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Recognizing and Treating Depression

How can a person tell if she is clinically depressed or just down?

Depression is the most common mental/emotional disorder, costing American business untold billions of dollars 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, & 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.

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.

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.

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About Dr. Paul Schmidt, PhD

Dr. Paul Schmidt, PhD is a psychologist life coach with offices in Louisville and Shelbyville, KY, 502 633 2860.