ESSENTIAL & SHORT GUIDE TO DEPRESSION

 DEPRESSION ANXIETY TRAUMA PTSD

How To Tell If You Have Serious Depression

And What You Can Do About It

Depression is a term that most people are familiar with because it is frequently used to describe one's mood. You no doubt have often heard someone who is facing a challenging time in life say “I guess right now I'm just feeling a little depressed about all of this” or something to that effect. Or, you may have heard others comment “Oh, now that's really depressing.”

What these comments point to are not the sort of depression we will be considering. What those statements (and similar statements) refer to are momentary periods of time when a person is rather sad, disappointed, or melancholy.

When therapists refer to someone as depressed they have something much more severe and more specific in mind. Indeed, therapists try to be very specific regarding depression and therefore divide this concept into various subtypes such as major depressive disorder, dysthymia, cyclothymia, etc. 

I also want you to keep in mind that depressive symptoms may occur in conjunction with other disorders. For example, one may have a psychotic disorder with depressive features, an Adjustment Disorder with depressive features, and so forth. People who suffer with anxiety will also often have symptoms of depression. This is due to the stress and sense of isolation that frequently accompanies severe anxiety.

You can see that depressive symptoms are depressingly common across many disorders.

Depression shows up in many different ways, and some of these are not easily identifiable, while others are more obvious.  For some folk depression comes on suddenly (over a matter of days or a few weeks). For others it develops more slowly over the course of several months (this slowly developing depression may make it more difficult for the person who is experiencing it to realize that he, or she, is depressed). 

The main feature of depression, not surprisingly, is a depressed mood. Not just a little sad or blue, but truly depressed. The world begins to appear rather grim, the day to day present moments lack joy, and the future holds less appeal than it once did. In addition, those who have severe depression typically experience “anhedonia”, which is a fancy way of saying that there is a lack of interest in events/people/hobbies that, previous to the current time, had given the  child, teen or adult a good deal of enjoyment.

Related to this symptom is another, a tendency to become more socially withdrawn. The problem here is that when someone withdraws from family and friends they end up feeling more isolated and uncared for – leading to greater depression.

Quite frequently depressed individuals have difficulty concentrating, sometimes to the point that their school or job performance is compromised.

A lack of self-esteem is frequently seen in those who are depressed, and this is most often thought to be a result of all the other symptoms that haunt the depressed individual.

There is another class of symptoms that need to be looked at and these are called vegetative (related to functions essential for life). The list is rather short.

1.   Lack of energy being common among those suffering from a severe depression.            This will most often be seen in general fatigue.

2.   Changes in appetite are common (both increased appetite as well as a lack of                appetite... it varies from individual to individual). These changes are generally                accompanied by changes in weight.

3.   Disturbed sleep is frequently seen and may appear as insomnia, restless sleep, or          a need for longer periods of sleep.

4.   A diminished sex drive is also common.

5.   Frequent crying is not uncommon (with or without a reason).

6.   Thoughts of suicide or self-harm sometimes arise (but not all people with a severe          depression experience these thoughts).

COURSE OF DEPRESSION

Depression is one of the most prevalent mental disorders found among adults. About 6% of the population struggles with depressive symptoms. It is somewhat more common with women (8%) than with men (5%). Depression also is a major problem impacting children and teens.

Those who suffer from depression are also likely to suffer from anxiety (approximately two thirds of those who are depressed also have anxiety).

People who have experienced childhood trauma are more likely than others to have depression and anxiety. Moreover, when depression occurs with anxiety it is likely to last longer than when it occurs without anxiety. 

Although the course of depression varies according to the individual, research suggests that 70% of depressed adults recover within a year of the onset of symptoms.  Of those who are still depressed at the end of the first year, many (approximately 12%) will remain depressed for up to another five years.

Early intervention is crucial, although it should also be stressed that it is never too late to make significant changes that result in the resolution of depression.

Depression may develop gradually or quickly. At times it can be traced to specific events in an individual's life such as the loss of a loved one, or a series of significant misfortunes (e.g., divorce followed by the loss of a job followed by a major move that puts trusted family and friends on the other side of the world). Conversely, it may develop gradually, with no specific event being easily identifiable, but instead a steady decline in the individual's mood and reduction in healthy ways of thinking and behaving which in turn accelerate the depressive decline.

KEY SYMPTOM CHECKLIST FOR DEPRESSION

Depressed mood

Anhedonia (lack of interest in events/people/hobbies)

Lack of energy

Changes in appetite

Low self-esteem

Disturbed sleep

Diminished focus/concentration

Social withdrawal

 DEPRESSION ANXIETY TRAUMA PTSD

HOW TO BEAT DEPRESSION: THE ROAD BACK TO A HAPPIER, FULLER LIFE

There is good news. Depression can be resolved. Although when you are depressed it may feel hopeless, the truth is that most people do not stay depressed. That by itself tells us that logically, there is every reason to expect that depression will be beaten, and a happier life regained.

There are many ways to fight back against depression. Some of these strategies are specific to what has caused the depression. Other strategies are not related to the exact reasons the depression took hold, but they are nevertheless effective. I’ll briefly mention several of the general strategies.

Take the Positive Psychology Approach          

Positive Psychology is a field that focuses on maximizing psychological health and happiness through positive thinking and behavior. Sound simplistic? It is. Also, effective.

Gratitude     Using this approach you could try focusing on gratitude (shameless plug alert, you can get a pdf guide on research-based gratitude exercises by signing up for my newsletter at forresttalley.com).

If you take this approach you might try keeping a daily gratitude journal, or writing a single one-line gratitude note to someone each day.

Help Others     Research, and common sense, also show that focusing your energies on helping others who are in need helps to lift depression. We’re not talking the “rushing into a burning building” type of help. Even giving someone a ride to the doctor’s office, or mowing the neighbor’s yard, will boost one’s mood.

Exercise     Brief moderate daily exercise is a tried and true mood booster as well. No need to go wild, just 15 to 20 minutes a day of walking is likely to make a difference in depression when done regularly over time.

Behave The Way You Want To Feel     Act as though you were happy. Actions have powerful consequences. Actions send signals to the brain that in turn responds by releasing certain neurotransmitters that change our mood.

For example, research has found that when you have people smile, even when they do not know that you are intentionally having them smile, their mood improves. In one study researchers compared people who held a pencil in their mouth in a way that imitated a smile to those who also were instructed to hold a pencil in their mouth, but in a way that inhibited smiling.

All subjects then performed an identical task and given a questionnaire to report on their mood (among other things). The unwitting smilers were much happier than non-smilers.

There are numerous other studies showing the powerful link between behavior and mood/attitude (interesting fact, did you know that even simple changes in your posture can influence your confidence?).

The bottom line is, when depressed it is helpful to act happy. You don’t need to be the life of the party or pretend that things have never been better. But you will do yourself a favor by smiling, pulling your shoulders back, greeting others warmly, and engaging with family and friends.

When we give in to feelings of depression, looking glum and keeping away from others, we make things worse. I would not want to do that and I’m certain you would not want to either.

Before moving on, however, I want to be clear. It’s fine, in fact it’s a good idea when you are depressed to confide these feelings to your inner circle of friends/family. Everyone needs support, make sure you find it among those with whom you are closest. But having done so, dust yourself off, and continue on with the business of life. By taking this approach you will be training your brain to resist depression.

Three Good Things     The last thing I’ll mention regarding positive psychology is that it can be helpful to end each day by writing down “Three Good Things” that happened, what part you had in making them happen, and how you can use those insights to make the next day a little better. Do this for two weeks and see if your mood has not improved.

Psychotherapy

There is a mountain of research showing that psychotherapy is an effective approach for dealing with depression. The real question is what type of psychotherapy is most effective? This has been debated for years and continues to be debated.

The data suggest that there is no one approach that is clearly the winner. What matters most is that the therapist and client are a good fit (the client likes the therapist, believes he/she is competent, understanding, respectful, trustworthy, and has a reasonable plan for dealing with the depression).

What this means for someone who is depressed and seeking psychotherapy is that finding the right therapist is more important than finding the right type of therapy (see blogs dated July 17th and 24th 2018).

But let’s be clear, the right therapist is at least somewhat related to the sort of therapy he or she practices. If you hate the idea of hypnosis, then you will not feel as though a hypnotherapist is a good fit for you, no matter how competent, understanding and trustworthy that person may be.

In all likelihood a therapist will primarily practice one of the following three types of therapy.  Cognitive Behavior Therapy, Interpersonal/Psychodynamic Therapy, or Eclectic Therapy.

Cognitive Behavioral Therapy (CBT) focuses on finding the links between one’s thoughts, behaviors and emotions. After discovering these links the therapist makes recommendations on how a client can change his or her thoughts and behaviors in order to bring about a change in emotions (in this case, depression).

An interpersonal/psychodynamic therapist will help a client discover these same links, but also tries to put that information within the context of the client’s history. The past is considered an important force in molding the client’s current patterns of thoughts/behavior/feelings.

By uncovering how it has impacted a client (that is, making clear the connection of the present with the impact of the past), the client is better able to free him/herself from its powerful influence. Being aware of these connections provides freedom to choose differently, behave more adaptively, and see present circumstances without the distortions caused by painful events in one’s history.

The eclectic therapist uses a combination of therapies (such as CBT and IP). Many therapists, perhaps most, consider themselves to be eclectic.

Medication

People often have strong views about the use of psychiatric medications. Some are huge supporters whereas others see the use of medication to treat depression as a high-risk gamble, or worse, a sign of weakness.

The bottom line is that medication has a long record of being effective in reducing depression in most people.  When used appropriately, antidepressants are extraordinarily safe, although some side effects are possible.

Moreover, they are often used in combination with psychotherapy – for good reason (Read my blog of August 11, 2018 to learn more about when to use medication). These two approaches combined are generally more effective in bringing relief than either approach in isolation. Medication brings about faster change, and psychotherapy brings about more lasting change.

 DEPRESSION ANXIETY TRAUMA PTSD

CONCLUSION

The impact of depression is felt in many families. The good news is there is much that can be done to identify and treat it effectively.  Depression plays tricks with your mind. It makes you believe that life will never get better. That the happiness you once knew has been irretrievably lost. But there is hope, and every reason to expect that one or more of the approaches outlined above will be able to help you turn thing around. Regain the joy and vitality that depression has stolen.

So, if you, or someone you love, has several of the symptoms listed at the start of this blog, consider talking to your physician or a counselor to learn whether it might be time to get some help. There is nothing to lose by taking that first step.