Susan Says: Recognizing and Treating Clinical Depression

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Even the happiest people will have periods of feeling down or sad. Sometimes it’s the big stuff that triggers these feelings–like getting fired; financial problems, medical issues, grief and loss, or family conflict – but it can also simply be a result of not sleeping well, bad weather, extra stress in your life, or just a “bad day.” These feelings come and go for all of us and may last a day or even a couple of weeks–but usually do not affect our ability to function.

Clinical depression is different. It is a serious medical illness that affects millions of people each year, and is one of the most prevalent mental health problems in the United States. This illness completely disrupts a person’s life to the point that they may take their own life to escape the way they feel.   

Depressive Disorders affect all ages–even very young children. Depression is the most common mental health problem in adolescents. Eleven percent of teens will suffer from depression before age 18, and suicide attempts are much more common in depressed adolescents than in adults.  For kids aged 15-24 suicide is the third leading cause of death! Depression is also an illness seen in young children–affecting about 2% of children in pre-school and elementary school.

Clinical depression is the number one cause of disability claims and inability to work in adults.  It is seen more frequently in women than men, however men are more likely to take their own lives. It is statistically higher in the Caucasian race when compared with African Americans and Mexican Americans.

Clinical depression is also significantly higher in states with higher altitudes like Montana, Alaska, Colorado and Utah. A recent study shows counties at or below 2000 feet above sea level have half the rates of depression and suicide. It may be that high altitude and lower oxygen disrupt our brain’s levels of serotonin and dopamine–chemicals in the brain that regulate our sense of happiness. Seasonal depressive episodes are also much more common in winter months due to the change in the amount of light we receive.

For someone who has never suffered from clinical depression it may be difficult to understand what a loved one is experiencing. Symptoms include:

  • A sense of hopelessness – the feeling that nothing good will even happen again.
  • A profound sense of fatigue and loss of energy – everything feels like too much of an effort.
  • Physical aches and pains along with slowed movement and speech.
  • Low self-esteem–people dwell on every loss or failure and engage in a constant litany of negative self-talk.
  • Lack of interest in all activities and inability to experience joy in past hobbies
  • Inability to concentrate to the point that reading or following a plot on TV is impossible.
  • Changes in sleep and eating habits.
  • “Flat affect”—this is a term used to describe the emotional blunting or inability to express any feelings either verbally or non-verbally that are commonly seen in depressed individuals.  There is no show of sadness, anger, excitement, or affection. This can be very difficult for family and friends who are attempting to provide support.

Treatment for clinical depression often involves the use of anti-depressants that act on neurotransmitters in the brain to increase serotonin and dopamine. There are many antidepressants available that work in slightly different ways, so choosing the right one is important. Seeing a psychiatrist can be helpful in identifying the subtle differences.

However, anti-depressant medication is usually only half the equation for recovery.  Antidepressants treat what are common symptoms of depression, rather than the condition itself, and medications alone are only effective in about 1/3 of the cases; this is because of the cycle of depressive thinking styles, negative rumination, and feelings of hopelessness need to be broken.  Good psychotherapy will break this cycle as quickly as possible, giving the person new skills to ensure they stay emotionally healthy and able to cope.

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