Written by B. Imei Hsu, BSN-RN, MAC-LMHC, Artist
A few weeks ago, I found myself musing about the real “face” of depression. I personally find it absurd to think that anyone who lives a full life can escape the feeling of being depressed at some point in their lifetime of 365-1/4 day trips around the sun. A full life – one in which you choose to be awake – includes its fair share of tragedies, heartbreaks, endings, and losses. As I am writing this, we are on the eve of experiencing a hurricane that affects hundreds of miles of homes and businesses, which can only mean that millions of people’s lives and livelihoods are at stake, and the thought of human loss is grieving and yes, depressing. Yet rather than sharing only statistics and norms and “how to’s, I’m sharing my personal and professional musings on depression not just as a situationally-caused mood disorder, but also as a real “face” that seemingly has no cause, or to which we look beyond cause. What is the real face of depression?
“I have no reason to be depressed”
You probably know at least one person who tells you, “I have no reason to be depressed.” Such a statement falls falls from a mouth of an intelligent, successful, healthy adult man or woman who appears well-loved and appreciated for his or her contribution to the community, the workplace, and the home. She or he can count off at least ten or more reasons why depression should have no place in her life, and yet there it is: this heavy, achy, tired, brooding feeling of either not wanting to have to wake up to another day (with suicidal thoughts and fantasies of ending it all), or the same heavy- achy-tired-brooding-feeling, only without suicidal thoughts. That same person may have tried counseling or some form of “talk therapy“, and while strategies for managing the symptoms of depression are discussed and employed, the person expresses dismay that after six months of weekly sessions, she doesn’t feel much different. Just depressed.
Note: It’s not that the other faces of depression – Manic Depression, Major Depressive Episodes, and depressions manifesting themselves in repeated threats and attempts at suicide aren’t any less “real”. What I’m contrasting is that suicides from depression are a smaller subset (though not less painful) of a larger group of people who experience daily depression as a chronic feature of their life, and I’m addressing it as if categorically different than the one who needs hospitalization, ECT (electroconvulsive therapy), and other more radical interventions to halt the cycle of suicidal attempts to end the pain.
When you’re the friend to someone who is chronically depressed, you may be apt to tell that person to “hang in there” and “stay with the process” (that is, the treatment program). But when the above description of depression is you, it changes everything, doesn’t it? When it is you crying for hours for no apparent reason, when it is you feeling like you don’t want to socialize with anyone, when it is you who wants to curl up into a ball and sleep every available hour you can just to not feel miserable, every kind word and intention from friends and loved ones can feel like yet another person who cannot possibly “get” how you’ve managed to put up with depression for so long.
I’ve watched many people literally drag their bodies into my office, hoping to find a solution to this suffering. Like Wil Wheaton, an actor turned writer, many resist available solutions and try talk therapy because they are informed that counseling therapy may help. Wheaton astutely named that some depressions are not “mental” in nature (here, I believe his reference meant he attributed his own depression to something that was not classic mental illness); that is, some depressions presently exist beyond any triggers, childhood traumas and losses, and situational events that a clinician can point to, say, “Ah ha! This is the source of your depression!” and then provide a repeatable recovery path. Even if there once existed a trigger for an initial depressive episode, the current chronic manifestation can be resistant to some methods of talk therapy in providing relief from the worst of its symptoms. While talk therapy is often the starting point for depression treatment, it may not be the end solution. Is there something more?
“I’m ready to try something different”
If you’ve ever sought help for depression (mild to moderate) in the U.S., clinicians are familiar with the current DSM-IVR recommendations for the treatment of depression, which include a medical assessment and labs, family history, medication review and possible prescription, psychotherapy (almost always in adjunct with medicine, and not a sole treatment option unless the depressive symptoms are mild in nature), and non-medicinal treatments, such as dietary supplements, exercise, evaluation of sleep/rest cycle, and support systems. For the purposes of this post, let’s focus on three: exercise, medications, and dietary supplements.
When you find yourself saying, “I’m ready to try something different”, this is a real face of depression of which clinicians should pay more attention. You are messaging to them that you have experienced a number of options in treating your symptoms, and for whatever reasons, it’s just not working. If you can help your clinician to hear that message, the next question for the clinician is to ask you, “Let’s review everything you’ve tried, so we can get a baseline.” A thorough review of your history can help. If something isn’t working for you, it’s worth looking at the other options you might not have tried or might not have employed in a way that could be of more effective help.
Exercise. Depending on your current level of fitness, any movement limitations or health restrictions, exercise might be your “go to” for helping to ameliorate mild and moderate depression symptoms. While experts don’t fully understand how it works to reduce stress, we do know there is a strong connection between stress reduction, exercise, and the increase in endorphins that flood the body during moderate to vigorous cardiovascular movement. If you have never tried a strategic exercise program for the reduction of depression symptoms, you can talk to your physician about starting one. Many gyms and physical fitness trainers provide coaching and programming to help you safely start and maintain a fitness program that could reduce your depression symptoms. If your depression is more severe, vigorous exercise may not be your option until your symptoms are reduced through other means.
Anti-depressants. I personally feel anti-depressant medication has received a bad reputation in the media, mostly likely due to the ease in which they can be prescribed as well as mythology surrounding mental wellness treatments in general. You may have some reservations about medications: Does it mean you are weak? Is it a “cop out”? Does it mean you’re just like your ‘crazy’ Uncle Fred? What will my spouse or GF/BF or BFF or employer or Dog think of me?
The skinny on anti-depressants: sometimes, anti-depressant medication, along with other treatments such as rest, exercise, and talk therapy, is the solution for you. You won’t know personally unless you set up an appointment with your physician, find out if medication is an option for you, and you begin a trial of an anti-depressant with the lowest amount of side effects for the dose. For some people, medication doesn’t give them enough positive effects to be worth it; for others, it works better than any other solution they’ve tried. If the latter is true for you, it begins to defy logic to continue to defend general feelings about medicinal treatment, and start looking into making the smartest choices for your own health.
What sometimes happens is that those who have had chronic and long-standing depressive symptoms (not a severe Major Depressive episode) will try a trial of an anti-depressant for six months, feel better, and then step down from their medication to see if they can stop taking their medication, even when they have experienced relief by taking anti-depressant meds. Some may have to be on medication for a slightly longer period of time. Others may discover over time that the best solution for them is long-term medication management. Often, it is a family member who points out that s/he can observe a noticeable difference as to when you are on a medication and when you’ve stopped taking it [oh yes! If it’s working, they can tell!].
Dietary Vitamins and Supplements. The reason why dietary supplements are so critical to any depression recovery program is because a number of deficiencies caused by nutrition-poor diets manifest as some of the symptoms of depression, such as fatigue, aching joints, listlessness, sleepiness, and that awful feeling of dragging. I’ve mentioned it in earlier posts, but some issues such as iron deficiency, folate deficiency (found in Vitamin B and B-complex), Vitamin D deficiency, and magnesium deficiency have already been linked to depression. Taking Omega-3 Fatty Acids in pill or liquid form is often prescribed in the treatment of depression. Restoring electrolyte imbalances (calcium and potassium in particular) in Anorexia and Bulimia clients often has an unsurprising positive effect in reducing depression and anxiety symptoms in those populations.
While there is plenty of information on what recommended supplements and vitamins would help boost energy and restore these deficiencies, the first step to dietary vitamin and supplement therapy is to talk to someone in-the-know: naturopaths, physicians, and ARNP’s are professionals who can draw labs, interpret the data, and give you recommendations on how to best address your deficiencies. Just because the FDA does not regulate supplements does not mean these products do not have a real effect. They can have a powerful effect on your health, and they should be taken with care at the dosing that is recommended by your practitioner.
So, what is the “real” face of depression? It’s often the person who may never or infrequently experiences thoughts of suicide, but feels sad and tired for long periods of time without a sense of being able to point to what she or he has to be depressed about. And what the real face isn’t? It was never about being able to eradicate their feelings with a pill. No, the real face of depression recovery is about a person, their loved ones, and the persistent and tenacious application of support, sometimes medication, and personal grit required to commit to care for oneself when everything feels hopeless, heavy, and gloomy.
At SDC, we help those with depression symptoms, work with your doctor or health care practitioner to determine your best options for treatment, and encourage you to talk about your situation and support to help you start feeling better and manage your symptoms.