Understanding Different Types of Depression and Finding Solutions
Hello, my name is Dr. Patricia Bowskill. I worked most of my life as a psychotherapist. I am now retired from practice, but I still care deeply about mental health issues. The purpose of this article is to explain a few of the more common types of depression—and then help you examine steps you can take to combat depression.
What is Clinical Depression?
Clinical depression must be distinguished from "the blues." All of us get the blues! We all have those days or even weeks when we feel "down in the dumps." When we are just down in the dumps, we can learn strategies to help pull ourselves out of it. However, clinical depression is a different animal completely.
Clinical depression is an illness. It involves the chemistry in our brain, not just a bad mood we are in. It can involve a myriad of symptoms which include our thoughts, feelings and behaviors. Some of the more common feature can include feelings of worthlessness, feelings of despair, thoughts that we can never succeed in life, or thinking and feeling like a total and complete failure. Our body may seem to slow down. We may seem to be moving slowly or want to stay in bed. Conversely, we may be unable to sleep with the thoughts running through our heads and then feel even more fatigued in the morning.
Aches and pains are common this type of depression. We may notice more pain in our bodies, more headaches and just feel overall "unwell." Often it is hard to tell if someone is sick because they are depressed, or if they are depressed because they are sick.
Some depression gets so bad that people even contemplate suicide. The suicidal person is not able to see any other way out of their endless suffering.
More than 15 million Americans, or about 6.7% of the population, will experience clinical depression each year. If you are suffering from clinical depression, I want you to understand that it is not your fault. It is not a character defect but an illness. I also want you to understand that there is help available.
Dysthymia is also known as "chronic depression." The symptoms do not usually appear as severe as clinical depression but the bad news is that dysthymia last longer. Originally, dysthymia was called a depressive personality.
Dysthymia can be diagnosed when a person has a chronic depressive mood, fatigue, low self-esteem and a lack of ability to move forward in life. There can also be memory problem, changes in appetite (either eating more or less), changes in sex drive, feelings of hopelessness and sometime irritability.
Dysthymia appear to involve an area of the brain called the corpus callosum. Dysthymia often can occur with other mental health issues such as substance abuse, anxiety or a risk for a major depression at some times in life.
Treatment for dysthymia is often a combination of medication and psychotherapy. Often, the patient feels like there is a little hope because "this is just how I am." However, if someone is motivated to try to feel better there is hope! Sleep is also critical for people with dysthymia. Refraining from drugs and alcohol is also a good idea. Alcohol makes a depressed person more depressed.
Bipolar depression use to be called "manic depression" and is still sometimes called that by lay people. Bipolar depression can occur with typical depressive symptoms but also periods of time of mania when the person feels "on top of the world", has little need for sleep, rapid speech and impulsive behaviors. The person may seem to cycle from depression to mania or they may have what is called a "mixed state" where depression and mania and present at the same time.
Often a person with untreated bipolar illness may also abuse substances such as drugs or alcohol. Often, the person engages in reckless behaviors that may include sexual acting out, gambling, compulsive shopping, dangerous driving, risk taking or other behaviors that jeopardize their health and well-being.
If misdiagnosed, treating the depression alone may lead to an increase in mania. Anti-depressants should not be used alone but may be used in combination with a medication such as Lithium or Depakote.
Bipolar is not a rare disease. About 5.7 million adult Americans are affected each year. This is about 2.7 % of the adult population.
The Baby Blues
Post-partum Depression is often called the baby blues. It is caused by hormonal changes after giving birth. It usually occurs (if at all) between 2 days and 2 weeks of giving birth. In most cases, the blues will be just temporary and relieved with love, support, a smile and a little rest. However, post-partum depression will not be resolved by love and support and a cute little baby face.
When a woman has post-partum depression, she may feel like she is a failure. She may feel like she is not good for her own baby. She may feel like the baby would be better off without her or that she is "doing it all wrong". She is most likely exhausted but even more so than the exhaustion most new Mom's feel. She may become so depressed she may even contemplate ending her own life. In post-partum depression, the obstetrician should be your first resource but a referral to a psychiatrist may also be useful. It is nothing to be ashamed of! Your hormones are to blame, not you.
In rare cases a woman may experience postpartum psychosis. This is a severe emergency and requires immediate attention. She may see to have a lot of energy (mania) and she may seem like she has too much energy although she reports feeling exhausted. Her thoughts are often racing. She may have less inhibition in her speech and her behaviors compared to her normal self. She may tell you that she is "going crazy" and may express fears that she is going insane. She might hallucinate. In this description, I say "she" as the woman with postpartum psychosis is not likely to be reading this. If you think your loved one has postpartum psychosis, get her help.
Andrea Yates is perhaps one of the extreme examples of postpartum psychosis. She was a Texas mom who drowned her 5 children in a bathtub to "save them" as the Devil was speaking to her. I have deep sympathy for the children, the husband and the mentally ill woman who has spent so many year incarcerated and will remain in pain for what she has done.
Thankfully, even postpartum psychosis does not have such tragic ending in most cases. In most cases, it can be resolved with medications which might include both hormones and anti-depressants.
Seasonal Affective Disorder
Seasonal Affective Disorder (SAD) occurs when the sunlight shift from fall to winter. It is a result of the light changes. Symptoms are fatigue, changes in appetite (hungrier, overeating or undereating), a need for more sleep, feelings of sadness and mood changes. A person with this condition will experience this year after year at the same time of year.
If bad enough, antidepressants can help with your mood. A Lux light is also helpful in many if not most cases of SAD. They can be purchased without a prescription. To use a light box, you sit in front of it every morning while looking down slightly. You may also sometimes rent a LUX light from a medical supply company if you are not sure if this will work for you.
Good diet and a consistent sleep schedule is also important. Some people with SAD actually chose to move to a place where there are not drastic seasonal changes but many of us can not/will not do this for many reasons including jobs, family, homes, friends or money.
When It is Grief
Grief is a period of mourning, usually for the loss of a loved one. However, grief reactions can also occur with the death of a pet, loss of a job, loss of health or loss of anything of great importance to us. Grief is normal and should be expected when a person loses a loved one.
Elisabeth Kubler Ross writes that there are 5 normal stages of grief which are:
DENIAL: when the person is likely to be in shock. They might ask the same question over and over again and they may say "it doesn't feel real". The denial phase is our minds way of protecting us from the powerful emotions that we must deal with. At most funerals I have attended, the bereaved is often in denial. At one funeral I attended the man told me that the body in the casket was not his wife. I have often heard "I can't believe it" or "is this really happening". What the person needs is the love and support of family members.
ANGER: Anger usually follows the denial phase but each of these phases can happen at any point. The anger may be at someone that the person in question is blaming for the death such as the driver that hit a loved ones car or the doctor who treated the deceased. At times, the anger can be directed at the deceased for "not taking better care of himself/herself" or even "just for leaving me". It can also be irrational, directed at people who have nothing to do with the death or even at God.
BARGAINING: is a phase that can occur before a death or even after. Often bargaining is with God or the person's higher power. The person may say "take me, not him" or may make promises to God "if you just let this funeral all be a bad dream I will devote my life to you.
DEPRESSION: often sinks in when the person realizes that bargaining is not working. Grief may lead to a true clinical depression but often it is better characterized as a grief reaction. At times, the person may even want to die in order to be with the person they love.
Acceptance: I really do not like the name that has been given to this final stage of the grief process. I prefer to use the term Incorporation. People may not totally accept the death but they choose to move on with their own lives. They incorporate the death into their new normal.
When a person you care about is in grief, provide them with as much love and support as possible. Typically, there is a great deal of love and support when the death first occurs and during the mourning period. However, when the last mourner leaves, that might be the time your loved one truly needs you!
First holidays, the deceased birthday, Mother's Day/Father's Day or the anniversary of the death are also all days when your loved one need you. Or if you are the person who has lost a loved one, a day when you need extra love and support.
At times when a bereaved person comes to therapy, they complain that "no one wants to talk about" the person they lost. Often, people are afraid to bring up the loved one for fear of "upsetting" the bereaved. My comment is "why, do you think he/she forgot"? At times, doing a meaningful activity such as a scrapbook can be helpful. There are support groups for grief which are often very helpful. Couples sometimes come to therapy for marriage counseling and I find that men and women grieve very differently. The marriage can suffer when the parties do not understand the other ones grief reaction. Therapy is often helpful or groups are also helpful.
Do not forget children when you are talking about grief. Kids often appear to be unaffected by the way that the handle grief. Parents may be so consumed in their own grief that they forget about the children. Don't be afraid to talk to kids about how they are feeling. They are hurting too and may benefit from a group or a therapist specializing in children.
Holistic Treatments for Depression
There are holistic treatments for depression. Some people find help in herbs, exercise (such as yoga, running, aerobics), deep breathing massage, chiropractic, acupressure, or other alternative therapies. Proper nutrition and adequate water intake is something I suggest for all people with depression. For some, journaling or art or music may help. I am in favor of doing what helps! However, in most cases, a combined approach may be most useful.
Find what feeds your soul! Find what makes you happy. Research what is available in your community. In some cases, a holistic approach works well for people. Psychotherapy (my field of expertise) is often helpful. In many cases the best approach is a combined approach. Your therapist can suggest an appointment with a psychiatrist if needed.
Do not attempt to use holistic treatments alone if you have thoughts of suicide, harming other, have racing thoughts or high-risk behaviors.
When I just have the Blues
We all get the Blues at times. When you have the Blues, it is not a medical condition. Try eating healthy, getting enough sleep, finding time for yourself and time with people you care about.
Sometimes the Blues are a way of you mind telling you something needs to change. Eating lots of fast food can give some people the blues due to the lack of nutrients and the overload of sugar, fat and bad carbs.
Lack of time outdoors can also give some people the Blues but is less severe than SAD. Get outdoor. Feel the sun on your face! Breath deeply! Ground yourself by walking barefoot in the grass.
We all get the Blues sometimes and we all can help ourselves "snap out of it". However, do not apply your ideas about the Blues to someone who has a True Depression. It is not helpful and makes them feel more isolated. Most clients tell me about well-meaning people who equate their Depression to the Blues. These are each and everyone different animals.
I hope this is helpful to you whether it is you, your spouse, your child or your friend who is suffering. There are many kinds of depression and each kind requires a different approach. This article is not meant to be a substitution for medical treatment. See your medical provider for a referral to a therapist or psychiatrist. If you have feelings of harming yourself or others, please seek help from your nearest Emergency Room.