Most everyone occasionally feels blue or sad, but these feelings are usually fleeting and pass after a certain period of time. When a person has a depressive disorder, these depressive instances can last for extended periods of time, sometimes feeling almost constant. Depression interferes with daily life and the ability to function, and causes real pain and suffering for both the person with the disorder and those who care about him or her. Clinical depression is a common but serious illness, and most that experience it need treatment to get better.
If you're living with depression, you know only too well how it feels for you. Each person experiences depression in their own unique way. One person may sleep too much, while another sleeps too little. Some people don't eat enough and begin to lose weight, while others overeat and gain weight. Other symptoms include poor concentration and memory, withdrawal from social situations and activities, reduced sex drive, and thoughts of death or suicide. We here at Cairn Center believe that depression is more than a collection of symptoms and direct our treatment towards not only effective symptom relief with medications when indicated, but focus our work towards addressing how depression can slowly erode a person’s sense of self. Major types of depressive disorders include:
- Major depressive disorder, also known as clinical depression, depression, or unipolar depression
- Dysthymia, a long-term low-grade depressive condition
- Atypical depression, characterized by overeating and over-sleeping, with feelings of extreme lethargy but a perception of pleasure
- Melancholic depression, characterized by an inability to feel pleasure in almost all activities, excessive guilt, insomnia, and significantly decreased appetite
- Seasonal affective disorder, a depressed mood related to the season
- Other types include: psychotic depression, post-partum depression, reactive depression
Most depressions are episodic and time-limited (in other words, they come and go). In about 50-60% of people, depression may return sometime in the future, and a quarter of patients will have more than 6 episodes. The risk for recurrences increases with every episode, especially if not fully treated. In 10% of people, depression can become chronic, and affect them to the degree that they no longer feel like their usual self again. Depressive behaviors and thinking can include:
- A strong and immediate correlation between adverse events and feelings associated with depression like hopelessness. Genetic predisposition creates vulnerability, which may get activated by stressful events.
- Depressed individuals make negative evaluations of themselves and their capabilities, their relationships, the world, and have a bleak view of the future.
- Depressed people may be preoccupied with, or ruminate over thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness, hopelessness, and self-hatred.
- Depressed individuals can be quick to make arbitrary inferences that reach unjustified conclusions, over-generalizations, magnify the negatives, minimize positive attributes, and can selectively take things (often negative) out of context and believe them to be truths.
- Depression is fueled by repeated, intrusive thoughts that push themselves into consciousness and preoccupy and dominate the mind, leaving little opportunity for the experience of happier thoughts. These automatic thoughts often follow the themes of low self regard, excessive self-depreciation and self-blame, feeling deprived or “less than”, irrational self-commands to assume more responsibilities or difficulties than are warranted, and self-scapegoating.
- Depressed individuals can have unrealistic assumptions, standards and goals that set them up for failure, thus compounding their depression. Common themes are: perfectionism, “I should never fail in anything that I do," "I cannot be happy if anybody criticizes me," "Everybody must like me," "I must come in first and be the best,” and "I cannot be happy unless I have _______."
- Occurrences, particularly negative ones, in everyday life tend to take on a personal significance.
- Depressed persons assume failure before they start, over-appraise risks, can be plagued by fears of loss of control, and often play debilitating ‘what-if’ games with themselves.
- Final Catch-22: Thinking in unhealthy ways leads to unhappiness, and being depressed and unhappy fosters negative and depressive ways of thinking. A vicious circle develops which produces and maintains a depressive syndrome across months or years.
Between 29% and 46% of patients who take an antidepressant either do not respond or have only a partial response to treatment. Depressed patients and even their clinicians get satisfaction in partial (but much appreciated) improvement in symptoms, and may not even recognize or report residual symptoms.
We, at the Cairn Center, are pleased when our patients' symptoms lessen, but we aim further. With potential use of both medications and therapy, the established goal of treatment for depression is the full remission of symptoms, with the patient being free of all depressive symptoms and in charge of renewed coping mechanisms.
What Can You Do to Help Your Doctor Treat Your Depression
- Keep all of your appointments.
- Take the medication exactly as prescribed
- Just as with a condition such as Diabetes one needs to monitor progress with regular blood sugar checks, with depression regular monitoring using a questionnaire scale like the PHQ-9 is essential. We use it to assist with diagnosis and identification of problem symptoms at the initial visit and to measure treatment response and identify specific symptoms that are not responding in follow-up visits. Please help us by filling out the form before each visit.
Key Antidepressant related questions:
- Antidepressants only work if taken every day.
- Antidepressants are not addictive or habit forming. If you are using alcohol or other drugs, please discuss this with your doctor and be completely honest and forthcoming. We cannot treat what we do not know.
- Benefits from medication often appear slowly. 50-80% of people with depression recover completely with an adequate trial of medication. People with depression usually start to feel better after taking an antidepressant medication for two to six weeks. Don't give up if you don't feel better right away.
- Continue antidepressants even after you feel better. Once you have completely recovered from your depressive episode, you should stay on the medication for another six to nine months to prevent your depression from returning. Some people who have had previous episodes of depression should stay on antidepressant medication for longer periods of time to prevent new episodes of depression.
- Mild side effects are common and usually improve with time. The first week or two are the hardest. Try to stick it out. The side effects usually go away in a few days and the medicine should start to work soon.
- If you're thinking about stopping the medication, call your doctor first. If you stop taking the medication too soon, you would be at high risk for having your depression return. In addition, some medications must be stopped gradually to give your body time to adjust.
- The goal of treatment is complete remission. Sometimes it takes a few tries.
- In many cases, poor sleep is a primary symptom of depression. Once the depression lifts, sleep improves as well. Some antidepressants can help restore normal sleep, even in people who do not have depression. They are advantageous over other sleeping pills in that they are not habit-forming, and they usually do not impair concentration or coordination.
- Life stress can cause or worsen the symptoms of depression. The depression can then worsen the impact of stress (such as work stress, family problems, physical disabilities or financial worries) and your ability to cope with them. Treating depression can help some patients break out of this vicious circle.