Look all you want in the discussion of my professional background, and you’ll find nothing about training in psychology. That’s just not what I do. In my practice, though, I’ve seen depression so often among my clients in divorce that I took the time to learn something about it.
- Symptoms of Depression
- You’re Not Alone
- What Causes It?
- So What Do I Do?
- What Kind of Therapy
- What about Medicine?
- Any Other Treatments?
- Who Else Can Help?
People who are depressed often feel sad, blue, or down. Almost all of us feel that way from time to time, then we cycle back out of it. Depressed people, on the other hand, sometimes experience these feelings for weeks or months without interruption. Here are some of the signs that may point to depression:
- Feelings of sadness and/or irritability
- Loss of interest or pleasure in activities once enjoyed
- Changes in weight or appetite
- Changes in sleeping pattern
- Feeling guilty, hopeless, or worthless
- Inability to concentrate, remember things, or make decisions
- Fatigue or loss of energy
- Restlessness or decreased activity noticed by others
- Thoughts of suicide or death
If you have five or more of the above symptoms for more than two weeks, you may have depression, and you should check with your doctor.
There’s no quick and simple test like a blood test to determine whether you have depression. If you visit with your doctor, he or she will likely inquire into your mood changes and other symptoms. He or she also will probably administer a battery of tests to rule out other causes, like thyroid problems and side effects from medication.
The terminology professionals use to describe depression can be confusing. “Clinical depression” simply means depression that’s serious enough to require treatment. In “manic depression,” sad times or low times alternate with terrible highs in an often bewildering oscillation. The highs may be characterized by inappropriate elation, irritability, insomnia, increased talking, and poor judgment. “Major depression” means depression marked by particularly severe symptoms.
“Post Partum Depression” affects many new mothers (and a surprising number of new fathers). New babies change things. Single mothers are particularly susceptible to depression.
The bad news about depression is that when it’s left untreated it can disrupt your job, your relationships, and your life. No amount of “cheering up,” “toughing it out,” booze, or exercise will make it go away. The good news about depression is that, once recognized, it usually responds well to treatment.
Depression affects about one of every seven Americans every year. Take a moment to reflect on what that means. In any average group of 30 people, for example, the odds are that four of them will suffer from depression this year. Women are twice as likely as men to be affected. Or perhaps it’s just that men are half as likely to ask for help.
At any rate, depression strikes people of all religions, races, genders, and income levels. About two thirds of those who suffer from depression don’t get treatment for it.
This question has two answers. The physiological cause of depression is an imbalance in chemicals in the brain, called neurotransmitters. Neurotransmitters help the brain cells to communicate with each other, and an imbalance of them disrupts the brain’s mood-regulating system. Researchers have tied changes in the levels of particular neurotransmitters to the individual symptoms of depression, including sleep problems, irritability, anxiety, fatigue, and feelings of sadness.
In terms of what makes a particular person susceptible to depression, we know that depression runs in families. And we know from studies of twins and adopted children that the susceptibility is more genetic than environmental. Depression is more likely among people who are under prolonged stress, among abuse victims, and among people who have suffered a crisis like divorce, separation, job loss (or promotion), changes in living space, or the death of a loved one.
The first thing to realize about depression is that it often (not always, but often) goes away by itself after 9-12 months. The problem with just “waiting it out,” however, is that untreated depression, even if it eases spontaneously, will usually return later. That’s why it’s smart to seek treatment.
Don’t self-diagnose depression. Depression is too dangerous, and too unpredictable, for any of us to attempt to diagnose and/or treat it without professional help. You need the experience and savvy of a physician or mental health professional to help you understand your own case and get the right treatment for it.
The treatment for most cases of depression is two-fold, psychotherapy and medication; smart people disagree about which is more important. I think that although it sometimes makes sense to use therapy without medication, it almost never makes sense to use medication without therapy.
Sometimes we imagine therapy to be a process of reclining on a couch and complaining about our mothers while therapists catch up on their mail. This may never have been the case, and it certainly isn’t the case now. The therapists active in the field today are generally competent, caring, and professional. They operate from a variety of faith perspectives, professional theories, and interpersonal styles. Most therapy sessions occur with both the therapist and the client simply sitting in the same room and talking with each other.
The right therapist can help you understand the events that led up to your depression and the measures you can take to change your life for the better. Depending on the theories the therapist uses, he or she might also work to help you understand the roles your family and friends play in your emotional health. If you’re confused about the professional designations counselors use, there’s an explanation on the Counseling page.One caution about psychotherapy: If you’re a parent, and custody of your children is likely to be an issue, you should know that the things you tell your therapist may not be privileged. That is, your spouse or others who accuse you of being an unfit parent can argue that you are mentally unfit. As part of their case, depending on the law in your state, they may be able to force your therapist to tell a court what they remember about your mental state. If you expect a disagreement with someone about custody of children, you should check with your attorney before entering psychotherapy.
Medication to treat depression keeps getting better. The medications available today for the treatment of depression are generally more effective and faster-acting than their predecessors, they have fewer and less disruptive side effects, and they’re not habit-forming. Most fall into four groups: heterocyclics, serotonin reuptake blockers, MAO inhibitors, and lithium. And newer medications are coming on line every month. Here are some suggestions that will help your doctor find the best medication for you:
Use a psychiatrist. Generally, psychiatrists know more about the range of medications available than do general practitioners, for the same reason that pediatric cardiac surgeons know more about the options available for treating heart problems in children. They do it all the time.
Be patient. Although some symptoms may respond to medication quickly, the medications for depression usually take three to six weeks to become fully effective. By far the most significant factor in unsatisfactory treatment for depression is the impatient patient.
Expect changes in the medications. Most good practitioners expect to treat depression in a trial-and-error manner. Your doctor’s decision to change medications after several weeks is the normal process of finding the solution that’s right for you. It’s not an indication that he or she made a mistake in the initial prescription.
Follow instructions. Many patients dealing with depression fail to take their medicine on schedule or decide they’re “feeling better now” and stop taking it entirely. Don’t. If you follow your doctor’s instructions carefully and completely, you equip your doctor with a full range of options for improving your treatment regimen over time and tailoring it for you. Psychoactive drugs are powerful, and stopping them on the wrong schedule can be dangerous.
Understand side effects. The side effects of medications for depression include dry mouth, blurred vision, constipation, and changes in urinary and sexual function. Whenever your doctor prescribes a new medication, ask about side effects and what you can do to control them.
Avoid alcohol. Even in moderation, alcohol acts as a depressant. It can interact with medications in unpredictable ways. If you are an alcoholic, make sure your doctor knows this when he or she prescribes medications for you.
Keep your doctor informed. Conscientious physicians want their patients to let them know when they’re experiencing something unexpected, because they can then evaluate the case and decide whether to change the medication. Don’t expect to talk to the doctor whenever you want, but you should be able to describe your unexpected experiences to a knowledgeable person on the doctor’s staff and get a reasonable response. If everyone seems too busy to talk to you, and if you’re convinced you’re not just being a pest, find another doctor.
Although psychotherapy and medications are the most common treatments for depression, some patients also have responded to full-spectrum light therapy, particularly when their depression is more severe during winter months. This involves sitting or standing in the presence of a light panel for several hours each day.
In addition, depression that doesn’t respond to other treatments will sometimes respond to ECT, or electroconvulsive therapy. ECT today is a long way from the “shock treatments” that horrified us in One Flew Over the Cuckoo’s Nest, and it’s often effective for dealing with traumatic impairment. ECT involves mild electrical stimulation, and muscle relaxants eliminate pain and shaking.
Several organizations are available to help you deal with depression: