Coming to Terms With Depression

From the WebMD Archives

You’ve just been diagnosed with depression. You may feel as if you are the only person in the world with this problem. That kind of feeling is just one symptom of the illness.

Of course, you aren’t alone. Nearly 17 million adults in the U.S. suffer from depression. It affects people of all ages, races, ethnic backgrounds, and socioeconomic classes – even those who seem to have everything in life.

Terry Bradshaw, a Hall of Fame quarterback and well-known sportscaster, struggled for years with crying jags and breakdowns before medication and therapy helped relieve his pain. British comedian and actor Hugh Laurie, best known in the U.S. as TV’s Dr. House, realized he was depressed during a charity stock car race when he felt utterly bored even as cars crashed all around him. The famed author of the Harry Potter novels, J.K. Rowling, dealt with crushing depression and suicidal thoughts after a failed marriage in her 20s.

Major depression is a medical illness, just like heart disease or diabetes. You didn’t ask for it, you don’t deserve it, and nothing you did caused it. But you can get relief. According to the National Alliance on Mental Illness, 80% to 90% of people who are diagnosed with major depression can be treated effectively.

You may wonder how to move forward with such a difficult and painful illness weighing you down. This article can help you understand how depression affects you and provides tips to help with your recovery.

What Triggers Depression

Health experts don’t know exactly what causes depression, although a person’s genetics, environment, and brain chemistry probably all come into play. “Stress early in life, such as neglect or childhood trauma, can also set you up for becoming depressed in response to later stress,” says Jon Allen, PhD, senior staff psychologist at the Menninger Clinic in Houston.

Often, major life events such as job loss or the breakup of a marriage, drug or alcohol abuse, or chronic stress triggers an episode of depression. “If someone has had an episode of major depression, it’s likely that stressful life events occurred prior to the depression,” Allen says.

“How you perceive these events, and how you feel about yourself in relation to them, can have a big impact on your vulnerability for depression,” he says. “Feelings of failure and loss and feeling trapped in a difficult situation can lead to a sense of helplessness and hopelessness.”

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What Depression Feels Like

“There is nothing worse than depression,” says Anthony Rothschild, MD, professor of psychiatry and director of the Center for Psychopharmacologic Research and Treatment at the University of Massachusetts Medical School. “I’ve had patients who were cancer survivors tell me that they would take a recurrence of cancer over a relapse of depression.”

Yet, unless someone has experienced depression, it’s difficult to understand just how profoundly it can affect your life. Serious depression affects your thoughts, moods, behavior, and body. It saps your energy and makes life seem hopeless and empty.

Once those feelings build up and you start to slip into depression, it becomes more difficult to function, and a downward spiral begins. “As depression becomes more severe and long-lasting, the risk of suicide increases,” says David Brendel, MD, PhD, assistant professor of psychiatry at Harvard Medical School.

If you have any thoughts about suicide, tell your mental health provider right away. He can work with you to help keep you safe.

The First Step: Facing Your Depression

In order to get relief and reduce the risk of worsening depression, you need to face it squarely and acknowledge that you need help. “The first step toward recovery is to accept that you have a serious medical illness that will require major effort and treatment over an extended period of time,” Allen says.

“Depression is easier to treat the earlier it is caught,” Brendel tells WebMD. “Treatment can reduce the frequency and severity of major depression.”

Depression Relief: Finding the Right Treatment

Talk with your mental health provider about your diagnosis and treatment options. “With mild depression, studies have shown that therapy or medication are equally effective,” Rothschild says. “People with moderate or severe symptoms should usually receive medication. Treatment with therapy alone usually isn’t effective, as people are often too depressed to really do the work of therapy.”

Many people respond well to both medication and therapy, especially if they have an underlying problem that they need to resolve in their personal or work life. “Therapy and medications work on different things,” Rothschild says. “Medication works on the depression itself, and therapy can help a patient deal with a particular stressor in his or her life, such as the loss of a job or relationship troubles.”

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Treatment should be tailored toward the type of depression you have. For example, bipolar disorder is an illness characterized by rapid swings of mood from extreme highs (mania) to devastating lows (depression). It can be difficult to tell bipolar disorder from major depression when the person is in the depressed phase of the illness, but treating it with antidepressants alone may cause rapid and dangerous changes in mood. So getting an accurate diagnosis of your depression is important to treating it effectively.

You and your mental health provider should decide together on the best treatment plan for you. You’ll want to consider the severity of your depression and your health plan coverage, as well as your needs and preferences.

Getting Treatment for Other Conditions

Depression often occurs in conjunction with other illnesses. These include:

Talk with your doctor or mental health care provider to determine whether you have other health problems that should be addressed along with depression.

Getting Support From Family and Friends

Depression often causes people to isolate themselves. You may not feel up to social interaction or ashamed to be struggling with a mental disorder. But as with any other illness, you’ll need help to overcome it. “Support is essential for people with depression,” Allen says. “It can be impossible to recover on your own.”

Start by telling trusted friends and loved ones that you are suffering from depression. It’s important to have people there for encouragement and to help you see small improvements in your mood or energy level that you may not notice. And if depression-related fatigue makes it difficult to keep up with tasks such as grocery shopping or cleaning, they can step in to help.

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Should You Tell Your Employer About Depression?

Consider whether you want to talk to your employer or any co-workers. If you need to take time off or adjust your job responsibilities to lessen the pressure, then it may make sense to explain why. You may want to bring in educational materials about depression or a note from your doctor for your manager to read.

However, not everyone understands the seriousness of the condition and how it can affect a person’s ability to work. If you’re unsure about whether to mention it at work, it may help talk it over with a trusted friend or your therapist.

No matter what you decide, it’s important to understand your rights as an employee. The Americans With Disabilities Act protects people from discrimination because of a disability. You can find information on it at the U.S. Department of Justice web site www.ada.gov or by calling 800-514-0301.

If you find that you need more time off than is covered by your vacation and sick leave, see if your employer offers short or long-term disability insurance. This will allow you to take time off while receiving a percentage of your pay. If this is not available, the Family and Medical Leave Act allows employees with a serious illness to take off up to 12 weeks unpaid without losing their job. You can find more information online at www.dol.gov/whd/fmla/index.htm or by calling 866-4USWAGE (866-487-9243).

The Road to Recovery: Small Steps Add Up

Recovering from depression requires compassion -- above all, from you. You have a medical illness and you need time to recover. But one of the difficulties of depression is that its symptoms often interfere with the activities that can help you feel better.

Getting enough sleep, eating a healthy diet, exercising, and reaching out to trusted friends and family can all aid recovery. But depression affects your energy level and ability to sleep and eat. Feelings of hopelessness and sadness can make it difficult to contact people or even go for a walk.

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This means that healing can be a slow process -- often several months, according to Allen. There may be days when you don’t have enough energy get out of the house. That’s OK. If all you do at first is take your medication as directed and go to therapy appointments, that’s enough to move forward.

As your depression lifts, your symptoms should gradually fade. Your sleep and appetite will improve. On days when your energy level and mood are better, take advantage of it. Go out for a walk or call a friend. Take what small steps you can to be more active and involved with the world.

Tips for Depression Recovery

As you start to feel better, there are some things you can do to help:

  • Recognize that you are not your depression. Your negative feelings are because of the condition and are not reality.
  • Focus on a healthy lifestyle. Good body health will help your mental health. Try to stick with the same sleep and wake times, eat a healthy diet, stay physically active, and avoid alcohol and recreational drugs.
  • Minimize the stress in your life. Stress can prolong an episode of depression and interfere with recovery. You can’t eliminate stress completely. But you can learn healthy ways to cope with it, such as talking to trusted friends, getting regular exercise, and learning relaxation techniques.
  • Widen your support network. This is the time to be with people who are comfortable with depression. Talk with your therapist or doctor about support groups in your area or look for online support groups.
  • Don’t make major life changes until you feel better. Depression colors the way you see the world, so it’s difficult to know whether some of your perceptions are based on fact or mood. Talk over any serious decisions you can’t avoid with someone who can be objective about the situation.
  • Be socially active in a low-key way. You don’t need to become a social butterfly. Going to the movies or a concert can help you get out and reconnect with people but doesn’t require a great deal of interaction or energy.
  • Be resourceful. Take advantage of anything that can help you without adding stress to your life.

Remember that healing from major depression takes time, and you will have good and bad days throughout your recovery. Knowing that these ups and downs are normal can help you have realistic expectations and be patient with yourself. With persistence and support, you will get there.

WebMD Feature Reviewed by Brunilda Nazario, MD on July 06, 2010

Sources

SOURCES:                                                                                                                                   

Pampallona, S. Archives of General Psychiatry, July 2004; vol 61(7): pp 714-719.

Jon Allen, PhD, senior staff psychologist, Menninger Clinic, Houston.

David Brendel, MD, PhD, assistant professor of psychiatry, Harvard Medical School, Boston; associate medical director, the Pavilion at McLean Hospital, Belmont, Mass.

Anthony Rothschild, MD, Irving and Betty Brudnick Endowed Chair, professor of psychiatry, director, Center for Psychopharmacologic Research and Treatment, University of Massachusetts Medical School, Worcester.

American Psychiatric Association: “Practice Guidelines.”

National Institute of Mental Health: “The Numbers Count: Mental Disorders in America,” “Depression.”

National Alliance on Mental Illness: “Major Depression Fact Sheet.”

Depression and Bipolar Support Alliance: “You’ve Just Been Diagnosed.”

Allen, J. Coping With Depression: From Catch-22 to Hope, American Psychiatric Publishing Inc., 2005.

Depression and Bipolar Support Alliance: “Frequently Asked Questions,” “Wellness at Work,” “Recovery Steps.”

Psychology Today: “Depression Doing the Thinking.”

Parade Magazine: “Too Tough to Seek Help”

London Evening Standard: “A Brighter Life for Hugh Laurie.”

Telegraph.co.uk: “JK Rowling Contemplated Suicide.”

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