Episode 65: September 28, 2010
by Rob Lamberts, MD
Last week I explained how anxiety is a medical problem that needs to be taken seriously. Today I am going to talk about the other head of the emotional dragon: depression. Unlike anxiety, which I described as a feeling of helplessness, depression is more a pervasive feeling of hopelessness.
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I want to re-emphasize an important point from last week: there is a big difference between emotions and clinical problems. Just feeling depressed doesn’t mean you are clinically depressed. The two important factors that help distinguish between the emotion and clinical depression are duration and severity.
What Is Clinical Depression?
Clinical depression is defined as having five or more of the following symptoms (at least one of which is either depressed mood or loss of interest or pleasure), present most of the day--nearly every day--for a minimum of two consecutive weeks:
• Feeling of depression
• Losing interest or pleasure in most or all activities
• Sleeping too much or not being able to sleep
• Having a change in appetite or weight
• Being really slow emotionally or agitated
• Having low energy
• Experiencing poor concentration
• Having thoughts of worthlessness or guilt or recurring thoughts
about death or suicide
A lot of time people know they are depressed, but not always. Sometimes people don’t actually feel depressed, so figure they must not be. But these folks are tired, don’t have any interest in the things that they usually enjoy, they can’t concentrate, and they can’t sleep despite being very fatigued. That is depression, and it can go undiagnosed for years.
Why Is Depression Often Misdiagnosed?
Nearly 20% of the U.S. population has an episode of major depression in their lifetime.
But how could that be? There is a certain stigma attached to depression, because in the past, people who were depressed were often falsely considered either too emotionally weak to face the hardness of life or just plain crazy. That perception was, in part, due to the fact that the old depression medications were very strong and had bad side effects. The only people who got put on these drugs were those with very bad depression.
How Does Depression Affect People?
There’s a vicious cycle with depression. Many depressed people don’t sleep, which makes them tired and unfocused. That in turn can make them more likely to struggle at work or school, causing poor reviews or grades, which makes them more depressed—and so on.
Additionally, a person with depression is generally sad, has no energy, and feels bad about his or herself. They need to get help, spend time around other people, and find things that make them feel good. But depressed people often isolate themselves. It’s hard for them to be around people who ask how they’re doing, and even more difficult when people try to fix their problems. So as to avoid those situations, the person often feels more depressed and becomes more withdrawn, making matters even worse. It’s like they’ve painted themselves into a corner.
And if depressed people have feelings of death or suicide, they may isolate themselves even further. Having suicidal thoughts can make depressed people believe they’re crazy or weak. They don’t want others to know about the thoughts and so they isolate themselves even more, making their depression worse. They may interact with others if they have to, but they don’t connect.
How to Cope with Depression
So what should you do if you think you or a loved one might be depressed? Here are my 5 quick and dirty tips:
Tip# 1: Don’t be ashamed. Nearly 20% of the US population has an episode of major depression in their lifetime. It’s a problem that needs help, and that’s just part of being human.
Tip# 2: Talk to your doctor. Hopefully he or she won’t just throw pills at your problem, but actually figure out whether you are depressed and determine what is the best approach.
Tip# 3: Talk to someone. Talk to a counselor, close friend (especially one who has been depressed in the past), or someone else you trust. Figuring out what is beneath the depression is a big part of overcoming it. Counselors don’t wave a magic wand over you, they work with you to figure out what core struggles or past trauma are causing your depression. It takes a lot of work on your part to really make progress in this area.
Tip# 4: Consider medications. I see medications for depression as being like supports you would put up on a wall that’s falling down. They keep the wall from falling and they allow you to work to fix the wall, but they are not a solution. Medications work wonderfully, but should always be only part of the solution.
Tip# 5: Get help immediately if you think you or your loved one is at risk of self harm, suicide, or physically harming others. It’s hard to see straight when you are in the depths of despair.
An Important Message
Let me finish with a statement to those thinking about killing themselves. A lot of people who are depressed think they are a burden on their friends and family. They rationalize that killing themselves will free their loved ones from that burden. That is a lie. There is absolutely nothing worse you could do to your loved ones than to kill yourself. Suicides wreak havoc in the lives of those close to the person. Suicide is never a selfless act. If you have thoughts of suicide--of really going through with killing yourself, not just fleeting thoughts--remind yourself of the pain you would put your loved ones through and seek help immediately.
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Let me once again remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Catch you next time! Stay Healthy!