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I am devoted to helping people become more of what is possible for them. My commitment, actually my passion, is to help people become more fully alive.

The Many Faces of Depression

In any given year more than 17 million Americans suffer from some type of depressive illness.  Many symptoms are common to different kinds of depression and are present with different levels of intensity.  It is important as mental health professionals we understand the origin and meaning of the person’s depression, and not label many states and experiences under a generic label.

The biologically based depression known as Bi-Polar has to have medication in order to chemically balance the brain. Earlier the Bi-Polar diagnosis was known as manic-depressive illness due to the fact there is frequently intense mood cycles.  The manic cycle is characterized by excessive expansiveness and over the top energy.  This cycle will more often spiral into psychosis and need hospitalization or leave the client exhausted and in deep depression.  This depression is frequently accompanied by such melancholia that hospitalization is needed until its safe for a client to be seen as an outpatient.  The risk for suicide is high when a person goes into such depths of depression.

Quite often out of balance people are medicated and sent along to do the best they can to function in a world that is out of balance.  What I have found to be helpful for my clients is to spend some time in life review, examining the ways that life was out of balance before they lost their personal controls.  It is of utmost importance that clients with any of the Bi-Polar diagnoses in addition to medication have enough sleep, eat balanced healthy meals, exercise regularly and to have relationships that are supportive and nurturing.  Medication is only one prong of what is required.

We are all familiar with reactive depression that is a reaction to a significant loss in our lives.  The response typically varies in intensity depending on to the level of energy we invested in the object of our loss.  When a child goes off to college; when our youthful sense of invincibility is cut off as the knees with a debilitating illness and we lose control of our body; retirement that caught  us ill prepared; the end of a relationship; are all examples of grief or reactive depression.  This type of depression can become pathological when it goes on too long.  How long is too long?  Again it varies with individual but an example of such a complicated grief, pattern might be Dodi Fayed’s father.  It has been ten years since his son’s death and it doesn’t appear that he has moved on to the larger task of letting go.  He is stuck without relief, overinvested in his loss.  Granted it was a horrible tragedy, but he cannot change what happened and he seems to be stuck.

In reactive depression we are called to examine the larger task inherent in it. In most cases we are yet again called on to grow up some more.  Every crisis we go through brings us an opportunity to broaden our frame of reference in the world and to see the meaning of our pain in the bigger picture of our lives.  If we don’t do this we tend to become narrower in our world view and stay stuck in our pain or numbness.  A child leaves home that means we have done that which we were called to do as parents, to empower them to prepare them to fly into the adult world.  Oh yes it hurts but we need to work through our sadness and let go.

Sometimes cancer survivors say cancer was the best thing that happened to me.  It doesn’t mean they didn’t howl from the hurt and have terrible pain, fear and distress.  However they went through it all coming out on the other side with a more expanded view of living whatever life they have left, more meaningful.
 
Frequently in the mental health profession we are faced with depression that is not due to chemical imbalance or that of an intense reaction to a loss, It is generally diagnosed as dysthymia, a low grade chronic depression that tends to generate within people who ask “is this all there is?”, in regard to life.

This is a depression that more often occurs at points of transition in life.  It is referred to as an intrapsychic depression.  It often comes about as an agitation or an anxiousness, restlessness to do something different.  It is an opportunity if we take it as such to go inward, to look at the lives we are living in a reflective manner and to ask the questions.  Am I living the life I want or have I been living somebody else’s version?  Am I happy, peaceful, curious growing into a more expanded version of myself? Or am I unhappy, stagnant living a restricted life?  Is there a chasm between where I am and where I want to be?  Does my life as I am living it have meaning?  These is a time of questioning of change and growth, a time to narrow the chasm of the what if’s?  This type of anxiety usually becomes depression if the person facing the transition sees change as a fearsome thing and flexibility is lacking.  If one has not been reflective and changing with every decade it is harder to tackle change at midlife, but it can be done.

Another way this type of depression shows up is in people who have had early childhood abuses, losses, traumas that were never healed.  To suppress such pain takes an enormous amount of energy and often low grade depression is a way of life.  Emotionally they remain stuck in the past.   Suppressing this type of depression with medication is not helpful.  Medication just bevels the edges of misery and makes it harder to connect with emotions that tell us the story to propel us towards change.

There’s a line in September Morn “We traveled all around the world to find ourselves again.”  Midlife depression is like that.  We can if we review our life with all of its struggles, tears and richness circle back to create more of how we want it to be as we go into the second half.

This type of passage is often referred to as the “dark night of the soul” a time of slowing down and a time of examination.  The life we have been living is no longer working for us.  Maybe its time for spiritual analysis.  Have we served others at the expense of our own authentic self.  Women are notorious for reaching this point and wondering what in the world happened to me, my talents, dreams, values, beliefs that are more or less suppressed under a mountain of other people’s laundry.  What about me?, they often ask.  Men on the other hand find that the success they chased to the top rungs of the ladder of the god of speed and the material is full of hurts.  They may not have tools in place to deal with their disappointments and may become bitter and depressed.

The prognosis for depressions is quite good with treatment.  It can be treated successfully with psychotherapy and or with medication depending on the type of depression.

Psychotherapy teaches people better ways of handling problems by talking with a trained Mental Health Professional.  Such therapy helps change negative or faulty thinking and behaving that contributes to depression.
 
Anti depressant medications act on chemical pathways of the brain and are not habit-forming.  It may take several weeks before improvement is evident.  It is usually recommended that medications be taken for 6-9 months after depressive symptoms have improved.

Following is a list of symptoms that are evident with a greater or lesser intensity with every depression.  If you experience 4 of these symptoms or more longer than two weeks, if they are interfering with your daily routine or if you feel suicidal, seek professional help:

  • A persistent sad, anxious or “empty” mood or excessive crying
  • Appetite and weight loss or increase
  • Persistent physical symptoms that do not respond to treatment, such as headaches and chronic pain 
  • Irritability, restlessness 
  • Decreased energy, fatigue, feeling “slowed down”
  • Feeling of guilt, worthlessness, helplessness, hopelessness, pessimism 
  • Sleeping or eating too much or too little, early-morning waking 
  • Loss of interest or pleasure in usual activities 
  • Difficulty concentrating, remembering, or making decisions 
  • Thoughts of death or suicide, or suicide attempts

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