According to a Gallup and Sharecare poll in 2017, 18% of the American population has been professionally diagnosed as depressed.  To get an idea how common depression is, work absenteeism due to depression costs employers more than $23 billion per year.  Depression is a common condition for which people seek therapy. It often goes unrecognized and/or is misunderstood.   It’s more than just being sad; it changes physiological and neurological functioning.  Sadness can be a symptom of depression but isn’t the defining feature.  Most depressive symptoms are physical, not emotional.

• Sleep disturbance
• poor memory/concentration
• Appetite change
• Irritability
• Not enjoying activities/relationships

 

People with depression frequently see a Doctor to address the physical components of depression (for example, tiredness, sleep disturbance, concentration difficulties) without recognizing depression is the root cause or a second medical issue to be directly addressed to alleviate. Physicians can miss depression in patients and focus on physical symptoms. Additionally, there is huge overlap between depression, chronic pain, fibromyalgia, and other physical conditions.

There is a biological predisposition to depression but it doesn’t necessarily activate unless the right experiences/circumstances in life occur.  (Similarly, alcoholism involves a genetic predisposition, but if the individual doesn’t ever drink, it can’t be activated).  Besides the biological component, depression can result from being under stress for a prolonged period or other circumstances.

There are ways to reduce depression:

• Therapy
• Medication
• Exercise (See our previous blog on exercise and depression 9/6/2018)
• Diet
• Meditation/breathing exercises

 

Depression tends to “feed” on itself.  The effects of depression make it hard for the sufferer to take the steps that would combat the depression.  This is an example of how depression could feed itself.  One  symptom of depression is lack of motivation, which can make it difficult to make behavioral changes that are helpful.  Having social support is important when making these changes.  Unfortunately, another symptom of depression is social withdrawal, creating another obstacle for a person with depression to reach out to others.  When depressed, a person can feel worthless, leading them to feel as though others would be burdened by them or see them as a waste of time.

If I feel worthless, I’m unlikely to engage others.  Decreased engagement in relationship increases a sense of isolation, which increases the sense of worthlessness.  Depressed people are not choosing to be depressed, and often spend lots of time criticizing themselves for not “snapping out of it,” which can fuel a sense of hopelessness.  When people feel worthless, isolated, and hopeless, their sense of life being meaningful can get lost.  The different symptoms of depression work together and can keep a person stuck and confused about what to do.

Depression is a medical condition.  The brain functioning of a depressed person is markedly different from someone who is not depressed.  FMRI’s (real time viewing of brain functioning) shows clearly that non-depressed people have objectively different activity than depressed people.  There are changes in the levels of neurotransmitters (chemicals used by the brain) produced by a depressed person vs. a non-depressed person.  When someone has been depressed for somewhere around 6 months, the brain adjusts to stop wasting energy producing chemicals that it doesn’t use.  A person at that point is likely to need an antidepressant to have the raw materials to function in a non-depressed way.  (Anti -depressants prevent the brain from reabsorbing neurotransmitters, which forces increased levels of them to be available-imagine closing a drain so water will build up in a sink.)  Antidepressants do not create a dependency on artificial substances, they increase the amount of naturally created chemicals in the brain.  Doctors will usually ask patients to stay on medication for about a year, so that the brain will adjust once again to producing normal levels of the chemicals a non-depressed person has.  A person can stop taking medication at any time, but they must be sure to taper off of them.  Stopping taking medication abruptly can lead to a reoccurrence of depression of greater intensity than it was before medication.  That does not happen when medication dosages are tapered.  It can be done in a week or two typically.  Another unhelpful tendency people have is to stop taking medication once they feel better, not realizing that the improvement is supported by the medication, and they can drop back into depression.

The good news – It’s very treatable.  For roughly 4 out of 5 persons with depression, first time treatment is successful.    When it is treated from the multiple directions as mentioned above, successful treatment occurs more rapidly. There are a few cases of depression which are treatment resistant. Therapy is not a never-ending process.  Both the patient and therapist should clearly understand and agree on the goals they are working towards, what the steps are to get there, and how they will know when work is complete.

Here are some therapy goals:

1. Establish behaviors that prevent depression from reoccurring.
2. Adjust inaccurate thoughts and perceptions.
3. Identify any unmet interpersonal needs and find healthy ways to address them.

If you think you may have depression, there are many free depression screens available online.  The Beck Depression Inventory II is a very commonly used screen (http://www.bmc.org).  Looking at diagnostic criteria for depression and see if symptoms describe your experience may be beneficial. Asking a family member or friend if they recognize any of the symptoms in you is another option.  The vast majority of the time treatment is effective.  For a person suffering with depression that can be hard to believe, but it is true.