When Is It Depression?

Depression has become one of the most common psychological disorders of our time.  Although not unheard of in other cultures and in other eras it has become most prevalent and diagnosed in the industrialized world of the last thirty to forty years.  Unless extremely fortunate, everyone will, in their lifetime, have some experience with depression. Temporary feelings of being unhappy or “blue” are common to most all of us and, in many instances, they are a normal part of everyday living.  So when does it become depression?  That is a complicated question. 

To begin, it might be helpful to distinguish between situational depression and clinical depression.  Some suggest that, with the exception of the severity, there is no difference.  Others in the field believe that these two are quite different.

Situational Depression: Situational depression is the normal, usually short-term reaction that most of us experience when confronted with an upsetting event.  Any situation, which we perceive to be a loss or where the outcome does not meet our expectation, is a possible trigger for situational depression.  Divorce, death of a loved one, job lay off, failed promotion, or child leaving home, are examples of events that can cause temporary symptoms of depression.  As we resolve these issues the symptoms normally mellow and we return to our “usual selves”.  This process usually takes only a few weeks and most likely would not require medication or therapy though one or both might be of benefit.

            Clinical Depression: Clinical depression is usually seen as a more severe, longer-term period of emotional unhappiness.  Although not proven to everyone’s satisfaction, there does appear to be a genetic link to major depression as it can be traced back in some families several generations.  Current research into this form of depression centers around the functioning, or more appropriately the non-functioning, of several “chemicals” in our brains that contribute to our moods.  The best known and researched is Serotonin although other neurotransmitters may be involved.  It is theorized that dysfunction of this neurotransmitter is a culprit in the development of major depression.  It is these “chemicals” that are the target of many of the new anti-depressants coming on the market.  What specifically triggers the malfunctioning of these transmitters remains unclear.  Though some might be genetically predisposed to depression, it still may take a precipitating event to cause the change to occur.  Major, chronic depression most likely will require therapy and/or medication to control.

            Symptoms of Depression: It is estimated that somewhere between ten to as many as twenty-five percent of adolescents and adults have significant symptoms of depression. Research concerning depression and it symptoms in younger children is currently sketchy at best although it is now recognized that it occurs far more frequently than had been previously estimated.  Depression can and does dramatically affect an individuals overall quality of life.  If you experience three or more of the following for more days than not for several weeks or months you may be experiencing some form of depression.

·        changes in sleeping patterns (feelings of wanting to sleep all the time or inability to sleep)

·        changes in eating habits (significant weight gain or loss)

·        loss of libido (no interest in sex)

·        uncontrollable crying

·        intense anger or rage (seen many times in adolescents)

·        feelings of helplessness, hopelessness, and low self worth

·        excessive guilt

·        loss of interest in activities that normally bring joy or pleasure

·        no motivation or energy

·        feeling like “there will never be another good day”

·        easily frustrated

·        increased periods of anxiety

·        suicidal thoughts or self mutilation

            What to do: If you believe that you may be experiencing some form of depression, the first consult should be with your physician.  Sometimes certain medical conditions or reaction to medication for medical conditions can result in symptoms that mirror those of depression. For this reason it is important that a complete physical be performed to rule out any undetected medical problem that may be the source of the mood change.

            Ruling out a medical problem your physician may then want to refer you to a counseling center or behavioral health center for diagnosis of depression. In addition to or in lieu of referral he may decide to prescribe medication.  This is an area where there still remains some controversy in the treatment of depression.  Some researchers, many physicians, and most pharmaceutical companies believe that medication alone will effectively relieve depression.  Other research suggests that this is not the case.  In some studies a counseling approach with different forms of  “talk therapy” has proven just as effective as medication and in some instances more effective.  It may be that a combination of talk therapy and medication eventually proves to be the best approach, although this remains to be scientifically documented. 

            Medication: Most of the antidepressant medication being prescribed today belongs to a classification known as selective serotonin reuptake inhibitors (SSRI’s).  In addition, there are older types of depression medication on the market that belong to other classifications, but these are rarely used anymore and need not be discussed here. There are many companies making SSRI’s and selling them under different brands names.  They are just enough different that they each have received a patent and each works just a little differently.  The one that will be prescribed can depend on several factors, but most likely will come down to physician preference.  Unfortunately, antidepressants sometimes require “trial and error” before finding the one best suited for each individual.  In addition, some people, although a minority, experience side effects that makes taking a particular drug impossible.  These side effects vary with the particular brand of medication and with each individual response to that brand.  The physician, physician’s assistant, or psychiatrist who prescribes the medication should cover all aspect of the medication with their patient before allowing them to take it.  If they do not fully explain the side effects, ask!  And as with any medication, if unpleasant side effects develop, call your physician immediately.

            Medication also requires a time commitment.  When first starting a program of medication, several weeks may elapse before an individual notices any difference.  Many people, unaware of this, often get discouraged and discontinue the medication before it can reach a therapeutic level.  Also, once started, a medication program may need to be continued several months to insure total effectiveness. Some individuals will need to be on their medication for a year or more and some may require it for life.

            The one big disadvantage to a pharmacological approach is of course the cost.  These medications are costly and very few have gone generic. So a dollar commitment is also required if considering a medication approach to depression.  Some but not all insurance companies will help cover the cost of medication.

            Counseling/Therapy: There are several different counseling approaches to treating depression, with the most popular and perhaps the most effective being a style known as cognitive.  This approach will be discussed fully in another article.  For the purpose of this article it is important to know that research shows, regardless of the approach used, counseling/therapy is most effective when there is a good patient, therapist match. Therefore it is important to do some homework before settling on a therapist.  A person should ask for credentials and references (if possible) before attending the first session.  Ask friends or relatives who may have sought counseling, currently or in the past, who they would recommend.  If after attending a session an individual does not believe that it is a good match they should feel free to try elsewhere.

            As with medication, counseling requires a time commitment.  Sessions are usually once a week or sometimes every other week.  Therapy can last months but should not require years as with medication.  Results can take a few weeks to a few months depending on the severity of the depression, the individuals commitment to the therapy process, and the building of a positive therapeutic alliance between the therapist and the patient.

            Individual therapy is usually employed but studies indicate that often times the involvement of the patient’s family in the therapeutic process can build support and speed recovery for the patient.

            Also, like medication, therapy can be expensive. Once again many insurance companies will help cover the cost, but it is best to check this out in advance.  Many counseling centers offer a sliding scale fee based program.  The cost of therapy is determined by an individual’s income with the behavioral health center attempting to make the cost affordable for everyone.

Some people still believe that there is a stigma associated with therapy, but fortunately this way of thinking is quickly being left behind as research and public opinion both embrace therapy as an effective method of treating many disorders such as depression.

Depression is a serious illness. It destroys quality of life. It divides families and ruins relationships.  It cost thousands of dollars yearly in lost wages and missed productivity. And in its severest forms it can be deadly.  People do die from depression.  If you are suffering with this disorder, seek help.  Fortunately today there are treatments that can give you back your life.  Please take advantage of them!