I recently received a letter from a woman who said she’s been feeling depressed because a significant relationship ended. She felt consumed by angry and sad thoughts and felt it was time for help. But under no circumstances would she take medication.
Without seeing her, I cannot diagnose her. But the fact that she is feeling depressed does not necessarily mean she has a clinical depression. Sometimes when we feel depressed, it’s a reaction to loss or trauma and we usually recover on our own. Because feeling depressed is so distressing, we always want to recover quickly. But most often, it takes time. Wounds to the body heal at a rate of one millimeter a day. Wounds to one’s psyche probably heal as slowly.
Far too many people, with the help of well-meaning but misguided doctors, take medication for normal sadness. Although many report that the medication makes them feel strange, others say they feel better. This is not necessarily good because when we experience loss, we are supposed to feel pain. It’s the natural healing process.
Clinical depression is another story. It is not a symptom of weakness or poor attitude. It is a very serious brain disorder. It is often genetically based and can be triggered by loss, trauma, or normal developmental issues such as puberty. Its effects are far more pervasive than normal sadness or even mild depression called dysthymia. Clinical depression can affect sleep, appetite, and intimate relationships. It’s quite common for people with depression to feel hopeless, worthless and consumed with guilt.
When I experienced clinical depression, my first thought in the morning was: “how many hours before I can get back into bed tonight?” Mild depression or grief feels as if you are going through your life with sunglasses on. Clinical depression feels like carrying a 1,000-pound gorilla. Some evidence suggests that depression is a brain trauma not unlike an epileptic seizure. The longer it lasts, and the more often it happens, the more vulnerable the brain becomes to having it happen again. That’s why treatment for clinical depression must not be delayed.
Those who fear medication should understand that the options have changed greatly in recent decades. In the old days, the only treatment was with powerful mood-altering drugs that could be habit-forming and ineffective.
Today, these medications are designed to recalibrate the brain chemistry. Although most antidepressants are not habit-forming, many cause uncomfortable side effects. Some of the newer medications can take a month or longer to be effective, and even then, it could take some trial and error to find the best medication and dosage. So be patient. Also, while some over-the-counter medications such as St. John’s wort have shown promise with milder depression, they seem ineffective with clinical depression.
Most important, with the combination of medication and psychotherapy, most people reported significant improvement.
Whether your depression is clinical or mild, here’s how to help yourself:
Set small, reasonable goals each day. Your impulse may be to withdraw or bury your feelings. Both might make you feel worse.
One should not make important decisions during clinical depression or grief.
Mild exercise and healthy diet are good for the brain.
So is social engagement. Spend time with people who care for your well-being and won’t try to talk you into feeling better. And be open to their observations. A guest on my radio show once said that depression begins from the outside in – people around you will notice that you are behaving differently before you are aware of it.
Depression also heals from the outside in. Those same people will notice that you are looking and sounding better before you do.
In my next column I’ll talk about some things we can do to prevent depression in ourselves and our children.