Many people get confused about depression, partly due to societal stigma, ignorance, and outdated research/conventional wisdom. Depression is now considered more of a physiological illness than a psychological one. It it no different than any other physical disease you might get and need to treat. There are many types of depression, so if you think you may have some symptoms, don’t try to self-diagnose (even if you have access to the DSM), but rather see a professional. Depressive symptoms can sometimes be the result of other problems.
A rough guide to depressive symptoms is in the acronym SIGECAPS. Feel free to Google SIGECAPS and you’ll have access to the mnemonic used by many psychiatrists to diagnose the major areas. But as I said, you’ll need to see a professional to verify that what you have is actually depression, and then the type of depression, as treatment can vary. Depression is a very common illness. Over 50% of people will have at least one major depressive episode in their lifetime, and roughly one third of the population struggles with depression on a more regular basis. Depressive symptoms sometimes look different in men than in women. Depression commonly finds a partner in substance abuse, and the majority of persons affected by depression will not seek treatment (estimated at approximately two-thirds of depressed persons). An increase in substance use or a substance use problem may sometimes be an unintended attempt to self-medicate depression.
Depression is considered a fully treatable illness, yet most people do not seek treatment for it. In fact, people with chronic life-long depression often resist treatment, or discontinue treatment after starting it. Habits are hard to break, and sometimes depression becomes part of a person’s identity, making it harder to treat due to insecurity about how to live from a non-depressed state. Depression can be situational, such as due to a specific event in one’s life (unresolved emotional loss or traumatic events are common culprits),in or it can be chronic and not due to any event in particular. A reasonable way to understand susceptibility to depression is through the diathesis-stress model. There is often a genetic predisposition to depression (it runs in families), yet it sometimes takes a particularly stressful period in one’s life to capitalize on the susceptibility. Depression is often cyclical, meaning that depressive episodes come and go. This causes some people to not treat the depression or be consistent with treatment. But it is important to be aware that chronic depression has a cyclical pattern and while an episode may recede for a while the overall problem of cycling in and out of depression may still remain.
Depression is a neurochemical imbalance that is difficult for the brain to correct on its own. It tends to perpetuate in a self-reinforced negative cycle. While depression is often medically treated (a whole other subject for another day), there are some lifestyle modifications that can help. Beware that depression is harder to treat the longer it has been present in the system, so don’t dawdle when it comes to treating it. Depression also has negative effects on the structure of the brain, another reason to treat it before it has set in for too long. Depression is most effectively treated through a combination of medication and counseling, although as I said, you could try some lifestyle changes before medication. But be careful, depression can be sneaky and corrupt your thinking before you realize it. If you have feelings or thoughts of self-harm or of harming others, seek full treatment right away.
The counseling portion of depression treatment is extremely important, assuming you work with someone familiar with treating depression. Counseling is critical, not just to address the psychological component of depression, but also to have someone consulting on the entire treatment process. If one is pursuing a medication regimen, remember that one of the benefits is the window it provides the brain to process new and positive information in counseling. Sometimes these changes of thought achieved through counseling allow a person to taper off of medication sooner. Depression is correlated with a compromised ability to think straight (increased negative thinking and reduced objectivity), so it can be very helpful to have a third party (the therapist) weighing in on treatment options and the monitoring of symptoms. A good counselor can assess the severity and type of depression, rule out other possible causes, recommend a good doctor, suggest lifestyle modifications, engage in psychotherapy to alleviate psychological symptoms, watch for trouble spots, and help to manage the process of making sure treatment moves forward in an effective manner.
Lifestyle modifications that have been shown to ease depression and help the body restore neurochemical balance include daily exercise of at least 20-30 minutes, high doses of a pure Omega-3 fish oil supplement, daily consumption of a Vit B complex including B6, 12 and 50 and regular social contact such as getting together with friends and talking about life, feelings, etc. Exercising outside during nice weather and as part of a group class can support your brain chemistry in multiple ways simultaneously. I like to add a “get up and out” routine, where one exercises outside first thing in the morning. Another option I recommend that is effective for some is to engage in volunteer service work aiding persons less fortunate. This seems to increase appreciation for our own circumstances as well as get our mind off of ourselves for a while. If you schedule service activities or exercise classes in the morning, such as at 9am or 10am, it can help stimulate neurochemical and hormonal balance by getting you up and out of the house earlier in the day, reversing one of the cyclical aspects of depression which is the lack of motivation. Exercise options can including hiking groups, martial arts like Krav Maga, bootcamps at Zilker, or rowing instruction on Town Lake where it’s beautiful to be on the water and you get a good workout to boot. One should also avoid alcohol ( a depressant) and stimulants (including coffee) while attempting to treat depression through lifestyle modifications because neither help the process of changing depressive brain chemistry.
Obviously, if lifestyle changes do not address the depression, if symptoms persist or worsen, and if the depression is interfering with your ability to work or relate well to others, medication may be advised. For those of you who actively try to avoid psychotropic medication, consider that the choice of medicating makes sense when the negative effects of the illness outweigh the negative side effects of a medication. The effects of depression can be severe and long-lasting. Medication treatment may last as little as 6-12 months, and many anti-depressants are fairly mild and simple drugs that have been on the market a long time. If your depression is affecting your relationship, your work life, or your personal well-being, it may be time to speak to a professional. Common signs of major depression include a change in sleeping patterns (getting more or less sleep than usual), a change in eating (again, could be more, could be less), low energy, negative thoughts, lack of motivation, not enjoying one’s usual hobbies, trouble focusing, mood outbursts, increased irritation, social isolation and possible suicidal thoughts or feelings.
The medical treatment of depression is its own little subject (OK, not so little), but there is a right way and a not-so-right way to go about seeking medical attention and then progressing through depression treatment. Some of the bad stories you hear about psychotropic drug treatment is due to bad care or uninformed patients. The advise of a well-trained and experienced therapist will come in very handy if you need medical treatment for your depression. A good therapist can help you avoid some pitfalls than can occur when seeking medical treatment for depression. I encourage anyone struggling with serious or chronic depression, or lifelong cyclical depression to call me or another therapist who specializes in depression so we can help you begin an effective treatment regimen immediately. Recent research shows the longer depression goes untreated the harder it is to treat, and the longer it resides in the brain the more permanent damage it can cause. The most important component of effective treatment is your commitment to your own well-being and your decision and dedication to treating your depression. A professional can help, but it is the patient who needs to be motivated to eradicate the depression.