have gone for the cancer treatment if my antidepressants were not on board. The hopelessness is complete when you're there. So let's hear it for anti-depressants!

    If your wife needs to talk, she can e-mail me on the private line. Depression can snowball, so if she's not getting treated, she needs to. If she's in treatment but still getting worse, her meds need to be tweaked, upped or changed. Meanwhile, I know you have so much on your plate, but please try to bear with her. You are a very strong man to have dealt with everything you have. Just love her and encourage her to get tweaked, upped or whatever.

    Hugs and prayers,
    Kirsten
  • snommintj
    snommintj Member Posts: 601
    kmygil said:

    Yes and No
    Arrggghhh. Having suffered from depression a few times in my life I have come to recognize the early symptoms of a downward spiral. This does not mean that my excellent denial system didn't work; I refused to acknowledge it the last time, even though I was practically living in my closet crying when I wasn't out trying to kill myself & other people in my car. It got to feel quite usual to have suicidal ideations 24/7. Somewhere in my head, I knew that this was the worst bout yet, but it sort of felt like watching a movie about someone else, because when not depressed, I am a very upbeat and optimistic person (oxymoron, right?) So. It took a visit from my younger sister (all 3 of us siblings have inherited not only the colon cancer gene, but depressive genetics) to slap me into reality. She hadn't been here for 2 hours before she cornered me and said, "Get some help, NOW!"

    So yes, the feelings are very real, and yes, you can recognize it for what it is without it being real. Trying to cope with it on your own is like trying to sprint through a swamp--impossible. I managed to get through the first 3 bad depressions, each lasting about 3-4 years, on my own. This time I got treatment. Thank God for that, because 2 months after tx started, I was dx'd with the cancer. I don't believe that I would have gone for the cancer treatment if my antidepressants were not on board. The hopelessness is complete when you're there. So let's hear it for anti-depressants!

    If your wife needs to talk, she can e-mail me on the private line. Depression can snowball, so if she's not getting treated, she needs to. If she's in treatment but still getting worse, her meds need to be tweaked, upped or changed. Meanwhile, I know you have so much on your plate, but please try to bear with her. You are a very strong man to have dealt with everything you have. Just love her and encourage her to get tweaked, upped or whatever.

    Hugs and prayers,
    Kirsten

    Thanks
    My wife has been and is being professionally treated. I'm the one that needs help understanding what she's dealing with. The Dr has informed me of the science but I'm having a hard time connecting the dots. I understand the emotions and feelings involved, I simply haven't been able to come to terms with the scope and magnitude of this. I would never tell my wife to suck it up and deal with it, but that's how I've always approached adversity. I won't claim to be a stoic but I do think a little stoicism goes a long way. I don't know if that is something you can learn or if it's something you're born with. I have dealt with and will continue to deal with my wife with compassion and tenderness, but seeing her down and blue is disheartening.
  • PhillieG
    PhillieG Member Posts: 4,866 Member
    snommintj said:

    Thanks
    My wife has been and is being professionally treated. I'm the one that needs help understanding what she's dealing with. The Dr has informed me of the science but I'm having a hard time connecting the dots. I understand the emotions and feelings involved, I simply haven't been able to come to terms with the scope and magnitude of this. I would never tell my wife to suck it up and deal with it, but that's how I've always approached adversity. I won't claim to be a stoic but I do think a little stoicism goes a long way. I don't know if that is something you can learn or if it's something you're born with. I have dealt with and will continue to deal with my wife with compassion and tenderness, but seeing her down and blue is disheartening.

    A question for you John
    Have you seen a therapist since you've been diagnosed with cancer?
    It can be a very eye opening experience to do so. I started seeing one a few months after my diagnosis and it's been nothing but helpful, for myself and for dealing with loved ones and getting some perspective on how they feel.
    Just asking...
    -p
  • snommintj
    snommintj Member Posts: 601
    PhillieG said:

    A question for you John
    Have you seen a therapist since you've been diagnosed with cancer?
    It can be a very eye opening experience to do so. I started seeing one a few months after my diagnosis and it's been nothing but helpful, for myself and for dealing with loved ones and getting some perspective on how they feel.
    Just asking...
    -p

    No therapy for me
    Oddly, I've taken this whole cancer thing pretty well. I came to terms with my mortality a dozen or so years ago while engaged in combat operations overseas. I took the whole life and death thing pretty hard for a while and then one day when I knew I was probably going to die a switch in my brain flipped and I was released from the burden of knowing I was going to die. For some reason that switch has stayed in that position since. I enjoy life, I know I'm going to die, but it doesn't bother me.
  • maglets
    maglets Member Posts: 2,576 Member
    snommintj said:

    No therapy for me
    Oddly, I've taken this whole cancer thing pretty well. I came to terms with my mortality a dozen or so years ago while engaged in combat operations overseas. I took the whole life and death thing pretty hard for a while and then one day when I knew I was probably going to die a switch in my brain flipped and I was released from the burden of knowing I was going to die. For some reason that switch has stayed in that position since. I enjoy life, I know I'm going to die, but it doesn't bother me.

    care givers
    John I understand your stoic attitude...that is an admirable quality...sometimes I think when we are the victims the sufferers that our path is more readily defined for us than for our caregivers.

    I wonder and i am constantly amazed by my husband and daughter.....they soldier on too but under such different stress than we. They just don't want us to hurt anymore and yet I know most times they feel helpless to solve the situation. For 5 years my husband has listened to me blather on regardless of his own pain.

    My hats off to your wife John and to all the wonderful caregivers who essentially give up a lot of their lives to care for us. Please continue to support and love that wonderful wife of yours.

    mags
  • PhillieG
    PhillieG Member Posts: 4,866 Member
    snommintj said:

    No therapy for me
    Oddly, I've taken this whole cancer thing pretty well. I came to terms with my mortality a dozen or so years ago while engaged in combat operations overseas. I took the whole life and death thing pretty hard for a while and then one day when I knew I was probably going to die a switch in my brain flipped and I was released from the burden of knowing I was going to die. For some reason that switch has stayed in that position since. I enjoy life, I know I'm going to die, but it doesn't bother me.

    Maybe rethink it, it is a Big Deal to her...
    Not for you as much as for your wife's sake. You've come to terms with your mortality but it sounds like she hasn't. She's the one with depression, understanding what she might be experiencing, more than you knowing it's a just a chemical imbalance etc., would in my opinion be a greater help to her than your It's no big deal attitude. To her, I think it's still a big deal. I live my life as if not much is different other than feeling crappy a few days here and there but the ones around us aren't always as confident as we may feel. I'm much more aware of that since going. It's a way to help her and to understand her. Isn't that what your post was about or was it just to know the chemistry of it?
    That's what you can possibly understand through going to therapy.
  • DennisR
    DennisR Member Posts: 148
    When my sister in law died
    When my sister in law died suddenly, though not unexpectedly, in July, I found myself in a deep depression and was unable to work my way through it. I was fortunate to be able to see my PCP at the VA who recognized the symptoms and got me into the VA Mental Health Unit immediately. The Psychologists I saw that day were, and continue to be, very, very knowledgeable and caring people who have helped me immensely, both in helping me get back on a more stable frame of mind through just talking about how I felt, and the use of some mild sedatives that allowed me to at least function.
    I have never experienced anything like this before in my life, but I can tell you that it is a very real and debilitating mental condition. I had absolutely no ability to deal with it and was unable to find joy in any aspect of my life, or anybody else's, I couldn't be bothered to listen to other people's problems, feelings, or emotional situations and avoided people that were close to me and that I loved. My wife who was also grieving recieved no comfort from me, my Daughters, my Grandkids, I shunned them all, and just wanted to crawl into the same hole in my life that Lyn's death had created.
    I'm doing much better now, after three sessions with the Counselor, I don't take the medications though, preferring to learn to cope with my grief by allowing it to run it's natural course without relying on drugs to deny that it even exists.
    The hardest part is admitting that for once in my life, I've run into a wall that I can't get, over, around, or right through the middle of, and that I needed help. Probably the wisest thing I've ever done in my life.
    I hope and pray that your wife will come to the conclusion that she indeed needs some help, preferably from a trained professional, to get herself back to the strong, courageous, caring, and encouraging person she obviously is and has been. I don't know exactly how to help her come to this conclusion, and just hinting she may need help may not be the right way to approach someone going through a depression. I would have resented it, had anyone else suggested I was too weak to take care of myself.
    I did read a book titled, "Tear Soup", written in simple terms, (just my style), that caused me to realize that I had a serious problem and caused me to seek help.
    Hope this helps,
    DennisR
  • PGLGreg
    PGLGreg Member Posts: 731
    snommintj said:

    No therapy for me
    Oddly, I've taken this whole cancer thing pretty well. I came to terms with my mortality a dozen or so years ago while engaged in combat operations overseas. I took the whole life and death thing pretty hard for a while and then one day when I knew I was probably going to die a switch in my brain flipped and I was released from the burden of knowing I was going to die. For some reason that switch has stayed in that position since. I enjoy life, I know I'm going to die, but it doesn't bother me.

    brain chemicals
    I don't get depressed, but my wife does. She is perfectly clear that it's a brain chemical thing, and that awareness doesn't help her in the slightest. And why should it? How can being aware that your brain chemicals are out of balance bring them into balance through the power of thought? You'd need some magical psychic power over those chemicals. The conceptual problem for those of us not subject to depression is to get beyond the illusion that our minds are not parts of our bodies and can stand apart from and control our bodies.
  • PhillieG
    PhillieG Member Posts: 4,866 Member
    PGLGreg said:

    brain chemicals
    I don't get depressed, but my wife does. She is perfectly clear that it's a brain chemical thing, and that awareness doesn't help her in the slightest. And why should it? How can being aware that your brain chemicals are out of balance bring them into balance through the power of thought? You'd need some magical psychic power over those chemicals. The conceptual problem for those of us not subject to depression is to get beyond the illusion that our minds are not parts of our bodies and can stand apart from and control our bodies.

    The mind and depression
    I know we've visited this topic before and probably will again. Depression is not just a chemical imbalance, there are many causes of depression. And as far thinking of it as being strictly chemical how would the placebo effect play into this. People's minds can make them feel or experience different things like a person thinking they are getting medicine and getting better while they are just getting an inert pill. The power of thought is a very powerful tool. It can work for or against you. When I was recovering from one of my operations, my brother(who practices meditation) suggested to try to be aware of and embrace the pain. I wish I was better at the meditation than I was but it did help to lessen the pain at times. So, many things can bring on depression and many things can help get you out of it. I also think some of it could be cultural. Some cultures have very strict ways of thinking. As it was said before, some people who never experienced depression can not understand how it is like for those of us who have experienced it. Just like how most things in life go.
    ;-)

    ~ from the NIMH ~
    What causes depression?

    There is no single known cause of depression. Rather, it likely results from a combination of genetic, biochemical, environmental, and psychological factors.

    Research indicates that depressive illnesses are disorders of the brain. Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different than those of people without depression. The parts of the brain responsible for regulating mood, thinking, sleep, appetite and behavior appear to function abnormally. In addition, important neurotransmitters–chemicals that brain cells use to communicate–appear to be out of balance. But these images do not reveal why the depression has occurred.

    Some types of depression tend to run in families, suggesting a genetic link. However, depression can occur in people without family histories of depression as well.9 Genetics research indicates that risk for depression results from the influence of multiple genes acting together with environmental or other factors.

    In addition, trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive episode. Subsequent depressive episodes may occur with or without an obvious trigger.