Depression

Everyone feels sad sometimes, right?  YES!  We all have low moods or sadness that can cycle through the day or week.  There is still some stigma associated with any mental health condition including depression.  Many people feel they can control it, will it away or just get over it . . . often that is the advice that other people give!  Major depression is not a sign of weakness; it is not a ploy for attention or sympathy nor is it not an act of self pity.  Most of the time we are able to pop out of the low mood and move on with our lives.  But what if the low mood won’t go away? The difference between situational depression or low mood and clinical depression or major depressive disorder is usually the duration of the symptoms and the extent to which the symptoms affect our lives.   Situational depression is usually caused by an event such as a breakup, job loss, death of a loved one, or a major health issue . . . major depressive disorder or clinical depression has become a way of life even if the origin of the symptoms were situational.  We can’t seem to move out of the sadness no matter what we try.

Depression can be caused by or made worse by health issues that mimic depressive symptoms such as hypothyroidism or menopause.  It can be worsened or prolonged by stressful issues in our life.  In turn our physical health can be affected by depressive symptoms.

Depression is characterized by these symptoms:

•  Prevailing feelings of sadness, anxiety, or a general “emptiness” —  No joy, no purpose, and no vision for the future. These feelings may also be interspersed with irritability, agitation, and lack of patience.  Often the first symptom of depression is anger.
• Pessimistic attitude — The depressed person may seem jaded, or express feelings of hopelessness. Why try, because it doesn’t make a difference.
• Strong feelings of guilt, worthlessness, helplessness, or self-loathing — Depressed people often blame themselves for the negative things in their lives or the lives of others. They believe that they cannot attain the favor or approval of others. Some even view depression as a form of punishment for their inability to bring happiness to the important people in their lives.
• Lack of energy and fatigue — The depressed person may walk and talk slowly, or have an overall feeling of lethargy. Mental functioning may slow down, making it difficult to process thoughts or follow a conversation.  It feels like being in a deep dark hole or like a heavy, wet blanket is covering you.
• Agitation — Some depressed patients will experience periods of restlessness, agitation, anger, irritation or lack of patience.  The restlessness may appear as pacing around aimlessly in an inability to relax or be still.
• Disrupted sleeping patterns — At least 80% of depressed people experience insomnia.  Although they may have difficulty falling asleep, more typically they will awaken early, or after only a few hours, and be unable to get back to sleep. Some patients suffer hypersomnia, or oversleeping . . . staying in bed for long periods even if not sleeping or sleeping too much . . . they want to stay in bed and pull the blanket over their head.
• Disrupted eating patterns — Some people experience a loss of appetite with resulting weight loss, while in other cases, overeating and weight gain may occur.
• Loss of interest in activities or hobbies that were once enjoyed – Not engaging in things you used to enjoy such as gardening or reading or having no interest in engaging in any pleasurable activities.
• Difficulty concentrating, focusing on or completing tasks, remembering details, and making decisions — This is compounded even more by a sense of worthlessness and prevailing fatigue.
• Increased crying — A depressed person may cry more frequently, cry for no apparent reason, and the episodes could last several hours.
• Reduced sex drive — Several people report a decreased sexual desire and a lack of energy, but some patients also report an aversion to being touched.
• Thoughts of suicide and/or suicide attempts — Up to 60% of people who committed suicide had a history of depression or other mood disorders. Studies show that most people will not make an attempt on their own lives when in the deepest stages of depression because they simply cannot muster the effort to do so.  However, the risk increases significantly during the period just before or immediately after – on their way into deep depression or on their way out. It is during these times that suicide watch should be most diligent.
• Withdrawal from social situations — Those with depression typically avoid being around other people. They often withdraw from their own family, and even when they are in the same room, they will sometimes appear comatose or disengaged.
• Physical symptoms — Depressed people often complain of headaches, digestive problems, cramps, or body pains such as back and legs.
• Altered mental states — In severe cases, depressed people may experience delusions or hallucinations. In most instances, these are very unpleasant, and contribute to irrational fear, anxiety, panic attacks, and erratic behavior.

Types of Depression

Depression is often difficult to diagnose, and even treat, because there are so many different types with a variety of symptoms.   And, often one type of depression can evolve into another, especially if treatment is not received.

Major Depressive Disorder or Unipolar Depression — Major depression is characterized by extreme sadness, a loss of interest in once-pleasurable activities, and an inability to carry out day-to-day tasks due to a combination of other symptoms with symptoms lasting longer than two weeks.

Psychotic Depression — A person is diagnosed with psychotic depression when they experience symptoms of major depression accompanied by some form of psychosis such as hallucinations or delusions.

Postpartum Depression — This is much more serious than the common “baby blues” and is estimated to affect 10-15% of women following the birth of a child.  Since it is marked by the same symptoms as major depression, many doctors and researchers believe that it may actually be a variant of major depression.  If untreated, postpartum depression can last for several months, or even years, and may occasionally develop into a condition referred to as postpartum psychosis, which includes hallucinations, delusions, and suicidal thoughts. “….yet many women fail to seek help but instead blame themselves for feeling sad at a time when they are expected to be happy.” (American Medical Association, Essential Guide to Depresssion, page 36).

Dysthymic Disorder or Dysthymia — This type of depression is characterized by long-term chronic symptoms (typically lasting 2 years or longer) that may not be severe enough to be completely disabling, but can prevent a person from feeling well or functioning normally.  Those with dysthymia may also experience episodes of major depression.

Premenstrual Dysphoric Disorder (PMDD) — This is a cyclic illness that affects 3-5% of menstruating women. Typically, a woman will feel deep depression or irritability for a couple of weeks before or during menstruation, with these symptoms being much too severe to be mistaken for normal PMS.

Seasonal Affective Disorder — This type of depression occurs only at certain times of year, usually appearing with the onset of winter; although, some people experience summer depression.  Since the symptoms are typically milder, it can usually be treated with short term antidepressants or Light Therapy. However, seasonal affective disorder can sometimes be very serious, especially in northern communities with long winters and shorter days.

What causes depression?

Depression is complicated and different for each person.  The fact that depression is related to changes on biological, psychological, and social levels lends to its complexity. However, research on depression has suggested the following:

• There is a genetic component to depression. If one or more people in your immediate biological family have experienced a major depressive episode, your risk of experiencing depression is several times higher than people with no family history. Even if you have inherited a greater susceptibility to depression, however, you can take steps to reduce your likelihood of developing this disorder.
• Depression is associated with electrochemical changes in brain functioning. Although there has been much focus in recent years on relationships between depression and levels of particular neurotransmitters (e.g., serotonin), newer research suggests that depression may be more closely related to the relative levels of activity in different parts of the brain.
• Depression is often accompanied by consistently distorted thought patterns. Depressed individuals commonly seem to process information about themselves and the world around them with a negative bias – screening out the good and accentuating the bad. Not surprisingly, this sort of thinking can prolong the duration of a depressive episode and increase subsequent risk of relapse.
• Interpersonal or social stressors can also trigger depressive episodes. Among the most common of these stressors are experiences of loss. Such losses may be tangible or symbolic, or some combination of the two.

Depression treatment tips:

• Learn as much as you can about your depression. It’s important to determine whether your depression symptoms are due to an underlying medical condition. If so, that condition will need to be treated first. The severity of your depression is also a factor. The more severe the depression, the more intensive the treatment you’re likely to need.
• It takes time to find the right treatment. It might take some trial and error to find the treatment and support that works best for you. For example, if you decide to pursue therapy it may take a few attempts to find a therapist that you really click with. Or you may try an antidepressant and need to try more than one to find one that works best for you. Be open to change and a little experimentation.
• Don’t rely on medications alone. Although medication can relieve the symptoms of depression, it is not always the best option. Studies show that other treatments, including exercise and therapy, can be just as effective as medication, often even more so, but don’t come with unwanted side effects. If you do decide to try medication, remember that medication works best when you make healthy lifestyle changes as well.
• Get social support. The more you cultivate your social connections, the more protected you are from depression. If you are feeling stuck, don’t hesitate to talk to trusted family members or friends, or seek out new connections at a depression support group, for example. Asking for help is not a sign of weakness.
• Treatment takes time and commitment. All of these depression treatments take time, and sometimes it might feel overwhelming or frustratingly slow. That is normal. Recovery usually has its ups and downs.

Lifestyle changes: An essential part of depression treatment.

Lifestyle changes are simple but powerful tools in treating depression. Sometimes they might be all you need. Even if you need other treatment, lifestyle changes go a long way towards helping lift depression. And they can help keep depression at bay once you are feeling better.  Lifestyle changes that can help treat depression:

• Exercise. Regular exercise can be as effective at treating depression as medication. Not only does exercise boost serotonin, endorphins, and other feel-good brain chemicals, it triggers the growth of new brain cells and connections, just like antidepressants do. Even a half-hour daily walk can make a big difference. For maximum results, aim for 30 to 60 minutes of aerobic activity on most days.
• Nutrition. Eating well is important for both your physical and mental health. Eating small, well-balanced meals throughout the day will help you keep your energy up and minimize mood swings. While you may be drawn to sugary foods for the quick boost they provide, complex carbohydrates are a better choice. They’ll get you going without the all-too-soon sugar crash.
• Sleep. Sleep has a strong effect on mood. When you don’t get enough sleep, your depression symptoms will be worse. Sleep deprivation exacerbates irritability, moodiness, sadness, and fatigue. Make sure you’re getting enough sleep each night. Aim for somewhere between 7 to 9 hours each night. Develop a good sleep routine that includes going to bed at the same time each night, taking a warm shower or bath before bed, reading or listening to soft music prior to bedtime; limiting TV/computer time prior to sleep as this increases brain activity; limiting caffeine past 3pm.  For more information on sleep hygiene: http://www.umm.edu/sleep/sleep_hyg.htm
• Social support. Strong social networks reduce isolation, a key risk factor for depression. Keep in regular contact with friends and family, or consider joining a class or group. Volunteering is a wonderful way to get social support and help others while also helping you.
• Stress reduction. Make changes in your life to help manage and reduce stress. Too much stress exacerbates depression and puts you at risk for future depression. Take the aspects of your life that stress you out, such as work overload or unsupportive relationships, and find ways to minimize their impact.

Ruling out medical causes of depression

If you suspect that you may be depressed, and lifestyle changes haven’t worked, make an appointment to see your primary care doctor for a thorough checkup. If your depression is the result of medical causes such as a thyroid problem, hormonal imbalance, untreated diabetes or hypertension, therapy and antidepressants may do little to help.   Your doctor will check for medical conditions that mimic depression, and also make sure you are not taking medications that can cause depression as a side effect. Many medical conditions and medications can cause symptoms of depression, including sadness, fatigue, and the loss of pleasure. Hypothyroidism, or underactive thyroid, is a particularly common mood buster, especially in women. Older adults, or anyone who takes many different medications each day, are at risk for drug interactions that cause symptoms of depression. The more medications you are taking, the greater the risk for drug interactions.

Finding a therapist to treat your depression

If there is no underlying medical cause for your symptoms of depression, then finding a mental health specialist is the next best step for treatment. Although there are many types of mental health professionals, one of the most important things to consider when choosing a therapist is your connection with this person. The right therapist will be a caring and supportive partner in your depression treatment and recovery.

There are many ways to find a therapist. Word of mouth is one of the best ways to find a good therapist. Your friends and family may have some ideas, or your primary care doctor may be able to provide an initial referral. National mental health organizations can also help with referral lists of licensed credentialed providers. If cost is an issue, check out local senior centers, religious organizations, and community mental health clinics. Such places often offer therapy on a sliding scale for payment.

Psychotherapy for depression treatment

Talk therapy is an extremely effective treatment for depression. Therapy gives you tools to treat depression from a variety of angles. What you learn in therapy gives you skills and insight to help prevent depression from coming back.  Some benefits that talk therapy can have are helping you:

• understand your illness.
• overcome fears or insecurities.
• cope with stress.
• make sense of past traumatic experiences.
• separate your true personality from the mood swings caused by your illness.
• identify triggers that may worsen your symptoms.
• improve relationships with family and friends.
• establish a stable, dependable routine.
• develop a plan for coping with crises.
• understand why things bother you and what you can do about them.
• end destructive habits such as drinking, using drugs, overspending, or risky sex.
• address symptoms like changes in eating or sleeping habits, anger, anxiety, irritability, or unpleasant feelings.

Some types of therapy teach you practical techniques on how to reframe negative thinking and employ behavioral skills in combating depression. Therapy can also help you work through the root of your depression, helping you understand why you feel a certain way, what your triggers are for depression, and what you can do to stay healthy.

One of the hallmarks of depression is feeling overwhelmed and having trouble focusing. Therapy helps you step back and see what might be contributing to your depression and how you can make changes. Here are some of the “big picture” themes that therapy can help with:

• Relationships. Understanding the patterns of your relationships, building better relationships, and improving current relationships will help reduce isolation and build social support, important in preventing depression.
• Setting healthy boundaries. If you are stressed and overwhelmed, and feel like you just can’t say no, you are more at risk for depression. Setting healthy boundaries in relationships and at work can help relieve stress, and therapy can help you identify and validate the boundaries that are right for you.
• Handling life’s problems. Talking with a trusted therapist can provide good feedback on more positive ways to handle life’s challenges and problems.

Individual or group therapy for depression treatment?

When you hear the word “therapy” you might automatically think of one-on-one sessions with a therapist. However, group therapy can be very useful in depression treatment as well. What are the benefits of each? Both group and individual therapy sessions usually last about an hour. In individual therapy, you are building a strong relationship with one person, and may feel more comfortable sharing some sensitive information with one person than with a group. You also get individualized attention.

Don’t rule out group therapy, however. Listening to peers going through the same struggles can validate your experiences and help build self-esteem. Often group members are at different points in their depression, so you might get tips from both someone in the trenches and someone who has worked through a challenging problem. As well as offering inspiration and ideas, attending group therapy can also help increase your social activities and network.

When the going gets tough in therapy…

As with remodeling a house, when you take apart things that haven’t worked well in your life, it often makes them seem worse before they get better. When therapy seems difficult or painful, don’t give up. If you discuss your feelings and reactions honestly with your therapist, it will help you move forward rather than retreat back to your old, less effective ways. However, if the connection with your therapist consistently starts to feel forced or uncomfortable, don’t be afraid to explore other options for therapy as well. A strong trusting relationship is the foundation of good therapy.

Medication treatment for depression

Medication management for depressive symptoms can be extremely beneficial especially when combined with therapy and lifestyle changes.  It is important to understand how medication works and any side effects associated with the medication.  Lifestyle changes and therapy not only help speed recovery from depression, but also provide skills to help prevent a reoccurrence.

Family doctors might be the first professionals to recognize your depression. However, while they can prescribe antidepressants, it’s a good idea to explore your options with other mental health professionals who specialize in depression. Ask for a referral. You might end up working with a therapist and not needing medication at all. If you do need medication, a psychiatrist has advanced training and experience in depression, treatments, and medications.

Alternative and complementary treatments for depression

Alternative and complementary treatments may include vitamin and herbal supplements or acupuncture treatments.  Relaxation techniques may also be used to relieve symptoms of depression, reduce stress and boost feelings of joy and well-being; you might also try mindfulness exercises, yoga, deep breathing, progressive muscle relaxation, or meditation.  To find out more information about stress reduction and mindfulness:  http://www.the-guided-meditation-site.com/mindfulness-exercises.html