Recognizing and Dealing with Depression (Part 2)

This is the second of a two-part series on depression. In this blog, I will describe how depression is treated and prevented. If you or someone close to you suffers from depression, it is important to educate yourself about it and seek treatment from qualified mental health professionals.

There are three basic ways to treat depression: psychotherapy, self-help, and medication. Many people respond best to a combination of two or more methods.

1. Psychotherapy: Exploring one’s beliefs and ways of thinking, and learning new ways of
thinking and behaving, with the guidance of a professional.
2. Self-help: Exploring one’s beliefs and ways of thinking on one’s own.
3. Medication: Altering one’s brain chemistry by taking antidepressant medication.

There are four types of antidepressant medication available today:

• Tricyclic antidepressants (TCAs)
• Monoamine oxidase inhibitors (MAOIs)
• Selective serotonin reuptake inhibitors (SSRIs)
• Structurally unrelated compounds

The TCAs and MAOIs have been used for decades. The SSRIs (such as Prozac) and structurally unrelated compounds are newer and are being prescribed more and more frequently. They have fewer and less pronounced side effects than the TCAs and MAOIs.

Treatment without Medicine

One of the leading methods for treating depression is cognitive therapy. Cognitive therapists help depressed clients feel better by identifying how faulty ways of thinking are making him or her feel bad. The client analyzes his or her thoughts and beliefs, and learns to substitute more healthy ways of thinking and believing.
Many mental health professionals believe that the ideal treatment of clinical depression is medication in conjunction with psychotherapy.

Prevention of Depression

Depression can often be prevented. It is especially important to take preventive action if you are aware that you have predisposing factors such as those mentioned in the last blog.

1. Identify your risk factors and be aware of where you are vulnerable. Each of us has unique
risk factors, such as things we were taught in our families of origin, values we have learned,
and the presence or absence of a family history of depression. Anything that has been
learned can be unlearned and replaced with something healthier.
2. Learn to manage stress. You can learn proven techniques for calming and relaxing
yourself. Consider taking a stress management class or buying a set of relaxation tapes.
3. Learn problem-solving skills. Many people who develop depression never learned
problem-solving skills. They need to develop the ability to see problems from many
viewpoints and to look for a variety of solutions.
4. Learn self-acceptance. Instead of rejecting the parts of yourself you don’t like, learn to
manage them more productively.
5. Become aware of selective perception. Observe how you generate ideas and opinions
about people and events. Remember that these are just your views, not necessarily
objective facts.
6. Focus on the future, not the past. Depressed people tend to be focused on the past. People
who set goals and focus on the future tend to be more positive about life.
7. Develop a sense of purpose. Many depressed people lack a sense of purpose or meaning.
This means they have no goals and nothing in the future drawing them forward. To prevent
depression, develop your sense of purpose and meaning.
8. Strengthen your emotional boundaries and set limits. Boundaries define your role in a
social situation. They determine how you will or won’t behave in a given situation. Having
clear, strong boundaries is empowering, while boundary violations make you feel victimized
and helpless. Setting limits means having and enforcing rules for the behaviors you expect
in a relationship.
9. Build positive and healthy relationships. Think about what you need from others in
relationships. Learn to read people and trust your instincts about which people are good for
you.
10. Avoid isolation. Talk to others about what’s going on with you. If you keep your thoughts to
yourself, you may be unaware that your thoughts are distorted. If you share them with
another person, you can become more objective. There is power in numbers.

Signs That Professional Therapy Is Needed

1. Thinking about death or suicide. This is always dangerous and you should see a
professional therapist immediately.
2. When symptoms of depression continue for a long time, you may need professional help.
Acute responses to events are normal, but they should not last beyond a reasonable time.
3. Your ability to function is impaired by your depression. Seek help before your life situation
deteriorates to a serious level.
4. You have become so isolated that you have no one with whom to test reality. Seek
someone out to share your thoughts and feelings with.
5. Depressive symptoms have become severe.

I hope these thoughts give you a starting point to become well and healthy. God bless.

Recognizing and Dealing with Depression (Part 1)

This is the first of a two-part series on depression. In this issue, I will explore what depression is and what causes it. In the next issue, I will describe how depression is treated and prevented. If you or someone close to you suffers from depression, it is important to educate yourself about it and seek treatment from qualified mental health professionals.

Depression is a serious illness, not a harmless part of life. It is a complex disorder with a variety of causes. It is never caused by just one thing. It may be the result of a mix of factors, including genetic, chemical, physical, and sociological. It is also influenced by behavior patterns learned in the family and by cognitive distortions.

Depression affects millions of people in this country. It is always troubling, and for some people it can be disabling. Depression is more than just sadness or “the blues.” It can have an impact on nearly every aspect of a person’s life. People who suffer from depression may experience despair and worthlessness, and this can have an enormous impact on both personal and professional relationships. In this newsletter, I will describe many of the factors that may cause depression, and I will explore strategies for preventing it.

Depression Is Pervasive

When a person suffers from depression, it can affect every part of his or her life, including one’s physical body, one’s behavior, thought processes, mood, ability to relate to others, and general lifestyle.

Symptoms of Depression

People who are diagnosed with clinical depression have a combination of symptoms from the following list:

• Feelings of hopelessness, even when there is reason to be hopeful
• Fatigue or low energy
• Much less interest or pleasure in most regular activities
• Low self-esteem
• Feeling worthless
• Excessive or inappropriate guilt
• Lessened ability to think or concentrate
• Indecisiveness
• Thinking distorted thoughts; having an unrealistic view of life
• Weight loss or gain without dieting
• Change in appetite
• Change in sleeping patterns
• Recurrent thoughts of death
• Suicidal thoughts
• A specific plan for committing suicide
• A suicide attempt
• Feelings of restlessness or being slowed down

When a person is suffering from depression, these symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. This means that the person’s family and social relationships, as well as work life, are impaired.
When a person is suffering from depression, symptoms such as these are not the result of a chronic psychotic disorder, substance abuse, general medical condition, or bereavement.

Grief, Sadness, and Depression

Depression may include feelings of sadness, but it is not the same as sadness. Depression lasts much longer than sadness. While depression involves a loss of self-esteem, grief, disappointment and sadness do not. People who are depressed function less productively. People who are sad or disappointed continue to function.

Depression and Socioeconomic Factors

Depression does not seem to be related to ethnicity, education, income, or marital status. It strikes slightly more women than men. Some researchers believe that depression strikes more often in women who have a history of emotional and sexual abuse, economic deprivation, or are dependent on others. There seems to be a genetic link; depression is more common among parents, children, and siblings of people who are diagnosed with depression. The average age at the onset of a depressive episode is the mid-20s. People born more recently are being diagnosed at a younger age.

Physical Causes

Many physicians believe that depression results from a chemical imbalance in the brain. They often prescribe antidepressant medication, and many people find relief as a result. However, there is no reliable test to identify such a chemical imbalance. It is unknown whether life experiences cause mood changes, which create changes in brain chemistry, or whether it works in reverse.

Depression may be associated with physical events such as other diseases, physical trauma, and hormonal changes. A person who is depressed should always have a physical examination as part of the assessment process to determine the role of physical causes.

Signs That Professional Treatment Is Needed

If you or someone you know is depressed and exhibits any of the following signs, it is extremely important to seek the assistance of a medical or mental health professional.

1. Thinking about death or suicide. This is always dangerous and you should see a
professional therapist immediately.
2. When symptoms of depression continue for a long time, you may need professional help.
Acute responses to events are normal, but they should not last beyond a reasonable time.
3. Your ability to function is impaired by your depression. Seek help before your life situation
deteriorates to a serious level.
4. You have become so isolated that you have no one with whom to check reality. Seek out
someone to share your thoughts and feelings with.
5. Depressive symptoms have become severe.

In my next blog, I will discuss the treatment and prevention of depression.

Dealing with the Holiday Blues

Not everyone shares in the celebration and joy associated with the holidays. Many people feel stressed and unhappy in response to the demands of shopping for gifts, spending large amounts of money, attending parties and family gatherings, and entertaining houseguests. It is not uncommon to react to these stresses with excessive drinking and eating, difficulty sleeping, and physical complaints. The holiday blues are a common result. If you experience reactions like these during the holidays, you are not alone. Let’s take a look at what causes the holiday blues and what you can do about them.

What Causes the Holiday Blues?
Fear of disappointing others. Some people fear disappointing their loved ones during the holidays. Even though they can’t afford to spend a lot of money on gifts, some people feel so obligated to come through with a fancy gift that they spend more than they can afford.
Expecting gifts to improve relationships. Giving someone a nice present won’t necessarily strengthen a friendship or romantic relationship. When your gifts don’t produce the reactions you had hoped for, you may feel let down.
Anniversary reactions. If someone important to you passed away or left you during a past holiday season, you may become depressed as the anniversary approaches.
Bad memories. For some families, the holidays are times of chaos and confusion. This is especially true in families where people have substance abuse problems or dysfunctional ways of relating to each other. If this was true in your family in past years, you may always carry memories of the disappointment and upheaval that came with the holidays. Even though things may be better now, it is difficult to forget the times when your holidays were ruined by substance abuse and family dysfunction.
It could be SAD. People who live in northern states may experience depression during the winter because of Seasonal Affective Disorder (SAD). SAD results from fewer hours of sunlight as the days grow shorter during the winter months.

Strategies for Dealing with the Holiday Blues

While the holiday blues are usually temporary, these ideas can help make this year’s holiday experience more pleasant and less stressful.

Be realistic.
Don’t expect the holiday season to solve all past problems. The forced cheerfulness of the holiday season cannot ward off sadness or loneliness.

Drink less alcohol.
Even though drinking alcohol gives you a temporary feeling of well-being, it is a depressant and never makes anything better.

Give yourself permission not to feel cheerful.
Accept how you are feeling. If you have recently experienced a loss, you can’t expect yourself to put on a happy face. Tell others how you are feeling and what you need.

Have a spending limit and stick to it.
Look for holiday activities that are free, such as driving around to look at holiday decorations. Go window-shopping without purchasing anything. Look for ways to show people you care without spending a lot.

Be honest.
Express your feelings to those around you in a constructive, honest, and open way. If you need to confront someone with a problem, begin your sentences with “I feel.”

Look for sources of support.
Learn about offerings at mental health centers, churches, and synagogues. Many of these have special support groups, workshops, and other activities designed to help people deal with the holiday blues.

Give yourself special care.
Schedule times to relax and pamper yourself. Take a warm bath or spend an evening with a good book.

Set limits and priorities.
Be realistic about what you will be able to accomplish. Prepare a To-Do list to help you arrange your priorities.

Volunteer your time.
If you are troubled because you won’t be seeing your family, volunteer to work at a hospital or food bank. Volunteering can help raise your spirits by turning your focus to people who are less fortunate than you are.

Get some exercise.
Exercise has a positive impact on depression because it boosts serotonin levels. Try to get some type of exercise at least twice each week.

After the Holidays
For some people, holiday blues continue into the new year. This is often caused by leftover feelings of disappointment during the holiday season and being physically exhausted. The blues also happen for some people because the start of a new year is a time of reflection, which can produce anxiety.

Is It More than Just the Holiday Blues?
Clinical depression is more than just feeling sad for a few weeks. The symptoms generally include changes in appetite and sleep patterns, having less interest in daily activities, difficulty concentrating, and a general feeling of hopelessness.
Clinical depression requires professional treatment. If you are concerned that a friend or relative may be suffering from more than just holiday blues, you should express your concerns. If the person expresses thoughts of worthlessness or suicide, it is important to seek the help of a qualified mental health professional.

For further information, visit these web sites:
American Psychological Association: http://www.apa.org
National Depressive and Manic-Depressive Association: http://www.ndmda.org
National Mental Health Association: http://www.nmha.org