Finding the Light: Overcoming Depression

FINDING THE LIGHT:
OVERCOMING DEPRESSION
By Laura Schultz, MFT

“We must accept finite disappointment, but we must never lose infinite hope”---Martin Luther King

In our modern society, external stressors are numerous including divorce, death of loved ones, economic anxiety and concern for the future. Additionally, our increased focus on work, success, and “going it alone” seems to foster a sense of isolation that makes it more difficult for people to cope. Most of us experience days where nothing seems to go right and “the blues” seem to take up residence. For the vast majority, these feelings of sadness lessen after a short period and people are able to deal with life as they had before. However, life is not that simple for those whose ability to function is greatly impaired and are debilitated by feelings of hopelessness and despair.

The World Health Organization has stated that “by 2020, depression will become the second greatest world issue in respect to ill health”. At any given time, up to 10% of American adults suffer from depression. Depression is considered a Mood Disorder (which describes one’s emotions) and diagnosed by a formal set of criteria listed in the Diagnostic and Statistical Manual (DSM) used by clinicians. In order to qualify under the category of depression, the symptoms must occur for two weeks or more. In addition to a depressed mood, symptoms of depression may include lack of coping skills, feelings of isolation and worthlessness, anxiety, thoughts of suicide, changes in sleep or appetite and loss of interest in regular activities. The physical symptoms that may accompany a depressive episode can be just as severe as any major physical illness and may include sleep disruption, intense fatigue, headaches, joint pain and even heart disease. Additionally, depression can destroy family relationships, friendships and careers if some form of treatment is not sought.

Although the origins of depression still remain somewhat of a mystery, there are certain factors that influence the tendency for it to occur. According to “Psychology Today” there can be genetic factors and neurochemical factors that influence each other in a circular manner. Simply put, a person’s coping style (whether it is proactive or avoidance-based), perception of themselves as being a victim versus having some power to change their life, and the quality of relationship skills all have effects on the body’s chemistry. In turn, a genetic/biological predisposition, changes in brain structure, medical conditions, as well as a serious loss or stress can contribute to the onset of a depressive episode.

The good news is there are a wide range of treatment options available for the treatment of depression that have given hope to millions. Once diagnosed (which remains one of the issues since many still do not seek treatment), people no longer have to suffer for years on end without hope. First, it is important to have a thorough diagnostic evaluation which includes a family history of depression, a complete list of symptoms and a mental status examination to assess whether memory is affected or suicidal thoughts are present. This evaluation forms the basis of determining the most effective form of treatment. They include:
1. Antidepressants in the form of the newer SSRI’s (Selective Serotonin Reuptake Inhibitors) which can take up to 6 weeks for maximum effectiveness, positively affect the neurotransmitters in the brain, elevating Seratonin and Norepinephrine levels and have relatively few side effects. Though there may be side effects in some cases, such as dry mouth or dizziness, they typically are not serious. However, some do have an influence on sexual functioning or other manifestations and can be addressed through a change in medication. The oldest and most common medication known as the Tricyclics are often effective but may have numerous side effects.
2. The popularity of natural treatments has grown in recent years. St. John’s Wort, (an herb used in the treatment of mild to moderate depression) is the most widely used treatment for depression in Germany and is being studied by the National Institute of Health in the U.S. as to its effectiveness. Omega-3 fatty acids (found in fish in high concentrations) show some promise whether in the diet or taken in pill form. However, when considering taking any supplement, a consultation with a physician is recommended.
3. For some people, medications or supplements are not an option and they would prefer other methods to alleviate symptoms. An expanding body of research shows that aerobic exercise at least 3 times a week can help the brain produce the chemical serotonin (low levels have been associated with depression) and a few minutes of natural sunlight per day can minimize depressive symptoms.
4. There are several psychotherapeutic models that are effective in treating depression.
A. The most popular treatment for depression, known as CBT (Cognitive Behavioral Therapy) has been shown in a growing body of evidence, to be at least as good as medication. CBT is a complicated term with a fairly simple meaning. Cognitions or thoughts, in a depressed person, negatively influence their symptoms. CBT helps the person change the style of thinking and behaviors that contribute to depression. One of the best resources to fully understand this treatment is the book entitled “The Feeling Good Handbook” by Dr. David Burns.
B. Traditional psychodynamic therapy can help the person examine their feelings and set realistic goals but is usually more effective when more serious symptoms have subsided.
C. A newer approach related to CBT, called Mindfulness-Based Cognitive Therapy (or MBCT), has shown to reduce depression relapse by about 44% for those who have had more than 3 previous episodes of depression. In teaching “’mindfulness” one learns to be present with their thoughts using meditation, the breath and body sensations to learn how to use thoughts to deal with distress, as opposed to letting the negative thoughts control them.
D. There are many support groups such as “Emotions Anonymous” for depression which help a person overcome isolation and loneliness.
E. For those whose depression is severe and recurrent, medication is usually prescribed along with therapy for the best results.

It is important to note that in the treatment of depression, feeling better does take time but eventually the person’s mood will improve. The great majority of depressed people, even those with severe symptoms, can be helped and all of the above treatments can contribute to easing the pain. With patience, empathy, and support, people with depression can both overcome the symptoms, and begin to enjoy activities again that once were sources of pleasure their lives. Thus, finding the light and beating depression is a more hopeful reality than ever before.