Depression

Surely it is possible to be chronically depressed as a result of intractable life circumstances and not serotonin deficiencies (or whatever the chemical imbalance theory of depression is). In such a situation, where drugs (at least, the ones we’ve invented so far) are not of any use, how does one end up getting over depression? What do you do when you just feel generally helpless?

I am not depressed. But I was reading on depression last week and found these sites which may be helpful to you, till the experts come in.
http://www.nimh.nih.gov/health/publications/depression/how-can-i-help-myself-if-i-am-depressed.shtml

Cognitive Behavioral Therapy is excellent for this kind of depressed mood. Life coaches and talk therapy can help some people with some situations. Medical social workers are an underutilized resource for people who need help with life circumstances that often bring people down, like ailing parents or social isolation among at-risk populations.

Basically, if it’s situational depression, you try to fix the situation. If you can’t, then you look at medication, because there’s something of a chicken-and-egg problem here. Situations can trigger depression which does respond to medication. If it responds, then you (can) use it. Very often people who believe that their situation is something that “anyone” would be depressed about in their situation are mistaken about that, and are suffering from clinical depression AND sucky life situations. The two are not mutually exclusive.

People suffer through a whole lot of shit in life without becoming intractably depressed about it. Call it denial, call it the endurance of the human spirit, whatever you like. Many people can survive war, genocide, famine and rape and still not feel depressed or hopeless about life in general. So if someone is in a deep funk with loss of interest in usual activities, appetite loss, feelings of hopelessness, etc. that lasts more than 2 weeks over (admittedly shitty) stuff like losing a job or facing foreclosure, then actual clinical depression should be considered as a possibility. Most people can be sad and face adversity and still move on with life.

http://moodgym.anu.edu.au
http://ecouch.anu.edu.au

Both of these are effectively do it yourself CBT (cognitive behavioural therapy) sites. They are free and open to anyone.

Exactly.
And it doesn’t mean that “normal” people are always optimistic or something; it’s normal to feel down and have bad expectations some of the time.
But depression is much more than that; and the specific set of symptoms of depression are associated with neurotransmitter changes in the brain.


I’ve seen both sides of this: I’ve studied at a neurological hospital (though IANA doctor) and I have suffered depression…

In terms of studying depression, the interesting thing is that most patients could point to specific causes of their depression e.g. death of a relative. But OTOH most patients would have deficiencies such as serotonin (note: to be referred to this hospital you would have to have severe depression), and it’s true that not everyone loses a close relative and gets depressed. So working out the cause and effect here is very interesting.

In terms of my own experience with depression, even in retrospect I believe my life was objectively terrible so I don’t feel like I was being irrational. But certainly I was in a psychological “box”, that I needed help getting out of before I could sort my life out materially.

I spent years on SSRIs before I started seeing a psychiatrist who helped me understand the reasons behind my depression. Not sure if that’s what CBT is or not, but for me the biggest hump is taking the actions required to fix myself within my life. I know the problems; I know them in the moment in which they’re occurring. Rationally, I know what I should be doing in those moments, but the decades of “training” keep me from doing what I know I need to do. This, sadly, compounds the depression because I then resort to beating myself up for NOT doing those things.

It sucks. It makes me feel horrible to go to the psych every month and say “Nope, I still haven’t made any progress”. I feel like I’m not only letting myself down, but also him. He tells me that it just shows how powerful your mind can be.

Sigh.

Moved from MPSIMS to our advice forum, IMHO.

There aren’t really great treatments for any type of depression. Medications are a hit or miss approach, and what works initially may not work long term. However, even if it’s not a problem with body chemistry some medications may help. When one is living in depressing circumstances, the accompanying depression becomes another one of the circumstances. So conventional treatments for depression, including therapy and medication, sometimes work as a way to put on the brakes and change direction.

Obviously the real solution is to change your life and remove the problem circumstances. But that isn’t always an option. But any positive changes that can be made in life can be helpful. Change your schedule, your habits, find some new friends, or hobbies.

There are plenty of studies that show most depressive states will dissipate over time, whether anything specific is done or not. I have to say I’ve been in the circumstance stated in the OP, and simply pouring myself into my work and ignoring the problem has helped at times. To paraphrase someone else, “I don’t have time to be depressed”.

I’d like a cite for “most” in that statement, but I don’t argue with the idea that “some” depressive states will dissipate over time without treatment. Some cancers are quietly resolved by the body without chemo or radiation. Some heart attacks are silent, and the body reroutes blood and repairs the affected area with no bypass treatment. Some bone fractures heal straight without a cast. Some MRSA infections clear without antibiotics.

What I worry about is that people who are depressed (whose brains aren’t working well at the moment, by definition) read a statement like that and use it as justification to not seek medical care for their condition. Some cancers get better on their own, and some don’t. Some depression gets better on its own, and some doesn’t. You never know which yours is.

I don’t really expect to get over my depression, but it’s who I am, and I can live with that if I have to.

No, it’s not who you are. Not at all.

Would you believe me if I told you that happiness is our natural state? Naw, probably not. Most people look at me like I’m crazy when I tell them that. “You can’t be happy all the time! It’s not natural!” But I’ve really come to believe it and live it.

I won’t go into any more details than I’m asked to, but suffice it to say that the secret is to remove those things that block your happiness. CBT can be a great help in that. And pay attention to where you pay attention. You can absolutely monitor your own thoughts.

And I don’t want anyone to read that and think that you’re “broken” if you’re not happy all the time. It takes work, and it takes practice.

Robert Whitaker, Anatomy of an Epidemic, chapter 8, “An Episodic Illness Turns Chronic”.

I’m sorry, AHunter3, but you’re going to have to point it out for me. I don’t see where what you posted supports the statement “most depressive states will dissipate over time, whether anything specific is done or not.”

I see some numbers that hospitalized patients don’t tend to become chronically ill with depression, but that wasn’t the claim.

I see numbers that say that some antidepressant drugs don’t work much better than placebo, but I wasn’t asking, nor will I argue that. There are about eleventy-four interventions I’d like to see patients try before or concurrently with drugs, for many health conditions. I mentioned a few in my first post that apply to Depression as well as depression (CBT, Life Coaching, talk therapy, MSW consult) and there are more I didn’t (diet, exercise, new hobbies, volunteer, get a goldfish) but would have if I had thought of them at the time.

I think with AHunter3’s cite, and others I’ve seen, it can be said that many depressions are temporary and do not require specific treatment. Further categorization may not allow the term ‘most’ to be applied, but there are a number of opinions on this subject, and some have characterized it that way. So are you arguing that the number lies below 50%, or that only a trivial percentage of depressions will dissipate without specific treatment? I’m not up for quibbling over the exact number, but there is substantial evidence to consider that depression may be highly over treated.

I thought you were going in a different direction with that question. My thought would be that if you can’t believe that people are naturally just meant to be happy all the time, then conversely why should you believe that you are naturally just meant to be depressed?

As I said, my quibble is with the word “most”, and it’s a quibble only in that I would be *surprised *if it was over 50% and I’d like to know, but not I would not be unaccepting of the fact if a decent study found it to be true. In other words, it’s an informational “cite?” not a challenging one. I was prepared to leave it at that, except that I truly don’t understand how/if **AHunter3 **thinks his cite contains that information.

We can still leave it at that, if you like. As I said, I think what you said works perfectly well with the word “some” instead. :slight_smile:

That too.

There’s an odd aspect to depression. When you’re depressed, you feel like you’ve always been depressed, and always will be. It can feel like your natural, never-changing state. Conversely when you’re happy, it can feel like you’ve always been happy, and always will be, and depression is a stupid “choice” that others make.

Our states are very powerful!

The insidious thing about depression is that while happiness is easily attainable at any time, we seem so separated from it, so much so that we don’t even bother trying. That, and there’s a comforting aspect to depression. Sometimes it feels good, oddly enough.

Maybe someone will come in with a specific cite. For the record, I don’t think there’s anything wrong with treatment for any kind of depression. It’s just a good idea to keep things in perspective before starting medication or it’s continued use, or even making depression a bigger part of your life than it already is. Dealing with depression can in itself be depressing.

I got off SSRI meds after 18 years and take an RX off-label that has kicked the crap out of my decades-long chronic depression. The psychiatrist I found last year is my goddess!

SSRIs never did much for me and recent research indicates that they don’t work for some people, or the benefits are negligible.*

I did CBT for years and learned a lot of strategies for coping; however, therapy wasn’t the full answer for me. All of my immediate family (including a brother who committed suicide) and many extended relatives deal with some species of anxiety/depression – for me, this argues that depression can be genetic and neuro-chemical imbalances/brain structure issues (may be) inheritable.

*I tried six or seven different SSRI-spectrum meds over the years. Most of them would give me a little “bump” about six weeks in (which is when this class of meds typically kicks in), then the effects would level off to almost nothing. Negative side effects included 45+ pound weight gain and hideous insomnia.

Footnote to footnote: Withdrawing from Cymbalta last year was an absolutely hideous experience. I’ve read that it can be worse than getting off heroin (no personal experience with this comparison:))

Chipping in three more advices:

First: exercise, sunlight, and Vitamin D supplements are extremely valuable resources in fighting depression. Recent studies rate exercise as more effective than SSRIs for many people. Even on insanely over-scheduled days I make time to take a walk outside and/or sit outside, sunglasses off, and absorb some rays. This makes an appreciable difference. The depression beast makes it easy to go lie down in a darkened room, this impulse must be fought off.

Second, PMS, peri-menopause, and menopause can really screw around with depression and anxiety issues. I’ve not done this, but some of my friends take birth control or an SSRI (YMMV) during “PMS week” to ease devastating mood drops.

Third: avoid benzos (Xanax, Valium, and so on) like the plague. I would recommend never taking these, but some folks with severe panic disorders don’t have a choice. These meds can exacerbate depression/anxiety issues effects, though some folks with severe panic issues don’t have many choices in meds. Also, addiction – or “self-medicating” - is often co-morbid with other issues and benzos are hideously addictive.