DISCLAIMER: The information and opinions expressed here are mine and mine alone. They are the direct result of working with acutely mentally ill patients for more than two decades. I am not a doctor or a prescriber. None of the information contained here should be used to diagnose yourself or others. If you suspect you need professional help, please call 911 or find a licensed professional. "Automat" Edward Hopper, 1927 Depression: highly treatable, often misunderstood
by Charles O'Meara, RN A lot of people have an incorrect idea of what depression looks like, as well as what it is. The stereotypical depressive is usually portrayed as mopey, down, crying, in bed with the shades drawn, unwashed, and wearing the same clothes for five days. And if they aren't doing those things they're staring out the window with an unfocused gaze while chain smoking and contemplating suicide. Indeed, that image is real for some depressives. In fact it might be accurate to say that image is true for all depressives at one time or another. But it's hardly the whole picture. But what's important to understand is not what depression looks like, but what it feels like to the person who suffers with it. From my experience, the way depression expresses itself in an individual depends to some extent on how they were raised and what cultural values they may or may not have. If you come from a stoic background, the tendency is to not discuss your depression (or anything else), but to just endure it and get on with your life. These are the depressives who were told "You think you're the only unhappy person in the world? We're all unhappy, life is hard, get over yourself." So they hold it in. If you come from a family or culture where emotions are right on the surface, you'll probably be pretty upfront about your symptoms. Probably a little too upfront, pouring out your sad tale to anyone within earshot. You can find these depressives at bars. Two drinks and it's "Can you believe I was good looking once? Hard to imagine I coulda been..." So what is depression? I would describe it as a collection of feelings and emotions that include a sense of hopelessness, a sense that things will never get better for you (only for others), the feeling that you "don't get it" when it comes to life in general, that you don't understand fun, that you missed the orientation lecture at birth and you never feel able to deeply connect with another person. And here's the kicker: you want all of that. You desperately want to be part of party, one of the people laughing with your co-workers, the happy helpful family member. You may not be dressed in black all the time, but you feel like you're stuck in a glass box, looking out at the world and unable to join in. And because depressives don't get it, because you can't easily connect, they begin a spiral that usually makes depression much worse. They begin to feel that they are a weight on those around them, a bother to friends and family, tiresome to be around. So they hang back. They stay on the edge, on the fringes, and when people invite them out they make excuses that aren't excuses, like "No, I just don't feel up to it," or "I'm sorry I don't feel like being around a lot of people tonight." So the friends stop calling and the family stops inviting the depressed person to events and so on until they up in a sad corner. At that point, suicide begins to look inevitable: "I'd be better off dead. Then people wouldn't have to deal with me anymore and I wouldn't ruin dad's birthday or my son's baseball game anymore." But long before that happens, depression often express itself in adults as a general sense of undefined anxiousness, feeling fidgety, restless, unsettled, unfocused, no direction - you want to do something, but you don't know what or where to begin. You may get in the car, drive for an hour with no plan, stop and have a cup of coffee, then turn around and go back home with no clear reason why you did it. I didn't say no memory of it, i said no clear reason why you did it. For many adults with depression there's a sense that they should or need to do something, anything, just get out there, join in. Then when they do 'get out there' in the world, they're too disconnected to enjoy whatever situation they encounter. Depression is that feeling of hope when you leave the house coupled with the feeling of darkness and loneliness when you come home alone and toss your keys and your coat onto a chair or sofa, and wonder what the hell you're living for. The sad part here is that many people with depression don't know they have it or even suspect it, nor do the people around them realize it. And by the way, you family members and friends and others don't help depressives when you say things like "Cheer up! Look at all you have to be thankful for! Quit being such a gloomy doomy person! Pull yourself out of it! Try harder!" People with depression know they have things to be thankful for. They want desperately to cheer up. They want to try harder. But they can't. Which is why depression is: a disorder that compounds its own symptoms. The worse you feel, the more the worse you feel; the harder you try the less you succeed; the more deeply you want something you can't grasp, the more desperate you become. But let's step back and be a bit more optimistic. Depression, compared to many diseases and disorders, is very treatable. Things don't have to get to the level I described before you seek help. We know that depression can be purely the result of a chemical imbalance in your brain, a big mess of stuff going wrong in the realm of neurotransmitters and serotonin receptors. And we know, too, that some people are predisposed to depression as they age. Children who are abused or neglected are at risk for developing depression. Children who grow up with one or two depressive parents are at risk, both biologically and in terms of learned behavior. An extreme loss or trauma can sometimes trigger a bout of depression that should clear up but doesn't, leaving a person's life in tatters. We know far more about depression and how to diagnose it than we did twenty years ago. For a large number of people, treatment for depression is as simple as taking antidepressant medication. You've seen or read the names of these drugs: Paxil, Zoloft, Prozac, Cymbalta, Wellbutrin, Effexor, Lexapro, etc (and no, i'm not getting anything in exchange for mentioning the trade names). These same drugs are often known by their generic names: sertraline, bupropion, escitalopram, citalopram, fluoxetine, etc. I'm not going to go off on a tangent about how these drugs work, adverse reactions, side effects or a discussion of alternate treatments for depression. I'm just going to tell you two things that you should remember: 1. As a general rule, these drugs are remarkably safe. Yes, some people don't tolerate them, but the vast majority do. 2. As a general rule, they help. Sometimes they help a little, sometimes they produce a 180 degree turnaround. A lot of people refer to antidepressants mistakenly as 'happy pills'. Antidepressants don't make you happy. They aren't supposed to. They make you not depressed, or at least less depressed. Happiness is not the opposite of depression. In addition, many people find that talk therapy is tremendously helpful in treating depression. There are two reasons for this. First, if there is an underlying trauma such as childhood abuse, a crime victim or surviving a plane crash, therapy can help get rid of feelings of guilt, shame, anger and other things will make depression worse. Second, even if you are not a trauma or abuse survivor, your depression may have directly caused you to abandon or hurt others, burn bridges or create a trail of broken promises and erratic behavior that has left you insecure and friendless. Feelings such as these cannot be addressed solely with medication. Now comes the part where I end by telling you that if anything you've just read applies to yourself or someone you know, speak up. So go forth and speak up, dammit. |
charles o'meara, r.n.I have worked as a registered nurse for more than two decades, ninety percent of that time as a psychiatric nurse. Archives
June 2017
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