Depression is more than sad

An important new study conducted by the World Health Organization (WHO) quantified the effects of depression on human health by comparing its impact with those of chronic diseases such as diabetes and arthritis. Conclusion: "the results of a quality-of-life index called the "global mean health score" showed that depression was, by a significant margin, the most difficult to bear." Link: Depression feels worse than many chronic diseases: study.

Depression is one of the most misunderstood phenomena in the wide world of health disorders. I see it occasionally in my practice when clients who are clearly depressed will dispute the very notion of it. They think that depression=sadness and that if they aren't crying, they aren't really depressed. But sadness is only one of numerous manifestations of depression. Chronic anxiety is actually the most common symptom, and also the hardest one to ferret out because many people think that constant worrying is normal. It is not.

A significant change in any of the following could indicate depression: change in sleep patterns (whether it's insomnia or needing to sleep more than usual); change in libido (whether it's a loss of sex-drive or an excessive ratcheting up of sex-drive); change in eating habits (whether it's starving or over-eating); change in grooming habits (either becoming obsessed with how you look or neglecting your appearance). If you have always struggled with any of the above, or careen between extremes, it could indicate chronic depression.

Some depressed people experience mild or limited sadness but huge and sometimes violent anger. Sadness is usually accompanied by passivity which is why, in my experience, suicide is less likely to follow a fit of melancholy than a fit of uncontrollable anger: a rage that, turned inward, turns poisonous and self-destructive. Suicides intended to mess with the minds of survivors are almost always acts of rage. The more dramatic the suicide, the greater the rage.

Self-destructiveness, of any type, is a symptom of depression. A mentally healthy person is driven to survive. Chronic eating disorders, addictions, self-mutilations, reckless driving or other high-risk behaviors (including unsafe sex in adults who know better) all express a certain death-wish. There are exceptions, but my clinical experience has shown that drunk, the gambler, the cutter, the anorexic and the morbidly obese are almost always suffering from chronic depression. We can argue which came first -- the depression or the disorder -- but that doesn't change the reality that you are depressed.

Some depressed people never consciously feel sad or angry, but suffer from aches and pains, frequent colds or infections and mysterious illnesses (such as fibromyalgia) that MD's can't cure or treat effectively. In adulthood, some chronic conditions may either be the direct result of depression or exacerbated by depression, which undermines immunological protections and brain chemistry. In children, depression may not be perceptible if you're only looking for signs of sadness. When a child has chronic stomach-aches or headaches that cannot be medically explained, the likely cause is depression. I was such a child: often smiling and cheerful in public, but secretly wracked by intense headaches and stomach aches. And, yes, I was chronically depressed.

Depression is hard to separate from stress and when combined with stress, the results can be fatal. It's a medical truism that attitude is an important ingredient in healing. Depressed people as a rule recover slowly or poorly from diseases and surgeries. Depression robs people of the ability to defend themselves mentally against the stress and fear that accompanies significant health crises.

There are more ways to cure depression than taking medications for it (though I recommend them as the most effective and immediate way to treat depression). Talk therapy has been proven to be the single most effective way to combat the blues. Beyond that, my own recommendations to patients who acknowledge they're depressed, want to do something about it but don't want to take drugs is to make behaviorial changes to pump up the good brain chemicals. The best natural remedies to bad brain chemistry IMX have been exercise, yoga, and meditation or a combination of the three. A satisfying sex-life can be curative too.

Another fine remedy is pet ownership. Whether they teach you new ways to live or provide the unconditional love and support you've missed in life, I believe that the company of a beloved little furry creature is the next best thing to an anti-depressant.

So if reading this has made you blue, here's your afternoon therapy:

OH! You're a cat person. OK.

Comments

[Jenny Lane]

What a load of crap...Psychology is about power and control. Telling someone what they actually feel instead of listening to them is projection. You need to learn to listen to people.

To suggest that anxiety, "the most common symptom" of depression is abnormal is to place a tremendous burden on people who are overstressed from a culture which will not just let them be, but demands that they sell their lives so that a small few can get rich. Our society is sick, the environment degraded, our connection to the earth lost...and we are supposed to be happy?

And self-destructiveness is not always a "symptom of depression". There have been cultures which existed in the past in which people would effectively commit suicide if they were too much of a burden to their community. The idea that death is terrifying was not ubiquitous across cultures.

[Gloria]

We'll have to disagree. It's easy to blame that amorphous thing called "society" instead of taking personal responsibility for one's own state of mind. The world has always been a hard place. There have never been any perfect societies. Still, individuals can and do achieve internal peace and balance. If enough individuals were to make the commitment to develop their internal lives and find their own truths, it would all add up to a better world.