Beyond Sadness: Treatment of Depression
Depression is by far the most pervasive, impactful, and costly medical problems we have in this country today. Aside from the emotional and spiritual life-toll that depression exacts from us, it has been estimated that just the combined economic costs associated with time lost from work and monies necessary to treat it has exceeded $16 billion a year.
Everyone knows someone who has suffered from a serious depression, even if it has not be so “labeled.” As anyone who’s actually experienced it can tell you, it’s not the same as a bad mood or a sad day. We have all experienced sadness, anger, irritability, guilt, loss, unhappiness. Depression is that, but also much, much more.
My response to that is usually, “You’re the one only who truly knows, but I can help you find out.” Then I ask a series of questions that help you to clarify it.
Depression has certain features or characteristics.
The primary one is a “dysphoric” state-a feeling of being down, sometimes experienced as helplessness, hopelessness, and despair. When feeling this way it can be hard to participate in your life the way you once used to or the way you may want to. There may be an increase in crying or a desire to cry, even if the tears don’t come (“dry tears depression”). People with depression look, feel and present as “down.” They’ve lost interest in things that used to give them pleasure-they don’t see the point anymore.
Their thinking may change: instead of feeling some self-worth, they may feel worthless, that they can’t make things any better, or that things will stay bad forever. They focus on the negative. They see “half-empty glasses” instead of “half-full ones.”
We may see disrupted sleep (insomnia, hypersomnia), a loss of appetite, a loss of sexual desire (that is not related to particular sexual changes or endocrine dysfunctions), fatigue during the day, an increase in anxiety and irritability (called “agitated depression”).
Depression can often be seen with alcohol or drug abuse.
Which came first is often hard to diagnose and it’s always important to treat the substance abuse first. Alcohol and drugs exacerbate rather than help cure the problem. Alcohol and drugs can often create depression. If the person was already depressed prior to using alcohol or drugs, they will most certainly make it worse.
There are numerous reasons for depression and no single cause. There are both external and internal factors to consider. It may be the result of repeated, major losses, chronic abuse, isolation, illness, or trauma. It may also be caused by irrational or “faulty” thinking patterns. A person may be used to see things through “mud-colored glasses”. Perhaps they were taught to see themselves or the world that way when they were younger, carrying with them into adulthood negative ideas about themselves, their relationships, and their futures.
It may also be the result of an inherited biochemical imbalance. For this reason, you often see depression running in families. As we understand depression today, it seems to develop as a result of the activation of a biological predisposition for the biochemical imbalance that has existed all along. It can be activated when a person experiences a major life event in a negative way (going to college, getting married, having to find a job) or a series of minor negative ones. It is believed that the biological features of depression are tied to this biochemical imbalance.
Absolutely. Between psychiatric medication or homeopathic treatment and cognitive behavioral therapy, a great many individuals find the relief they never believed possible. The majority of people with major clinical depression can expect to enjoy a significant partial remission within 3-4 weeks of treatment and long-lasting relief with 3 – 6 months of treatment. Some depressions require medication to “kick start” the recovery process. Some people stay on allopathic medication (such as tricyclics, SSRI’s, or MAO inhibitors) for years, enjoying full lives. Some depression (though rare) is so severe as to require shock therapy.
The clinical data has strongly supported the efficacy of the behavioral and cognitive behavioral therapies in treating depression. Behavioral therapies focus primarily on concrete behavioral techniques to enhance a person’s life skills (including interpersonal), while the cognitive-behavioral modality emphasizes the restructuring of a person’s thinking so that they see themselves and their world differently.