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Depression isn’t always outwardly.

It’s one of those inner demons that people don’t often notice or understand too well. Contrary to what most people think, depression isn’t just a momentary sadness that you can simply snap out of if you think happy thoughts. Defined by Mayo Clinic as “a mood disorder that causes a persistent feeling of sadness and loss of interest,” depression is a serious condition that needs attention and proper treatment.

Do you feel that you may be going through depression or that a friend is suffering from it? Watch out for these five signs of hidden depression and get help immediately.

Irritation and anger are two signs of depression. When we think about depression, it’s often characterized with a dejected state of being — helpless, apathetic, melancholic. But sometimes we mistake people with depression for simply having bad tempers. Often, this is how men express their depression.

2. They may withdraw.

When someone becomes depressed, it’s common for them to lose all interest in anything, particularly the things they once loved doing. Where they may have been a social butterfly, they are now withdrawn, sleeping late and calling into work. Withdrawing is a sign of depression.

3. They may become somewhat flaky.

When people become depressed, they’ll make plans with you at times when they feel up for it, but when it’s time for those plans to happen they may not want to follow through. Someone who suddenly begins flaking out on you could be secretly depressed.

4. They may be exhausted.

When depression sets in, sleeping becomes more difficult. Sleep problems are sometimes a warning sign of deeper problems. On the other hand, sleeping far too much is also a sign of depression.

5. They may suddenly gain or drop a large amount of weight.

People sometimes lose a lot of weight because they started eating better and exercising, so be careful trying to associate it with depression. If they’re losing or gaining weight because you think they’ve stopped eating or started eating too much in order to cope, it may be a sign your friend has depression.

Sure, the thought counts. So think twice.

I have clinical depression. It’s been a part of my life since I hit puberty. I have had highs and lows and will continue to have them throughout my life.

I’m an adult, I’m in treatment, and years of it has taught me incredible coping skills.

But that doesn’t always make it easy.

One of the toughest things about having depression is something people don’t always talk about: interacting with others.

In the US, depression is less stigmatized than it is in other parts of the world for sure. We’re more open about mental illness here, though we still have miles to go.

An unfortunate side effect of that openness can  be dealing with people who don’t understandhow to deal with people who have depression. 

Below you’ll find nine things people with depression (myself included) are tired of having to confront on a daily basis.

I don’t want to sound snide or unappreciative of the people who think they are showing us support, and I hope conversations like this one will make an ongoing dialogue about mental illness easier for everyone involved.

1. “You don’t seem depressed.” 

All depression is not created equal and the people who suffer from it are also all totally different from one another. I can get a blow-out, put on lipstick, laugh at a joke in public, and still have depression. That doesn’t make me magically better.

2. “You should try meditation.”

It’s great, great, great that your friend/uncle/co-worker cured their depression with a regularly scheduled meditation session. I’m so happy that they found the peace and coping mechanism that they needed. I’ve tried it, and meditation is great, but for me personally it is not as great as weekly therapy and a low dose of antidepressant.

3. “I exercise, so I never get depressed.”

It’s true that exercise releases serotonin, one of the chemicals produced by the brain that makes you feel happy. A natural side effect of exercise is that lovely rush of serotonin. I’m a depressed person and exercise definitely gives me a little boost. But it’s not a cure. People with depression have brains that actually produce LESS serotinin than everyone else on a regular basis. So while the uptick in the stuff feels great, it doesn’t solve the overall problem.

4. “Can’t you just take medication?”

I’ve been fortunate enough in my life to be friends with people who understand that managing depression is a lifelong struggle, and a real one. But I can’t tell you how many people I know whose mental illness has been dismissed as no big deal now that antidepressants exist. While we’ve made great strides with drugs to treat depression, that’s no reason to dismiss someone else’s experience.

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5. “It’s just a party.”

What feels like the easiest thing in the world to you can be a challenge of the highest order fora person going through a depressive episode. I have had days where the concept of blinking was more than I could handle. Sure, parties are great. But when you’re struggling to do simple things, please understand how a big social event might be overwhelming for us.

6. “You shouldn’t sleep so much.”

A person with depression isn’t sleeping because they are lazy. A person with depression is sleeping because they have real, physical symptoms that have totally exhausted them.Sleeping when you’re depressed can, in fact, be a good thing. Sleep is when the body does most of its healing.

7. “Oh my god I know, I get so depressed when it’s cold outside!” 

The word depression itself has become deeply overused. There is a difference because clinical depression and you getting a little annoyed that you have to wear pants instead of the cute skirt you just bought to work. We all get bummed out, depression is different.

8. “Have you ever tried to kill yourself?” 

Legitimately I have been asked this twice when talking about my depression. If a depressed person chooses to share their story with you, that’s their prerogative. I, for one, don’t relish talking about the darkest periods of my life while also splitting cheese dip.

9. “Don’t watch this part of the movie, you won’t be able to handle it.”

It’s really kind when people try to protect their friend with depression from things they think they won’t be able to handle. But here’s the thing, while we may have depression, we’re also adults. We know our own minds. We can turn away from something if we feel like it will be triggering. If we need your help, we won’t be afraid to ask for it.

All the effectiveness without the side effects.

Depression feels grey, like you’re under a huge dark cloud and heavy, like you are walking around carrying heavy weights. It also brings negative thoughts about yourself, about others, and about your future. Psychologist Aaron Beck called these bleak thoughts the negative cognitive triad.

If you’ve been feeling the dark cloud and thinking with the cognitive triad, you’re probably not just moody or sad. You’re depressed.

Medication sometimes eases depression but risks troubling side effects like foggy thinking, a numb feeling that blocks happiness, loss of sexual interest, and weight gain. Medication for depression can cause you to fall into a deeper and darker whole when you try to stop taking the pills.  And while meds can help you to feel better in the short run, they make you more prone to depressive episodes in the future.

Talk therapy can help and couples therapy can be especially helpful if relationship problems are triggering the depression. Exercise, socializing, sunshine and sex may be able to pop you out of the darkness, but the effects tend to be temporary.

If you already have a therapist, you might ask him or her to investigate learning these following depression treatment techniques to use with you. Some of the techniques you can even do yourself!

These 5 new alternative treatments have virtually no negative side effects and can bring a surprisingly speedy recovery:

1. Pre-frontal Lobe Energy Shifting.

New brain imaging techniques used by neuropsychology researchers have established that the brain of someone who is depressed shows more energy in the right prefrontal lobe than the left. The brain of someone who feels happy has more energy in the left than the right.

Reading this information one day, Dale Petterson, an energy therapist who works in my office suite, came up with a brilliant idea. “Let’s just shift the energy!”

Energy psychology utilizes the principle energy follows intention. It also uses the principle that intentions can be magnified by applying additional energy.

The therapist uses a special magnet with rollers on it which can be run down the governing meridian, that is, down a person’s back along his spine. While using the magnet the therapists verbalizes the intention of shifting the client’s energy from the right to the left pre-frontal lobe. The energy shifts and the depression lifts!

Sound too good to be true? Try it or watch the procedure in a video! You can even do this with Dale via Skype! If you feel better for a while, maybe a few days, and then the depression slips in again, repeat the procedure.

2. The 3 P’s Visualization.

The technique rests on an assumption that that I explain in my book From Conflict to Resolution: Depression is a disorder of power that’s triggered by a dominant-submissive interaction with a person of importance to you and/or over an issue of importance to you. That is, depression is a by-product of a win-lose conflict resolution process in which you have been the loser.

When you get depressed though you may not know what the situation was that triggered the depression.  In addition, you may feel too powerless, hopeless and helpless to come up with effective solution ideas.

You can do this technique by yourself, with the help of a friend, or with the guidance of a therapist. Close your eyes, and ask yourself the following series of questions. (If you’re doing the exercise yourself, read the question aloud, then close your eyes and repeat for each subsequent question.)

• If I were going to be irritated or mad at someone or something, someone other than myself, who or what would that be?
• As I picture that scene, what is the person doing that annoys me? How do I respond? What do I really want?
• As I continue looking at the scene, who looks bigger, the other person or me? If it’s the other person, you are depressed; if it’s you, something different is going on.
• By how much do you look smaller?
• Then take several deep breaths. With each deep breath picture yourself growing larger and larger until you feel substantially bigger than the other person.
• Now, from that position of bigness, of empowerment, what can you see that offers you ideas for a new way of solving the problem between you and the other person?
• As you picture the new solution, notice how much stronger and better you continue to feel! Alternatively, if the new solution does not keep you feeling bigger, try creating other options.

You can watch a video of this technique, which is called the 3 P’s visualization, here.

3. Emotional freedom depression treatment.

A lot has been written about EFT (Emotional Freedom Technique), a tapping depression treatment that’s like acupuncture minus the needles. There’s now been substantial research that corroborates its effectiveness. Search the internet for EFT research, and to find an EFT practitioner in your locale.

4. Emotion Code.

Bradley Nelson invented this new strategy for tracking down the experiences earlier in your life that created the template for a current excessive emotional reaction reaction such as feelings of depression. The treatment then neutralizes the negative emotional impacts of that incident or relationship.

Like the other methods above, Emotion Code depression treatment is likely to be brief.  You are likely to feel significantly better within one session, though follow up sessions may be helpful to consolidate the gains.

To stay happier it may be a good idea to add some sessions of conventional therapy treatment to learn about and change old habits of thinking and acting that otherwise might bring you down again.

5. Therapy.

There’s a whole range of treatment techniques that therapists can choose from. Whether a therapist has been trained as a psychologist or psychiatrist, a social worker or a counselor, he or she is likely to have many strategies for helping you feel better. Mindfulness and cognitive therapy are among the most popular, but other techniques can work as well.

Research has shown that psychotherapy and mediation both can be effective depression treatments. The main difference is that psychotherapy gives longer-lasting results, probably because you will be learning as well as healing. Also, psychotherapy does not risk giving you the negative side effects that medication can bring.

6. Marriage education or couples therapy.

As I mentioned above, depression arises from dominant-submissive (winner-loser) interactions, especially with loved ones or with a boss or a difficult colleague. If you settle disagreements by giving up, you will end up feeling depressed. Learn instead to use collaborative dialogue and conflict resolution skills when you and your partner disagree. I teach these skills in my Power of Two book, workbook and website.

As the two of you, or even just you alone, become empowered to settle your differences in win-win ways instead of resorting to anger, fighting, giving up, or withdrawing, that dark depressive cloud is highly likely to dissipate.

Let the sun shine in!

Harvard-educated psychologist and marriage counselor Susan Heitler, Ph.D. is author of a website that teaches the skills for relationships‘ success.To help you to feel better when you’ve been feeling distressed, Dr. Heitler has just published Prescriptions Without Pills: For Relief from Depression, Anger, Anxiety and More.

What you need to know to be the BEST support system.

If your spouse or significant other is suffering from a mental illness such as anxiety ordepression, here are a few things to keep in mind that can help them — and help you keep yourmarriage healthy.

1. Know It’s Not Their Fault

This may be difficult to remember when your spouse is acting sad, angry, anxious or generally unpleasant. Keep in mind that your spouse doesn’t like how he or she is feeling or acting any better than you do. Remember you are dealing with the symptoms of an illness. The symptoms are as real of a medical condition as diabetes or high blood pressure and aren’t simply the result of negative thoughts or a bad attitude.

2. Show Them Love, Affection, And Respect (Even When They Seem Unlovable)

They are not their illness. While it’s important to remember that they have a mental illness, it’s also important to separate your spouse from their illness. It is very natural to want to emotionally disconnect and safeguard yourself when your spouse is showing signs of depression, anger, or anxiety and exhibiting behavior that seems foreign from the person you know them to be. Remember that underneath all of those unpleasant symptoms is the person you married — who needs to to draw close to them during their time of suffering.

3. Remember That A Depressed Person Feels Like They’re In A Dark Hole

It does them no good for you to jump in the hole with them. Don’t let the person with themental illness paint your reality. You can support your spouse by staying grounded in the reality outside of the hole. Understand that the illness has tainted their perception, so don’t let their emotions dictate yours. Find an outlet so that you don’t become discouraged, overwhelmed, lost or jump in your own dark hole.

4. It’s Not Personal, It’s An Illness

This will be hard to remember when your spouse takes his or her feelings and behavior out on you, but remind yourself that the mood and behavior are symptoms of the illness. It’s NOT personal. At the same time, set your boundaries and gently let your spouse know when they’ve crossed the line and hurt your feelings. You can be supportive without being a doormat.

5. Know Your Spouse’s Limitations

Living with mental illness can be frustrating and discouraging. Don’t worsen the situation by unintentionally setting your spouse up for failure by expecting them to do things that they aren’t capable of doing. Know and accept their limitations.

6. Give Yourself The Freedom To Get Emotional About The Challenges

Living with a spouse who has mental illness isn’t easy. A great deal of emotional energy is often allotted to the person with the mental illness naturally causing you to put your own emotions on hold. Find a friend or a professional with whom you can talk when you begin to feel sad, angry, frustrated, or overwhelmed. Staying emotionally healthy will enable you to be a better support to your spouse.

7. Communicate Openly

Encourage your spouse to talk about his or her feelings. In the midst of a depressive episode, anxiety, or a bipolar state, your spouse may not have the best self-insight. However, If the two of you can learn to communicate during the difficult times and express your emotions, you can each find a bit of peace.

8. Give Your Spouse The Freedom To Share When They’re Having A Hard Time

Support your spouse by learning to listen without judging or trying to fix the problem. Your spouse may feel like it’s necessary to try and hide feelings of depression or anxiety for fear of being judged or disappointing you. Communication and good listening skills are key to taking the shame and embarrassment out of the mental illness.

9. Educate Yourself About The Illness

Educating yourself about the illness is absolutely essential in supporting a spouse with a mental illness. Mental illness affects EVERY aspect of life. The more you know, the more supportive and compassionate you will be toward your spouse.

10. Be Willing To Dish Out Tough Love

In the midst of deep depression or a manic episode, your spouse may not know when it’s necessary to seek help. By the nature of the illness, your spouse or partner may not be the best judge of their current mental state. You may need to seek medical help on your spouses behalf. Prepare yourself to hold them accountable to take their medication and manage their illness.

Together, you can work through this issue and become stronger — both individually AND as aunion.

Bipolar disorder doesn’t need to be a deal-breaker.

You’re not imagining it: mental illness is on the rise. It may be that it’s just being diagnosed more. Or maybe we live in such confusing, crazy times as to push us all a little closer to the edge.

If you’re single, it can be a daunting time to make the effort to experience dating and find someone you can be with. Intimacy is important to our health and happiness, so we need strategies for love in these maddening times.

Bipolar disorder is more prevalent these days. In any given year, 2.6 percent of US adults will have an episode, and in 2.2 percent, it will be considered “severe.”

The more you date, the higher your odds are of running across someone with this disorder.Among people who have bipolar disorder, you’re far more likely to meet them when they are manic, because they are more likely to be out and about then.

Bipolar disorder is characterized by dramatic shifts in mood, energy and activity levels. These changes are so extreme that an affected individual may seem like a different person when they are up, as opposed to down. Everybody has moods, but bipolar disorder interferes with normal daily living. It can be manageable when it’s recognized and addressed. The problem is thatpeople may not know they have it, or if they do, they hide it.

If you happen to meet a Bipolar person when they are up, you’d likely find them to be exciting, brilliant and sexy. They could be the most charming person you ever meet. A little mania can make it possible to be productive all day, then dance all night and be unstoppable in the sack.

Mania, at least the mild form known as “hypomania,” can be quite appealing. A slightly manic person is likely to be talkative, have high energy, and is really enjoyable to be around. The person who has it usually doesn’t want it to end. Who DOESN’T like being up? The problem lies in the downside. When the mania subsides, exhaustion and depression take over, and often persist far longer than the manic period.

There’s a temptation to hide the dark side. When we date, we put our best foot forward. The other side of the story isn’t told. The single Bipolar person is likely to date when they are up and tend to be downright anti-social when they are down. If you meet them and fall in love with their brilliant side, you’re bound to be left wondering what’s happening when they come back down.

Lots of people take medications for depression. Some anti-depressants can cause mania in non-bipolar people. The medications for Bipolar disorder are different from anti-depressants; they are meant to stabilize a person so they don’t become manic.

Bipolar people have a tendency to go off their meds because they like the high energy manic state. Unfortunately, this increases their odds of crashing back to the bottom of the pit of despair once again. It isn’t pretty, and they aren’t likely to tell you about it on a first date.

If you’re falling for a Bipolar individual, but have fears about their illness, here are six things to remember:

1. When seeking a relationship, remember that people are complex.

There are clues that will help you detect a bipolar pattern:

• Listen for stories of sudden or radical changes in interests, jobs or relationships.
• Take note if they say they have made and lost fortunes.
• Stay tuned for delusional idealism, excessive energy, or suicide attempts.
• Watch for drug or alcohol abuse, especially self-medication for moods.

2. Don’t let their charm obscure your view.

It’s fair game when you like someone to ask their mental health history, or if they take any medications. At the bare minimum, keep an active awareness that people have many different states, and you don’t know a person until you have seen their range.

3. Know that it’s not easy being with a person who has Bipolar Disorder.

They’ll wear you out when they’re up and be painfully miserable when they’re down. It takes a certain kind of patience and calm to maintain your center around this kind of chaos. Keep breathing and keep your eyes wide open. Don’t make any important decisions (like gettingmarried or entering a business deal) until you have seen the whole picture. The door is there; use it if you need to.

4. Don’t give up if you also have BPD.

There are many people in the world who are familiar with your challenge. People can be sympathetic or even supportive. The right person won’t be afraid of your diagnosis. He or she could know about it from previous experiences. The right person can accept you as you are, and provide one more anchor to the stability and satisfaction that you need.

5. Telling the truth about your mood swings is the first step.

You will build trust if you confess early. People who can’t tolerate your swings will bail out. This is OK. Say goodbye and tell the truth to the next person. Eventually, you’ll find someone who understands. It’s much easier to live outside of the closet, less musty.

6. Understand that hope is on the horizon.

Genetic testing continues to reveal clues about why people have mood instability. If you haven’t done it yet, seek help specifically for your condition. Consider getting genetic testing, and seeking treatment based on what you find. Don’t simply accept that you must take pharmaceutical drugs for the rest of your life.

Learn the lifestyle tricks that help you stabilize. Find practitioners who are willing to look deeper and help you develop a foundation of health. Find creative work in which your nature is a strength. You too can live a happy life and find a partner who loves you deeply.