Moods come and go but depression feels like it will never leave. Here are the main things one needs to know, it’s common, it’s serious, it has nothing to do with being “weak” and it’s treatable. Many people put off getting help and suffer needlessly. (Read that last part again.) There is a stigma everyone recognizes but still often perpetuate by not getting help. People can have liver disease or heart disease but when the mind is involved we call it “mental illness”, not a brain disease even though many of the symptoms are physical, mediated by grey matter.
The most common of these are an array of painful emotions that can include feeling worthless, helpless, hopeless, guilty, ashamed, lonely, sad, dead or numb. Self doubt, low self-esteem, even self-loathing are common. People are often more irritable and lash out at others, likely to throw themselves into work or to drink more. Sometimes anything anyone says can feel abrasive or somehow insulting. Mornings are often worse. Worrying and anxiety are often part of it, sometimes including a preoccupation with death or suicide. People have less energy, are unmotivated and have trouble enjoying things they know should be enjoyable. Many people withdraw from social contact. Some lose weight, some gain and many have difficulty concentrating or remembering things. Sleep patterns are disrupted, fatigue sets in, libido may decrease. Frequently there are assorted pains, headaches, stomach upset and increased proneness to accidents. Symptoms can occur in combination. Depression can be mild, moderate or disabling and last for weeks, months or years.
In children and adolescents depression may appear very different from adults. Younger children may seem lethargic, cling to parents, refuse to go to school, pretend to be sick or worry about losing a parent. Older ones may get into trouble, withdraw, feel misunderstood or angry. They may become preoccupied with violence and “dark” thoughts, get into fights, engage in risky behavior, cut themselves or develop extreme eating patterns. Since some of these can occur for periods of time during normal development they may be mistaken for normal mood swings. It can be tough for parents to know when things are serious. Untreated, depression in children can affect development including identity, social adjustment, academic or career functioning.
There are several formal classifications of mood illness. There is major depressive disorder (single episode or recurrent), dysthymic disorder (a condition lasting at least two years, one year in children), psychotic depression (involving delusions or hallucinations), postpartum depression, seasonal affective disorder (SAD) and bipolar disorder. Depression often accompanies other conditions such as heart disease, some cancers, hypothyroidism, diabetes, substance abuse, attention deficit disorder, post-traumatic stress disorder, eating disorders or obsessive-compulsive disorder. Distinguishing between an adjustment phase after a major loss and depression can also be a challenge.
The current thinking is that most depression involves an interaction between psychological factors, biochemistry, genetic vulnerability and stress. The Colorado rates of depression and suicide are among the highest in the country.
You can help yourself through periods of mild depression by distracting yourself, exercising regularly, eating well, setting realistic goals, getting support and confiding in friends. Spend time with people and do not expect yourself to just “snap out of it”. Simply acknowledging depression and taking care of yourself in small ways can provide some relief. Depressed children may need more time with their parents, more structure and extra support.
Should things get worse or just not get better and daily functioning becomes a challenge, it’s time to consult a professional. A consultation is not a commitment to do anything but an opportunity to get information. Expertise is available from most psychologists, psychiatrists, clinical social workers and licensed professional counselors. Don’t assume that every therapist is equally knowledgeable about depression. If treatment is recommended it is usually psychotherapy and/or medication. Psychotherapy helps most people, has lasting benefits and may reduce the likelihood or severity of future episodes. Many physicians prescribe medications though I usually recommend psychiatrists. Medication does not address underlying problems. Psychotherapy alone may be adequate but may be impractical if one’s daily functioning is significantly impaired. Mind or brain? We know now that just as medications change moods and the kind of thoughts people have, the kind of mental processing that occurs during psychotherapy can alter how the brain operates. It works both ways.
Getting help can be a hard step to take. We feel we should be stronger, can’t afford it, don’t have time, don’t believe anyone can really help or just don’t want to deal with itt. There is more open discussion of psychological problems these days and more awareness generally. There is often pride to be had from bearing up under adversity. There is also a price for trying to just push through when an individual becomes a source of worry to others, when someone else bears the brunt of hurtful remarks or for a parent’s emotional withdrawal from a child. In the extreme, suicide creates massive problems for those left behind. Suffering for a cause sometimes makes sense. Depression is not a cause.
