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Articles
 One of the questions I often hear is “how do I know if I’m
depressed?” It is important to help people understand the
difference between the normal ups and downs that we all experience
in our life, and what we consider a “clinical depression” that
may require treatment, either therapy, medication or both.
You may be depressed if you:
- have lost your interest and excitement for the things in life
you normally enjoy.
- feel sad or irritable
- have felt this way every day for 2 weeks or more.
When one is depressed, the whole world seems dark and gloomy,
nothing brings you pleasure, even the people and things that you
love. When people become depressed it is as though they become
caught in a downward spiral. Their thinking becomes distorted so
that they only perceive the worst in themselves and others. They
cannot imagine that they will ever feel better or that anything
good will happen.
Other signs of clinical depression:
- difficulty concentrating and doing normal tasks,
- feeling inadequate
or guilty, feeling worthless and to blame for problems,
- having no energy
- loss of sexual desire
- feeling hopeless, people may even have thoughts of suicide
as dying may seem the only way out of their pain.
- fatigue, no energy
- inability to care for themselves or their surroundings
- impaired
memory and concentration
- difficulty sleeping or sleeping too much
- loss of appetite
- physical problems, headaches stomach problems
Most depressed people will not experience all these symptoms,
but as you can see from this description, depression is more than
just “feeling down.”
Sometimes depression is not obvious. I have seen clients who
were depressed, but neither they nor their families realized it.
They had adapted, were able to function well, but as we talked,
it became evident that they were operating in a sort of numb state.
They didn’t feel terribly bad, but they didn’t feel
very good either. In fact, they didn’t feel much of anything.
Often they cannot tell me of a time that they really felt excited
or really enjoyed something. Their relationships may be affected
because it is hard for them to really engage or be close to anyone.
According to a report by the National Institute of
Mental Health, over 18 million Americans over the age of 18 suffer
from depression.
It further states that depression is often not recognized and so
people do not receive appropriate treatment. It is important for
people to understand that often a person who is depressed cannot
overcome their depression without help. Depression is not a sign
of personal weakness; it cannot be overcome by an act of will.
People with depression cannot just “pull themselves together.” Depression
is an illness. Like other illnesses, there are often multiple causes
of depression, including a genetic susceptibility, which may be
exacerbated by personal or environmental stresses. Physical changes
may also trigger depression, such as hormonal changes, illnesses
or some medications. The bottom line is that if you are depressed,
it is important to seek some help.
A good place to start is with your family doctor. It is good to
have a physical exam to rule out any possible physical causes for
your depression. If none is found, you may want to seek help from
a mental health professional. Treatment is not the same for everyone,
but most people respond best to a combination of medications and
therapy.
There are many good medications
that have proved extremely helpful for many people with depression.
However, some people object to
taking medications. They may experience side effects, or dislike
feeling that they may become “dependent” on the medication.
However, I think of medications that treat depression somewhat
like taking insulin for diabetes. Antidepressants help your body
overcome a biochemical imbalance that cannot easily self-correct.
There are now many different antidepressants, and it is not always
easy to predict which one will be right for you. You may like the
first one you try, or you may need to try more than one to find
which one works best for you. For the medication to be most effective,
you should take it regularly as prescribed. The good news is that
for many people the medications are a tool to “jump start” the
recovery process, and as a person begins to change and feel better,
often the medication can be discontinued. I ask my patients to
talk with me before they discontinue their medication, so that
we can make stopping the medications part of our planned work together.
Sometimes it is important to discontinue the medications gradually,
and to watch carefully for an increase in symptoms, which might
indicate that the medications need to be continued a bit longer.
The correct therapy for each individual
with depression will vary, as each person’s situation and
personal needs are different. In general, when I work with depressed
individuals we will do the
following:
- Determine if the person should see their physician for a checkup
- Do a diagnostic evaluation to explore the history of their
symptoms, and other relevant information about their depression.
- Depending
on the outcome of this evaluation, we will decide together
on a plan for treatment, whether medications might be helpful
and what methods we will use in our work together, including the possible
use of EMDR.
- We will work together to help them discover the
root causes of the depression, the experiences that may have
led to negative thoughts
and beliefs that, in turn, affect their behavior and view
of life. We can then work towards changing attitudes that have
become
habitual,
but are no longer appropriate or useful to them. This process
can be painful, but it can also be exciting as people open
to new choices
and new possibilities. It is wonderful when people make
the changes necessary to recover their joy in life.
National Institute of Mental Health
www.nimh.nih.gov
Depression and Bipolar Support Alliance (DBSA)
www.DBSAlliance.org
National Foundation for Depressive Illness, Inc
www.depression.org
National Mental Health Association (NMHA)
www.nmha.org
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