Riverview Psychiatric Center

Psychology Articles by Dr. Arthur Dingley - Living With Depression

Dr. Art Dingley

Depression is a disorder of mood. People with depression feel sad. Sometimes, people with depression completely lose the ability to feel good about the things they used to enjoy. It’s a serious illness. The World Health Organization reports that depression is the most common cause of disability across the Globe. In order to understand why this is true, we have to begin by looking at things which look and feel like depression but are caused by something else.

Chronic stress can make people feel sad and helpless. Poverty, unemployment, physical illness, loneliness, and difficult relationships are common causes of stress. Basically, the stressed person is having a normal reaction to bad circumstances, and the usual treatments for depression don’t work very well.

Grief certainly makes people sad, and can interfere with appetite, sleep, and concentration. Grief, although it feels like depression, is the normal human reaction to loss. Death of a loved one is a common cause of grief, but other losses, such as loss of a marriage, career, physical health, or even a beloved pet, can be debilitating as well. Unresolved grief can surface years later and masquerade as an episode of depression.

Medical problems can mimic depression. Obesity, physical deconditioning, thyroid problems, sleep apnea, and chronic pain all result in fatigue or lethargy. A person who is continually fatigued may begin to feel guilty over not getting things accomplished and may begin to believe that things will never get better.

Drug and alcohol addiction may cause mood changes that feel like depression. As soon as the intoxicating effect of an alcohol binge wears off, the drinker feels depressed. Alcohol is simply a depressant drug. Marijuana famously causes inertia, memory problems, and mood changes. When the euphoria of stimulants, like amphetamine and cocaine, wears off, the frequent user feels terrible. Stimulant drug addicts often lose the ability to enjoy the ordinary pleasures of daily life without the drug – a true devil’s bargain.

People with personality disorders often have brief bouts of “depression” which are brought on by unfortunate interactions with other people, or by negative thoughts. Medicine does not help with this type of “depression”, although some forms of psychotherapy are very helpful.

In the elderly, dementia may cause a condition which looks like depression. People with Alzheimer’s dementia, or dementia from stroke, may become apathetic or have pronounced mood changes along with their memory loss.

Now, if someone has been sad, or has lost all interest in life, for at least two weeks straight, and their difficulty is not the result of one of these other problems, she may be having a Major Depressive Episode. (There is no diagnosis of “clinical depression”, and the expression is meaningless to mental health professionals. I’m not sure how that “diagnosis” worked its way into the common parlance.) In order for two weeks of sadness, or loss of interest, to be considered a Major Depressive Episode, the person must have at least four from the following list of difficulties: appetite disturbance with weight change, problems with sleep, agitation or lethargy, decreased energy, feelings of worthlessness or guilt, diminished concentration, and thoughts of death.

How long does depression last? An untreated Major Depressive Episode will last nine months to a year. Anyone who has had a Major Depressive Episode can be said to have Major Depressive Disorder. Sometimes, people have repeated episodes of depression. In fact, if you have had an episode of major depression, there is more than a fifty-percent chance you will have another. If you have had three episodes, there is a ninety-percent chance of having a fourth.

How common is Major Depressive Disorder? If you are female, your lifetime risk of having at least one episode of major depression is twenty percent. If you are male, your lifetime risk is about ten percent. This means that, for the whole population, the lifetime risk is fifteen percent. Rates for both men and women are highest in the 25-to-44-year-old age group and lowest in people over 65. The lost productivity and disability from depression can be translated into a colossal sum of money. About fifteen percent of people with untreated Major Depressive Disorder commit suicide. In the United States alone there are more than thirty thousand suicides annually. This morbidity and mortality, combined with the prevalence of depression, result in a rate of disability which exceeds all other illnesses.

What makes depression worse? People with depression are extremely vulnerable to the usual stressors: poverty, unemployment, physical illness, isolation, and relationship problems. Negative thinking often contributes to depression. Alcohol is a particularly nasty drug for depressed people because alcohol is a central nervous system depressant. Alcohol interferes with the frontal lobes of the brain causing disinhibition. Disinhibition plus depression equals suicide.

How is depression treated? Eating well, getting enough sleep, and getting regular exercise are very important to people recovering from depression. Regular, scheduled, purposeful activity, preferably from employment, is very important. As for many psychiatric illnesses, work has an organizing power which is the equal of any other treatment. There are many medicines for depression. None works better than the others. None can say that it is the best. The goal is to select the right medicine for each individual. We know that an untreated episode of depression will last for about a year. So, for a first episode of depression, medicine should be continued for a year. The medicine can be withdrawn after that. If depression returns, medicine should be taken for three years before it is discontinued. If depression returns again, it is reasonable to take medicine continuously, since your odds of having a fourth episode are ninety percent.

Psychotherapy is very effective for depression. The client-therapist relationship is more important to recovery than the type of psychotherapy provided. Therapy and medicine work equally well. However, people with depression who take medicine and also get psychotherapy will have a faster and stronger recovery than people who get only one form of treatment.

Electroconvulsive therapy (ECT) is powerfully effective for depression. ECT is reserved for people who have been failed by medicines and psychotherapy because it is expensive and invasive. ECT is done under general anesthesia in hospital day-surgery units. Modern ECT bears no resemblance to the “shock” treatments depicted in popular movies. Side effects are uncommon and improvement is rapid. The limitation of ECT is that, as with medicine, treatment has to continue for substantial periods of time. Most people who do well with ECT need treatment every six weeks or so. One promising new treatment for depression is transcranial magnetic stimulation. This is being standardized by research in large medical centers like Massachusetts General Hospital in Boston.

There are an endless number of unproven “treatments” for depression offered by companies and individuals with no education or training in mental health. Most of them claim to use “natural” supplements or some type of “energy”. These are a waste of time and money. If any of them worked, your doctor would have been using them years ago. Depression is a very serious illness. Delaying treatment by pursuing “alternative” methods is about like delaying treatment for cancer or heart disease.

In my next column, we’ll take a look at Post Traumatic Stress Disorder.

Dr. Dingley is a psychiatrist with Evergreen Behavioral Services in Farmington. He may be contacted at adingley@fchn.org

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Psychology Articles by Dr. Arthur Dingley - Living With Depression

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