Reader: How can a person tell if she is clinically depressed or just down?
Dr. Schmidt: Depression is the most common mental/emotional disorder, costing American business an estimated $44 billion in productivity each year. That’s because most depressed people go to work anyway, and only 1/3 seek treatment, and because most folks believe they can and should bring themselves out of a blue funk without any outside help. But that’s wrong, oh so wrong.
The primary symptoms of depression are well known: loss of hope, energy, confidence, self-esteem, mental focus, sex drive, stress tolerance, and gains or losses of appetite, sleep, or weight. It’s like the way you feel all unfocused and unmotivated when you can’t get out of bed some mornings, only it’s a low-to-medium-grade fever of that all day, every day.
The cures have been well researched too. Take four groups of depressed people. Give one medicine only, one counseling only, another receives neither, and the last gets both. The first two work about the same, each works way better than the third, but nowhere near as well as the fourth. Most people try to pull themselves up by the bootstraps, but that only pulls you down, wears you out, and leaves you with more depression.
Once medicated and counseled, try to believe and do what you’re told. Get a forgiveness transfusion: put some grace in your veins, and then become a donor. Revise your expectations of yourself and others in light of what others tell you. Depression is like an emotional stoplight stuck on red. It works better to believe and act your way into feeling better than to sit and wait for that stoplight to change.
MOODINESS, MOOD SWINGS, AND BIPOLAR DISORDER
Most of us get called moody once
in awhile, and the term bipolar gets thrown around an awful lot these days.
When we discuss someone’s moods, we need to define our terms very
carefully.
Bipolar Disorder is a major psychological disorder, requiring
medicine, counseling, and in the lifetimes of most bipolars, even
hospitalization to treat. “Bipolar”
literally means subject to two extremes, in this case mania and depression.
To be diagnosed bipolar, you have to have a history of at least one manic
episode, but because most get somewhat depressed afterward, they’re called
bipolar.
A manic episode is a period lasting roughly one week or longer marked
by excessive amounts of roughly half the following:
self-esteem, talking, activity, energy, racing thoughts, distractibility,
losing one’s temper, or pleasurable but risky/dangerous behaviors like
gambling, spending sprees, and love affairs.
Manic episodes can wreak havoc on relationships and bank accounts if not
brought under control through treatment.
A major depressive episode is a period of two or more weeks with the
exact opposite: excessive lack of
energy, self-esteem, activity, and the preoccupation of with thoughts and
feelings of worthless, hopeless, useless, doomed, longing for sleep and death,
etc., all of which is usually disabling vocationally.
One thing all the disorders above have in common is that folks at these
extremes are generally the last ones to realize they have a problem, because
they trust their feelings way too much. Another
common trait: they get much better
with counseling and medication than with either or neither.
An intermediate level of disturbance is a personality
disorder (PD), a pervasive and stable pattern of emotional and relationship
problems that has existed most of one’s adult life.
Of the 12 kinds of PD, three are most likely to be called moody (correct)
or bipolar (incorrect): histrionic
(drama kings, crisis queens, exaggerators who need lots of attention), cyclothymic
(moods go slowly from up to down without quite hitting the extremes of
previous paragraphs), and borderline (relationships
and moods are unstable and intense, and though they always know basic reality
like who they are, they vacillate suddenly and without much apparent reason
between extremes of idealizing and villainizing key people in their lives).
Don’t throw these terms around at home:
diagnosis and treatment of these conditions requires a licensed
professional.
The mildest form of emotional disorders is adjustment
disorders. These do not have
manic periods, but discouragement will alternate with anxiety and/or misbehavior
(poor judgment) milder than a manic episode.
Adjustment disorders are basically triggered by life events, but involve
prolonged reactions, longer than three months (or if losing a loved one, 6 to 12
months, depending on how close was the deceased, and how suddenly or violently
they died).
Finally, all of us have moods,
emotional reactions which seem excessive to others.
Others of us are just moody, inclined
to be emotionally sensitive and over-reactive.
Neither medication nor counseling is going to change moody people that
are born that way, or moody moments that life just deals us from time to time.
It’s best for us to give the comfort and help we can afford to give
hurting people, and then just accept them, backing off to give them time and
space they need to heal. Otherwise
we’ll just put ourselves in a bad mood.
How
to Get Depressed
You can feed your
depression these body-building nutrients, or you can starve it to death.
Can you see how self-defeating and avoidable these behaviors and
attitudes are?
1. Shame: Hurt somebody, and don’t ask them or God for forgiveness. Don’t make amends either, or learn from it--just forget about it. That way you can’t forgive yourself either.
2. Resentment: Expressing anger is the normal human response to injustice. Hold it inside so it can turn its energy against you. Don’t forgive people until they repent and deserve it.
3. Chronic Frustration: We get depressed when life doesn’t meet our basic needs for friendship, affection, health, and the necessities money can buy (food, shelter, transportation, etc.), so take care of everybody else and just hope somebody takes care of you. Don’t take care of yourself—that would be selfish.
4. Unresolved Loss: When you lose a job or people dear to you, don’t replace them--just live in the past, the hole left behind.
5. Drifting: Avoid a life that has purpose and meaning. Avoid joining a group or reaching out for better relationships to get a sense of identity or belonging, as this all gets too confining.
6. Buried Hurts: If you were shamed or mistreated in your youth, don’t tell anybody about it. If you do tell, stay in the victim role. Don’t let God come into the memory for healing.
7. Unrealistic Expectations: Set your personal goals so high you can’t succeed, or so low you don’t feel any challenge.
8. Avoid Cure: Be too proud or scared to get medication. The same for counseling—be your own person. And avoid the support of groups—the people and principles of recovery are only for the sick, not you. Stay with your false pride, or your false humility, whatever preserves your privacy.
In 2002 more than one in three women who went to a doctor’s office walked out with a prescription for an antidepressant, most of them without even a follow-up appointment to see how it would work. Today 11% of American women and 5% of men are taking antidepressant medication.
The main reason these meds are so popular is that they work really well. They resolve one of the causes of depression (chemical imbalance, most often serotonin), and relieve many of its symptoms: thinking, feeling and acting DOWN.
People with depression feel down on energy, sex drive, self-confidence and the desire to enjoy life. They think negative thoughts about themselves, others, the world and their future. They act down because they can’t work, sleep, eat or make love the way they’re supposed to.
Antidepressants would be much more effective if more people took them strictly as prescribed. Since most of the bothersome side effects occur during the first 2-3 weeks, and as most of the symptom relief comes after those first 2-3 weeks, too many folks don’t give them a fair trial, and give up on them too soon.
A fair trial
would be regular dosage for three or four weeks.
If the benefits are still being outweighed by the side effects, a second
antidepressant should be tried for another 3-4 weeks.
But how do you know when you should take this medicine?
You should consult your primary care physician about antidepressants if you know what you need to be doing to make yourself feel better but you can’t make yourself do it. When making needed changes seems too difficult, you can level the playing field for yourself by trying medication.
Another way to tell if you need antidepressants is to give yourself the Beck Depression Inventory (Google it for a free copy of this quick 21-item test). If your score is 14 to 19, you’d probably benefit from antidepressants. But if your score is 20 or over, you might well be so depressed that efforts to cheer yourself up through counseling or willpower changes just won’t work without medication.
When you’re depressed, it’s a good idea to take that test (the BDI) once a week at the same time. This not only measures your ups and downs, but the items that are elevated will also show you where you need to adjust your thinking and behavior. Here are some signs that you are ready to cut back on your medication:
1. When your BDI scores are consistently below 14 for 2-3 months
2. When you are making the needed changes in your relationships, habits, and lifestyle
3. When your losses (loved ones, health, job) have been resolved to the point you are now opening yourself to new experiences that seem likely to become fulfilling.
One final mistake people make with antidepressants is to take themselves off of them cold turkey. Cutting antidepressants down and out should be done this way:
1. Seek confirmation of your significant others and any professional counselor you are seeing. These folks will make sure that the help you’ve been getting from your medication is going to be replaced by such mood lifters as lowered levels of alcohol, junk food, stress and conflict, and higher levels of appreciation, affection, inspiration, exercise, and fulfilling work to do.
2. Consult your physician, tell him or her about the changes being made in your life from the previous paragraph, and follow doctor’s orders about exactly how fast to cut back on the medication.
Medicine
can help you make significant changes in your relationships, habits, and
lifestyle. But don’t be foolish
and lazy enough to think that medication alone will change your life.
Antidepressants are only as helpful as the life changes they enable you
to make.