Depression

There is a dark space that almost everyone falls subject to at some point in their life. Depression can feel like being swallowed, but you’re too sad to fight it. People who have not struggled with depression will say- they need to just pull up their bootstraps and get over it! This mentality is WHY so many suffer with depression and don’t get help. It’s considered a character flaw. The belief that “If I was a better person, I could get over this.” Of course, this leads to even worse depression when faced with personal failure. 

Pull up their bootstraps and get over it

I’ve given dozens of lectures on depression and almost every time, I see someone tearing up in the crowd. They will often find me after the class to confess their personal struggle. I thank them. It’s always a blessing to be trusted with someone else’s vulnerability. I never take it for granted. Part of this perspective is due to my own battle with depression. I don’t share this with patients often, but the handful of times I have- it’s to show that it can be managed and even prevented with education and awareness. How can I be a good counselor if I've had depression? First of all, I haven’t been clinically depressed in years, but let me put it this way- if you were a recovering addict, would you go to a clinic where the staff has no idea what it’s like to battle addiction? Or would you feel more comfortable with someone who knows exactly what it’s like to be in your shoes and succeeded in treatment? I think we can all agree that experience is a strength.

Like inheriting freckles

Some people are predisposed to depression, like inheriting freckles or diabetes. Mental health exacerbations can also be triggered by life events like trauma or general stressors, such as a death in the family or lost job. Many people are predisposed to depression and any number of things may trigger a depressive episode. I can easily say I was predisposed to depression and "life" compounded the problem. My personal relationship with the “dark space” has been ongoing since adolescence. Of course in the 90’s, melancholy during teenage years were expected and even popularized. I listened to The Cure (not known for it’s cheerful prose) and Pink Floyd, poured over my journals and navigated interpersonal relationships to the best of my ability. Within these realms I battled an eating disorder and an abusive relationship that took it’s toll on me. I didn’t have the knowledge or coping skills to manage any of my emotions and while I saw my peers go on to succeed in college and relationships, my adaptation to adulthood was a lot like jumping out of a plane without a parachute. 

The Cure...not known for it's cheerful prose.

Let's talk about the criteria for depression. There is a diagnostic guide for mental health/medical professionals called the DSM V. We use this book to see if patients meet the criteria for a diagnosis. There are many variables to consider but short of getting a degree in it, I'll give you a blurry watercolor:

A person who suffers from a major depressive episode must either have a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a 2 week period. This mood must represent a change from the person’s normal mood; social, occupational, educational or other important functioning must also be negatively impaired by the change in mood. A major depressive episode is also characterized by the presence of 5 or more of these symptoms:

  • Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feeling sad or empty) or observation made by others (e.g., appears tearful). (In children and adolescents, this may be characterized as an irritable mood.)

  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

  • Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.

  • Insomnia (inability to sleep) or hypersomnia (sleeping too much) nearly every day

  • Psychomotor agitation or retardation nearly every day

  • Fatigue or loss of energy nearly every day

  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day

  • Diminished ability to think or concentrate, or indecisiveness, nearly every day

  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

This is a general guideline, but that being said, depression can be mild to severe, with a myriad of different factors. If you read this and you're "not quite there" for criteria, your depression is still real and any counselor would happily treat you for it.

I love showing this video to patients because they feel validated about their experience. Criteria aside, take a look at the black dog and see if it resonates with you. The odds are, if it does- you're going to feel it.

There are a lot of different types of depression. Here's a run-down of the basic differences.

  • Major depressive disorder: Addressed in the criteria above, major depressive disorder can be a life-long battle (but not necessarily). Many of my patients don't remember a time when they weren't depressed. This needs to be treated actively and can be 100% managed like any chronic condition. I believe in remission for depression.
  • Adjustment disorder: This means that things were going well and then something happened that you're having a hard time getting past. This could be a break up, graduation, retirement etc... These episodes are usually short lived and not a permanent issue. I  often see people recover within six months or less. Some therapists put grief under this diagnosis as well.
  • Dysthymia: This is a general low mood most of the time. Think Eeyore, but not sad enough to be suicidal. This is someone who is functional but bummed out- all the time. We all know someone like this.
  • Bipolar Disorder: I could write a book on this, but people who suffer with bipolar disorder struggle with extreme highs and lows. Every person is different, but this is a cycling of moods. At times, the individual will feel elevated, grandiose, really excited and have little need for sleep (mania). At other times, it may be impossible to get out of bed and the sense of hopelessness becomes all encompassing (depression). Thoughts of suicide may even be present. There is little in the way of balance and this cycling may be frequent throughout the day, or every few weeks or months. Bipolar disorder is very challenging for the person experiencing it and those that love him/her. This usually requires frequent psychiatric attention.
  • Cyclothymia: This one is like bipolar disorder, only diminished. Minor cycling, or simply less in severity. This disorder isn't often diagnosed clinically because it doesn't create as much distress in everyday life.
  • Seasonal affective disorder or SAD: This is very common where I live, a valley in Idaho. During the winter months, we have so much inversion that the sun is like an elusive mistress for what seems like FOREVER. I will have an increase in patients with depression right around October when the days get darker. A lot of it is about education. SAD can be easily treated with light therapy and increased self-care. People don't often need medication to resolve this. Plus, it's temporary. If people can identify and really understand the cause, it can be treated before it hits hard.

Depression can be managed like any chronic condition

So you've looked at these lists and have a pretty good idea you're depressed. What now? Treatment for depression can be intimidating for some people because telling a doctor or a counselor that you're sad is scary. You worry if you're going to be judged, or carted away to a padded room. It's a vulnerable position but a pivotal one. Simply put- suffering isn't necessary. You don't have to feel this way. Once you jump this hurdle and commit to treating your depression, hope will start find it's way into your space, making it less dark and far more manageable. 

The best treatment for major depressive disorder is a dual treatment- talk therapy (counseling) and medication. For the other listed depressive disorders, my recommendation is dependent on variables that I can't assess, but your counselor and physician/psychiatrist can. Talk therapy is always a good idea but medication may not be necessary in some situations. I know many people personally and professionally that rely on medication to keep them emotionally stable and anxiety/depression at bay, while others manage their emotional wellness through self-care, exercise and social support. It's always helpful to document your moods in a mood journal. There are also many mood tracker apps that cost very little and even graph your daily moods over time to identify trends or triggers.

Medication can reduce feelings of anxiety and depression

Medication is scary for some people. Let me explain to you how it works. There are three basic chemicals in your brain that maintain your mood. They are called serotonin, norepinephrine and dopamine. Antidepressants balance these and allow for people to feel less of the things that keep them from experiencing life to their fullest potential. Antidepressants tend to reduce feelings of anxiety and depression while limiting the repetitive negative self-talk that keeps people feeling rotten. One thing people don't realize, is that antidepressants don't work like Tylenol. You take a Tylenol and your fever or pain will go away in about 20 minutes. These medications take time to build up in your body and work their magic. This can take up to 4-6 weeks. Some people are so depressed that if they don't see an immediate improvement in mood, they stop taking the medication all together and say "it just didn't work on me!" That's not the case. You have to take it consistently every day until it has had a chance to work. At first, some people may experience side effects. Not everyone, but some may feel a little "off" for a few days. While others will have a hard time sleeping. It's good to talk about this with your doctor because changing the time you take the medication may be an easy fix for this. Most people find great relief from symptoms of depression with medication, but others need to try more than one medication before finding the right fit, so if you don't find the perfect medication at first, keep trying. Don't give up.

No one will ever love me...

So what about talk therapy? Talk therapy addresses core beliefs that perpetuate negative self-talk. A core belief would be something negative that your thoughts remind you of- like a tape player on repeat. Something like: I’m unlovable, I’m worthless, I always screw up etc… Almost every patient I see that struggles with depression has this narrative going on inside their head. When you see a counselor, we challenge these core beliefs and help you find evidence that you are lovable, worthy and not a loser. This is done through what's called cognitive behavioral therapy or CBT. We take you out of that "black and white" thinking and find more grey area in your internal monologue. So instead of saying "No one will ever love me," we will brainstorm all of the people that do love you in your life today so that statement becomes false. It takes some work but over time, people can start finding their own solutions and stop the self-talk as it happens. How do you find a counselor? I've got your back. One of the very best resources out there is: psychologytoday.com. 

Just enter your zip code and a list of practitioners come up. You can specify your insurance, what specialty you're looking for and even the gender of your therapist. Give it a shot! If you are struggling with depression, remember that you don't have to feel this way. Help is available to you. If you ever feel like harming yourself, call 9-11 or the suicide prevention hotline.

You aren't alone and depression can be managed, maintained and future exacerbations can be prevented. You don't have to endure the dark space. Grab the life preserver I'm throwing you and find your hope. Just for effect, I'm going to add one of my favorite songs to listen to when I've been searching for my hope. A gift to you:

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