What is Depression?
Depression is an intense constellation of symptoms, which directly impacts your life with negativity. Depression is on a continuum, there are less severe forms such as, melancholia and dysthymia. Symptoms vary from; loneliness, spontaneous crying episodes, sleep disturbance, weight gain or weight loss, thoughts of suicide, anxiety attacks, relationship dysfunction, substance abuse, and despondent withdrawn behavior. Not all of these symptoms need to be present in order for this to lead into a depressive phase. There are other forms of depression, which have a label attached to them such as; catatonia, depression with psychotic features just to name a few. Depression has long been established throughout cultures and other countries. Depression crosses all socioeconomic barriers, and effects all race and ages. It is under diagnosed in the elderly and children, and medication is all too frequently prescribed.
What causes Depression?
There are two major types of depression, endogenous depression, and depression from external stressors such as life trauma. Many individuals have life trauma; however it affects everyone differently. This depends, on coping mechanisms, peer and family support, as well as your own ability to ASK for help. Endogenous depression has a hereditary component and little to no stress can exacerbate the condition. Children are experiencing more and more depressive symptoms. This is a combination of social stress and emotionally absent parents. When financial woes occur, and parents become wrapped up in their every day stress, trying to make bill deadlines, failing with promised time with the children, working two jobs and combined marital conflict , children become effected.
In the geriatric years, physical health is on the decline, the elderly realize the absence of family time. They often feel forgotten, and cannot physically do what they have been able to do in the past. Depression is frequently not addressed by the health care provider and many times when it is, it is met with a resounding, “Hell no I am not depressed! “
Severe traumas, such as sex abuse, rape, post traumatic stress, divorce, and death of a loved one clearly will cause depressive symptoms. Our wonderful professional community has actually put a deadline on how long you should grieve before it is pathological. (Please see origin of the DSM Diagnostic Statistical Manual for Mental Disorders.)
What are treatments for Depression?
When one in our era thinks of treatment for depression they usually reflect to traditional medicine and pharmaceuticals. It amazes me that we consider traditional as medication. Traditional means handing down customs from one generation to another. Does this mean that we have handed down in our culture anti-depressants, electric shock therapy, and anti-anxiety medication? Should it not be that we have handed down, positive thinking, re-framing bad situations, family support, good work ethic, and the basic love of life? When Henry David Thoreau speaks of his elation with nature, and his disdain for government is he sinking in a depressive phase? His absence of socialization, and many a night sleeping on his own does not reflect a major depression. John Muir and Thoreau speak of the enlightenment and inspiration of nature. Go back to Native Americans and their treatment for depression. Did they conjure up a pharmaceutical? I think not. Medication has its place; however my issue here is the expediency in which our health care providers as well as our patient population gravitate to the miracle pill.
What are Anti-depressants?
Anti-depressants for the most part are now primarily prescribed as SSRIs (Selective Serotonin Reuptake Inhibitors.) Do they work? Absolutely! Should they be prescribed as often as they are? NOT A CHANCE! In twenty-five years of prescribing medication, I have been witnessed to poly-pharmacy (patients on more than two medication for the same diagnosis,) patients requesting and sometimes demanding ant-depressants. On the bright side, when other avenues have failed these medications work very well in the short term. I always tell patients, we may have to try a few different medications before we find the right one, PLEASE BE PATIENT. The medication takes at least two to three weeks to take effect. The most common side effects are; dry mouth, insomnia, inhibited sexual desire, light-headedness, and a racing heart. The black box warning that focuses on suicidal thoughts increasing is LUDICROUS. This warning was politically driven by distraught parents; lobby groups that blackmailed the pharmaceutical companies with law suits and monetary loss. The research DOES NOT hold true for this cause and effect. Welcome to our fear induced political system driven by monetary loss and gain. These anti-depressants have been around for thirty plus years, the only change is more of the medication was prescribed. The suicide rate in children did not increase with the proportion of medication prescribed. Shame on our government!
What are Non-Traditional treatments of Depression?
When one thinks of non-traditional treatment, one usually focuses on herbs, vitamins, meditation, prayer, and spirituality. Please be advised all herbs, and vitamins have side effects. Just like pharmaceuticals. Unfortunately, there are studies just now coming forward to have correct dosages on certain supplements. This is positive in the sense that they are now being recognized in the medical field, and our medical schools, physician assistant schools and nurse practitioner schools are now attending classes to look at alternative treatment.
What is re-framing?
It is not the event that causes anxiety or depression it is how you approach the event. Re-framing is the ability to change your perception of how you view a negative or stressful situation. When one views negative events as a constant black-cloud above them, they fall into a deep cycle of depression and a, “woe is me self view.” This stance gets sympathy from friend and family, up to a point. Then the healthy friends and peers begin to see what the truth is. Friends confront, and may distance causing an exacerbation of the behavior and depression. This has to be changed by the depressed individual if there will ever be a positive path in their life. Re-framing like any new behavior takes practice, and commitment. To be able to see the positive in all situations takes some work. How does one see the positive in a falling economy, the death of a loved one, or the turmoil of divorce? It is there, I promise you. Through time and practice, it can be done.
What is therapy, counseling and psycho-analysis?
Therapy, and counseling has been around since men and women interacted. The ability, to console, to care, and to reach out when one is in pain has always occurred. Unfortunately, not enough, but it has been there; parents council their children and teachers council their students. We all have the ability to be there for a hurt friend, some of us too much. When we cannot say no and we reach out to the point where we over-extend ourselves we become detrimental to others. The study of human behavior and psychology has a long history with constant changes. We have evolved minimally in relation to the age of the earth. Of course we would like to think we are smarter, we have computers and have made major advances in technology, however basic caring interaction has not increased. Divorce rate continues to escalate, war continues for monetary gain, religion remains to be the foundation to start conflict, induce opinions, and cause turmoil.
One could say that psychotherapy started in the 19th century with Freud, who made major contributions in the study of human development and behavior. In time schools were credentialed and the birth of psychiatrists, psychologists and social workers took over. Ah yes, to have the letters behind one’s name. It adds to the deflated ego, allegedly gives credence they know what they are talking about, governed by the state with licensure, and so importantly they get third party reimbursement from insurance companies.(MONEY.)
Very few therapists these days see patients for free. Some schools teach that there must be an exchange of money or it does not add credence to the session. It will mean more to the patient if they are paying for services. Regardless, there are some excellent therapists in the field that do a great service and then there are those that are atrocious and have no clue on how to have an honest human interaction. (Please see how to find a good therapist?)
Treating depression through therapy has the potential to be a great avenue at resolution of issues. Empowerment of one’s self esteem, re-framing the negative, teaching individuals to risk in the game of life, all help in moving in the right direction to help the patient see their strengths. Make sure you and your therapist set goals, this way you can measure your progress. Therapy does not work, if you assume one day a week for fifty to sixty minutes will make a difference. You as a patient need to work on your issues the other six days. The responsibility is ultimately yours; the therapist is the guide, the one to give direction. Therapy works; it is effective and can be motivating. It is imperative you trust, disclose and be very honest. Without a trusting relationship, you are wasting time and money. The dance with a good therapist can be life changing.