When you’re depressed, it seems like there is a black cloud always following you around. (This may be literally true: when depression lifts, colors seem brighter again, like in a movie that shifts from black and white to color). Depression can make it hard to get out of bed… hard to put one foot in front of the other… or, depression can cause agitation, making it impossible to sleep, hard to stop moving, and yet hard to get anything done. When you are depressed you may find it hard to remember what you ever liked about your friends, your spouse, the activities you used to enjoy… When you are depressed you can find it hard to see anything good about yourself. The future seems bleak, and it seems useless to try to change. You may be sad and tearful, or your depression may leave you irritable or angry much of the time.
Depression is very common: it’s been estimated that up to 12% of men and 25% of women will experience an episode of depression in their lifetime. Depression affects not only your own quality of life, but also your family life and work life. Depressed people may have trouble succeeding in school or work, and are more likely to become medically ill or injured. Tragically, some people suffering from depression may end up taking their own lives.
Depression can be triggered by a loss (of a job, a family member, a relationship) or it can seem to come out of the blue. Depression tends to run in families: if you have a parent or close family member who has suffered chronic depression, the odds of your being depressed are greatly increased. Scientists believe there is a strong genetic factor in depression. But depression can also be learned from your family, in a way: if one or both of your parents tended to think negatively, always critical, always anticipating the worst, you will have a harder time learning to look on the bright side. If you experienced abuse (physical, emotional or sexual) in childhood, you will have a greater likelihood of depression as an adult. It’s hard to feel deserving of love, acceptance and success if those closest to you treated you as worthless when you were growing up.
Having a serious medical illness can bring on depression, not just because of the losses associated with the illness but also due to the biological effects of the disease. Even some medications can cause depression, as can abuse of alcohol or drugs. Ironically, many people who abuse substances are trying to make themselves feel better – but the “self-medication” of substance abuse can worsen depression.
You may have heard that depression is caused by a “chemical imbalance” in the brain. It is true that neurotransmitters such as serotonin, a naturally occurring chemical that flows through the nervous system, are related to mood. What is not fully understood is whether the changes in brain chemistry cause the depression directly, or whether in fact the depression causes the brain chemistry to change
There are three major approaches to the treatment of depression: Psychotherapy, medication, and lifestyle changes.
Cognitive-behavioral therapy can help you learn to change your thinking patterns, for example by challenging your own negative and self-critical thoughts, and helping you to create a habit of focusing on the positive aspects of life. A related approach called solution-focused therapy can help you figure out what is already working in your life, or has worked in the past, and help you find ways to build on success. Interpersonal therapy, or family therapy, can help you to improve your relationships with the people who are most important to you. This can be an important part of healing from depression.
Psychodynamic (or insight-oriented) therapy can help you by enabling you to talk about key events in your past that may have led to your depression. When you share these past events and relationships in the safe, supportive environment of therapy, you can often release years of hurt, grief, guilt and shame that have kept you from experiencing joy and success in life.
Your doctor, psychiatrist or psychiatric nurse practitioner can prescribe a medication and/or nutritional supplement that may play an important role in helping you feel better. If you have tried medications in the past without success, please know that there are many different types of medications available. What works for one person may not work for another, and sometimes it is essential to try different dosages, or different combinations of medications.
Medication can help your mood improve enough so that you are better able to do the work of psychotherapy. Research has shown that medications tend to work much better along with regular psychotherapy. Either medication or psychotherapy alone can be very helpful, but a combination is often the most effective treatment.
Finally, there are lifestyle changes that can help lift your mood. Exercise, diet, sunshine, prayer or meditation, and reaching out to others for support – or to help – can all be important ways to lift the black cloud that is depression. (See the section on natural mood supports here: Mental Health Suggestions).
If you have further questions about the treatment of depression, please feel free to contact us.