Treatment for depression may require dietary and lifestyle changes, talking with a physician or counselor, and possibly taking medications. If you or someone you know is extremely depressed and/or suicidal, call 911 ASAP or get to an emergency room ASAP.
Medications aside, counseling can often help you to manage your depression. You may become less sad, sleep and concentrate better, have less negative self talk, cry less, be less irritable, have more energy, be less angry and disappointed. Once these depressive symptoms lessen, you may find that your stress level is significantly decreased and you are more happy in your marriage, work and life in general.
The Causes of Depression
Sometimes depression is biologically caused, hormones, neurotransmitters, lack of sun light, genetics, low testosterone, thyroid etc. Sometimes depression is psychologically caused, pressure from unconscious conflict, suffering from unmet developmental needs, burnout, etc. Sometimes depression is caused by unforeseen situations. This depression is in direct response to life experiences like the death of a loved one, the consequences of bad choices, etc. Sometimes depression is spiritually caused. The consequences of sin, such as guilt or shame can make people very depressed. There is a spiritual disorder which looks a lot like depression, but it is not depression. It is called, "Spiritual Desolation." Sometimes depression is caused by repressing anger can also cause depression. Instead of exploding into anger or rage they implode with depression. Most often, it is some combination of all the above.
Major Depressive Disorder - The patient has symptoms of depression most of the day, nearly every day for at least 2 weeks that interfere with your ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a person’s lifetime, but more often, a person has several episodes. Severe symptoms that interfere with the ability to work, sleep, eat, and enjoy life. Major Depressive Disorder is sometimes called, depression, clinical depression, or unipolar depression.
Persistent Depressive Disorder-This disorder used to be called Dysthymia. It's a chronic depressed mood that lasts for at least two years. The disorder may include periods of major depression and also less severe symptoms. Typically symptoms include low self esteem and energy, poor concentration, feeling hopeless, sleeping and eating difficulties. These symptoms look similar to major depressive disorder but their duration is much longer and they are also less severe than major depressive disorder. An episode can occur only once in a person’s lifetime, but more often, they have several episodes.
Seasonal Affective Disorder - This type of depression occurs during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer.
Disruptive Mood Disregulation Disorder - This is a newer disorder that wasn't defined until the publication of the DSM-5. It's similar but different from Intermittent Disruptive Disorder. The clinical picture includes explosive outbursts, rage, they are usually irritable and angry.
Vascular Depression - See Seniors and Depression .
Depression and Dementia - See Seniors and Depression
Depressive Disorder Due to Another Medical Disorder - Depression due to a chronic disease, like heart disease, cancer, multiple sclerosis, and can be intrinsically depressing.
Post Partum Depression - See Depression in Women
Treatment Resistant Depression - This label is assigned patients who don’t respond well to medications or counseling. Despite treatments which would work on 99.9% of patients, treatment doesn’t for them.
Substance/Medication - Induced Depression Depressive Disorder - This is caused by using alcohol, benzodiazepines, opiates and other drugs.
Psychotic Depression -This type of depression occurs when a person has severe depression plus some form of psychosis, such as delusions and or hallucinations. Technically the term, “Psychotic Depression,” is very outdated and not an official diagnosis. Insurance companies would not cover the diagnosis of “ Psychotic Depression” any more than they would the diagnosis of “alcoholic” or “nervous breakdown.” Diagnostic terms have changed over the decades and presently the contemporary diagnostic labels for a patient who simultaneously presents with symptoms of depression and psychosis are: Major Depressive Disorder with Psychotic Features, Bipolar Disorder with Psychotic Features, Schizoaffective Disorder
Accurately diagnosing between these three distinct disorders is very difficult since it requires an extremely complicated assessment. For example, if a patient presented with severe depression combined with delusions and hallucination and was diagnosed by 10 different mental health professionals there is a good chance some mental health professionals would diagnose the patient as, “Major Depressive Disorder with Psychotic Features,” others with, “Bipolar Disorder with Psychotic Features,” and others might make the diagnosis of, “Schizoaffective Disorder.”
There are a lot of similarities between these three disorders while the distinctions are very fine tuned. Diagnosing is complicated since many bipolar patients are mis diagnosed as depressed. They only present to the mental health professional when they are feeling down because of depression and somehow the mania of bipolar is missed. Major Depressive Disorder with Psychotic Features and Bipolar Disorder with Psychotic Features are distinct when compared to schizoaffective disorder only by the onset of the disorder. Since all three diagnoses have mood and psychotic features, a thorough assessment would look at which symptoms-mood or psychotic-presented first in the patients development. If the patient had depression and later developed psychosis, then their accurate diagnosis would be, “Major Depressive Disorder with Psychotic Features.” If the patient had depressive symptoms with mania and later developed a psychosis they would accurately be diagnosed as, “Bipolar Disorder with Psychotic Features.”If the patient was initially diagnosed with a psychotic disorder and latter developed a mood disorder the accurate diagnosis would be, “Schizoaffective Disorder” It is difficult for a mental health professional to catch these very fine tuned distinctions because many patients don’t have much insight into the interior movements within their own mind. In addition, they don’t always present coherently.
Depressive Episode with with Insufficient Symptoms - This occurs when a patient doesn’t meet the diagnostic criteria for major depressive disorder because they only have 3 or 4 of depressions nine symptoms, and five of nine is required to make the diagnosis.
Atypical Depression - The clinical picture for Atypical Depression is different than regular depression. It’s a type of depression which does not follow what is the typical presentation of the disorder. Unique to the distinction of atypical depression is heaviness in the arms and legs, oversleeping and overeating. Also they may have relationship problems, are especially sensitive to interpersonal rejection, and their mood spontaneously improves when something good happens to them. At other times they meet the diagnostic criteria for depression but aren’t sad.
Adjustment Disorder with Depressed Mood - This is an official diagnosis. The patient’s disorder is triggered by a lot of overwhelming stress. The death of a loved one, divorce, losing a job, etc., can trigger this disorder.
The most worrisome symptoms of depression are thoughts of suicide or suicide attempts. If you think someone is contemplating harming themselves, immediately call 911 or immediately bring them to an emergency room.
The depressed person is often unable to meet work and family responsibilities
They cry a lot.
Physical symptoms without a physical cause. For example-headaches and body aches
Feelings of hopelessness and worthlessness
Loss of interest in hobbies
Feeling empty or sad most of the time
Some depressed people never feel sadness
Increased fatigue and irritability
Difficulty concentrating and remembering
Unwarranted guilty feelings
Unwanted weight changes
Psycho motor retardation or agitation
Depression in Women
Women have depression more often than men. Life cycle and hormonal factors unique to women possibly cause their higher depression rate. Women with depression typically have symptoms of sadness, worthlessness, and guilt.
Certain types of depression are unique to women and occur at different stages in a woman’s life. These include:
Premenstrual Dysphoric Disorder - This disorder is much more severe than PMS's symptoms. It is less common but more severe. It is a serious condition with disabling symptoms such as irritability, anger, depressed mood, sadness, suicidal thoughts, appetite changes, bloating, breast tenderness, and joint or muscle pain.
Peri menopausal Depression - Transitioning into menopause can cause irritability, anxiety, sadness, loss of enjoyment, abnormal periods, problems sleeping, hot flashes, and mood swings.
Postpartum Depression - After childbirth mothers can experience extreme sadness, anxiety, and exhaustion that may make it difficult for them to complete daily care activities for themselves or family. Postpartum depression does not occur because of something a mother does wrong or because she failed to do something necessary. After childbirth, hormones levels quickly drop. When hormonal changes combine with the responsibility of motherhood it can be overwhelming and cause depression. They experience hormonal changes and stress adjusting to pregnancy and the new baby Combine the hormone changes with the exhaustion from constant sleep deprivation and you have a recipe to create the symptoms of postpartum depression. Depression doesn’t only affect the mother, but also her relationship with her baby, the child's development, the mother's relationship with her partner and with other members of the family.
There are some unique postpartum depression symptoms, which are not commonly found in other depressions. They include:
Having trouble bonding or forming an emotional attachment with her baby
Persistently doubting her ability to care for the baby
Thinking about harming herself or her baby
Left untreated, postpartum depression can last for months or years
The Syndrome describes a significantly increased abnormal interior state, but it is not a new psychiatric diagnosis. It naturally spews out psychiatric disorders but intrinsically is not itself one. Depression, anxiety, panic disorders, post traumatic stress disorder, chemical dependency, etc., as well as sub clinical but problematic emotions and behaviors like workaholism, burnout, becoming overwhelmed, promiscuity, anger, guilt or shame are also post abortion consequences. It has been used as a collective diagnostic dumping ground, as a catch all term which points to the fact that there are significant problems for the person experiencing it but never meets the diagnostic criteria for any specific psychiatric diagnosis.
Some early texts on post abortion, written by religious, not mental health professionals, include depression or anxiety as a symptom of Post Abortion Syndrome. When Post Abortion Syndrome, which is not a psychiatric disorder, is defined using actual psychiatric disorders like depression, or anxiety, as one of its symptoms, their conceptualization of Post Abortion Syndrome as a unique and stand alone psychiatric disorder becomes clinically useless and is at best illogical.
There are very real and genuine psychiatric disorders which are directly caused by the abortion experience. Abortion trauma creates a high number of psychiatric disorders per capita compared to the non-post abortive population. The prevalence of psychiatric disorders is increased in the post abortive population. In Post Abortion’s Psychiatric Disorders, grief is always co-morbid.
Worse yet, some therapists are culpable in their patients actually procuring an abortion.
There is evidence that it exists but it may not rise to the level of mental disorder now or in the future. That doesn’t mean that it can be the focus of treatment. ???
Sometimes depression is biologically caused. Neurotransmitters are improperly balanced or we don’t get enough sunlight. During pregnancy the moms body goes through many physical changes. Post abortion, the mothers biology still processes as if pregnant. It takes a while for her hormones to return to their pre pregnancy levels. So abortion and postpartum depression are possible. Sometimes depression is psychologically caused. Repressed anger can cause depression. Unprocessed grief can cause depression. Depression is different from bereavement and grieving. One of the diagnostic criteria between depression and bereavement is self esteem. The person who is in bereavement experiences no change in self-esteem level. We get depressed because a close friend died. To feel depression after an abortion is a common response for many people. Some depression is spiritually caused.
The Major Depressive Disorder diagnosis requires, 5 of the 9 depression symptoms, listed in the DSM’s, section A. Suppose the post abortive only has 4 of the 9 symptoms? This means they do not meet the criteria for depression. This is an example post abortion syndrome.
Worst case scenario they experience Major Depressive Disorder, recurrent, with psychotic features.
While women with depression are more likely to have feelings of sadness, worthlessness, and excessive guilt, men are more likely to be very tired, irritable, lose interest in prior pleasurable activities, and have difficulty sleeping. Men may turn to alcohol or drugs when they are depressed. They also may become frustrated, discouraged, angry, and sometimes abusive. Some men may throw themselves into their work to avoid talking about their depression with family or friends. When a man has depression, he has trouble with daily life and experience diminished interest in anything for weeks at a time.
Many men don't recognize or seek help for their depression. They may be embarrassed to talk about how they are feeling. Depression is a treatable mental illness, which can get better and improve their interest in work, family, and hobbies.
There are many good, spiritually mature, practicing Christians who live with depression as well as other psychiatric disorders. Probably on any Sunday at any church there are people in the congregation who are on psychotropic medications to control their depression. For some, they are ashamed of having depression and double embarrassed about taking medications like Zoloft, Effexor, Lexipro or, Prozac to ease their suffering. So, they suffer in secret. There are also other Christians who understand that having depression isn’t a shameful illness any more than having the flu or having a heart attack or stroke. They also believe that anti depressants are a gift from God to help hurting souls suffer less. Until the scientific discovery of helpful anti depressants, those suffering from depression had very few options for relief. Some would ingest St. John’s Wort. Even today there are mixed results from studies about St John's Wort's efficacy. It's always a good idea to pray to God for relief.
Depression in College Students
College can be very stressful and trigger depression. The student may be leaving home for the first time, learning to live independently, taking tough classes, meeting new people, and sleeping less. Depression is the most common health problem for college students.
If depression is interfering with the ability to succeed in school, get help right away. Depression usually gets better with care and treatment. Don’t ignore the bad feelings. If you neglect professional help you may begin self-medicating with alcohol. Most colleges provide low cost mental health services through their counseling centers.
Depression is not a normal part of aging and like younger people they also need treatment to feel better.
Depression in older adults can be difficult to recognize because older folks may show less obvious and different symptoms. Sometimes older people who are depressed appear to feel tired, have trouble sleeping, or seem grumpy, and irritable.
Vascular Depression - Vascular Depression (sometimes it’s called Subcortical ischemic depression) - You will not be able to find Vascular Depression in the DSM. Its diagnosis is from Magnetic Resonance Imaging and autopsies. The concept correlates late-onset depression, with brain vascular disease, lesions, cerebrovascular damage, blood vessels hardening, micro leaks, etc. These as well as other very technical medical terms describe different ways normal blood flow to the brain is interrupted and cause depression. But there is nothing scientifically conclusive so vascular depression is controversial.
Depression and Dementia - Depression combined with Dementia is often observed in the elderly. Importantly, many people with histories of depression never get dementia. Some do and some don’t. Still, many people with dementia have depression. They seem to go together like two sides of the same coin, but not always.
As people get older, they go through a lot of changes like retirement, the death of loved ones, stressful life events, or medical problems. It’s normal to feel uneasy, stressed, or sad about these changes. But after adjusting, many older adults feel well again.
Before starting a medication, older adults and their family members should talk with a doctor about whether a medication can affect alertness, memory, or coordination, and how to help ensure that prescribed medications do not increase the risk of falls.
For the treatment of depression older people, just like younger people, should see a physician for medications and a therapist for counseling. Interestingly, some older adults prefer counseling instead of medications to treat their depression.
Depression is best treated by Mental Health Professionals. They may be physicians, psychiatrists, counselors, and some respond well to pastoral counseling. There is a synergy when medications and counseling are administrated simultaneously.The goal is to be on the right medication at the right dosage.
Antidepressants are effective for lots of depressed persons but can be very dangerous for children, teens, and young adults. When children, teens, and young adults first start taking antidepressants they can initially increase suicidal thoughts or suicide attempts. When antidepressants are used it is best that parent's pay very close to their child on antidepressants and consult with the physician even when unsure of suicidal tendencies in their child. Always follow the doctor’s recommendations when taking antidepressants. This suicidal tendency also ocures when cit is time to stop the medication, the doctor will help you safely decrease the dose.
There are also more aggressive treatments like electro convulsive shock. In this treatment electric current is passed through the brain in order to relieve depression.
There are also many non medical treatments which fall under the homeopathic umbrella like St. John's Wart, Omega-3 Fatty Acid, SAM-e, and others. It's a good idea to check with your physician and pharmacist before taking these supplements because they may dangerously interact with any prescribed medications you are taking.
Here are some good ideas to help yourself. Try to do things that you used to enjoy. Be easy on yourself. Diet and exercise. Spend time outside in the sun. Get enough sleep and try to go to bed and wake up around the same time every day. Don’t do drugs or alcohol. Try not to do too many things at once. Spend time with supportive family members or friends. Try fun things. Postpone important life decisions until you feel better. Discuss decisions with trusted others.
Be supportive, understanding, patient, and encouraging.
Never ignore comments about suicide, and report them to your loved one’s health care provider or therapist.
Invite them out for walks and other activities.
Help them adhere to any treatment plan, such as setting reminders to take prescribed medications.
Help them by ensuring that they have transportation to doctor and counseling appointments.
Remind them that with time and treatment, the depression will diminish.
Depression and Codependency - Anger turned inward, unresolved grief, the chronic restraint of feelings, being identified more with one's false self than one's true self - codependents have plenty of reasons to be depressed. Typically, however, they view their depression as evidence of inadequacy and the failure to stay in control, and for this reason they usually deny its presence. To acknowledge depression is to acknowledge loss, which challenges the family's shared denial and focuses attention on one's own feelings.
Codependents often cite the pressures of children, work, and home life as justification for not indulging in their personal feelings. ("Too many people depend on me to be there for them.") Admitting that one is depressed means admitting that one has needs, and codependents, by definition, always place the needs of others above their own in importance. For children who spend their developmental years in chemically or codependent families, depression stems from actual deprivation rather than loss; a bond which never existed can't be loosened. Children naturally protect themselves from unstable bonds, and in those who develop codependent traits while their personalities are still forming, depression may become characterologic and normalized. Acknowledging their depression requires that they develop new levels of trust in others - a difficult task at best, since their early experience has taught them that their trust will not be reciprocated or respected.
Depression and Recovery
During this period recovering people become so depressed that they have difficulty keeping to normal routines. At times there may be thoughts of suicide, drinking, or drug use as a way to end the depression. The depression is severe and persistent and cannot be easily ignored or hidden from others. The most common warning signs that occur during this period are:
Irregular Eating Habits. They may begin overeating or undereating. There is weight gain or loss. They stop having meals at regular times and replace a well-balanced, nourishing diet with "junk food."
Lack of Desire to Take Action. There may be periods when they are unable to get started or to get anything done. At those times they are unable to concentrate, feel anxious, fearful and uneasy, and often feel trapped with no way out.
Irregular Sleeping Habits. They may have difficulty sleeping or be restless and fitful when they do sleep. Sleep is often marked by strange and frightening dreams. Because of exhaustion, they may sleep for 12 to 20 hours at a time. These "sleeping marathons" happen as often as every 6 to 15 days.
Loss of Daily Structure. Daily routine becomes haphazard. They stop getting up and going to bed at regular times. Sometimes they are unable to sleep, and this results in oversleeping at other times. Regular mealtimes are discontinued. It becomes more difficult to keep appointments and plan social events. They feel rushed and overburdened at times and then have nothing to do at other times. They are unable to follow through on plans and decisions and experience tension, frustration, fear, or anxiety that keep them from doing what should be done.
Periods of Deep Depression. They feel depressed more often. The depression becomes worse, lasts longer, and interferes with living. The depression is so bad that it is noticed by others and cannot be easily denied. The depression is most severe during unplanned or unstructured periods of time. Fatigue, hunger, and loneliness make the depression worse. When they feel depressed, they separate from other people, become irritable and angry with others, and often complain that nobody cares or understands what they are going through.
Misc------- bipolar, antidepressants