Depression is not a choice
It is so very important for all of us to better understand depression. As the third leading cause of disease burden world-wide, depression impacts every family in Canada.
“ True depression is not the blues, sadness or even grief. It is an overwhelming and enveloping despair, so bleak and dark that people who have experienced it say that it is the worst pain they have ever endured.”
MOOD DISORDERS OF CANADA
There are many common misconceptions and myths about depression. Many with depression hear phrases like “just get over it”, “look on the bright side”, “snap out of it”, or “stop being so sensitive.” In fact, one of the most common misconceptions about depression is that it is not a real medical diagnosis and is instead, a sign of weakness or ‘laziness’. Sadly, it is often this type of stigma about depression that prevents people from coming forward and seeking help.
Yet, not only is depression real, it is not a choice. Depression is not something people choose or have control over. According to Mood Disorders Canada, 1 in 20 men and 1 in 20 women will experience depression in their lifetime. Depression can be triggered by biological or situational factors and can come in many forms, with over 227 combinations of symptoms that can impact a person affected. Yet depression is, in fact, one of the most treatable mental illnesses. People can and do recover from depression. Recovery means living a meaningful and healthy life despite the challenges of a mental illness.
The myths vs the facts about depression
Myth: Depression and sadness are the same thing.
Fact: Being sad is not the same as having depression.
Depression is a mental health condition that cause people to experience extreme sadness, trouble sleeping, loss of energy, difficulty thinking and much more.
Myth: People’s genetics dictate whether they develop depression.
Fact: Depression is caused by one or more factors.
This can include biological factors, life experiences, family history, personality, and environment.
Myth: People with depression cannot work in stressful jobs.
Fact: People with depression can work demanding jobs.
People with depression hold jobs in diverse fields and at all levels. Depression impacts people’s work and personal lives differently. There is no “one size fits all” with depression.
Myth: Medication is the only way to manage depression.
Fact: Not all cases of depression involve brain chemistry.
In these cases, the use of antidepressants can worse symptoms. Everyone doesn’t experience depression in the same way, and because of that, neither should treatment.
Myth: Depression is temporary and will go away by itself.
Fact: Depression isn’t something you can “pull yourself out of.”
You wouldn’t avoid seeking help for a physical illness. Why would you not get the support you need to feel better?
Myth: Those impacted by depression do not recover.
Fact: People with depression do get better.
Early and effective treatment of depression leads to the best results and usually consists of medication, psychotherapy or a combination of both.
What causes depression?
Common Depression Causes
Stress
Experiences of trauma including sexual, physical or emotional abuse, extreme neglect or abandonment
Traumatic events including domestic violence, rape, war, kidnapping or witnessing / experiencing violence
Living with drug or alcohol abuse (in self or family members)
Recent events / life transitions such as: death of a loved one, job loss, chronic illness, retirement, attending a new school, a new baby
Family history / genetics
Gender and age
Poor nutrition, exercise, sleep
Physical health issues
Mental health problems
Prescription drugs / medications
Brain chemistry imbalance
Personality traits, thoughts and behaviours
The effects of depression
“ Depression is being colorblind and constantly told how colorful the world is.”
ATTICUS
Genetics, difficult life events, personality, uncomfortable feelings, low mood, and unhealthy behaviours – all these factors interact with one another, leading to the downward spiral that is called depression. As a result, low mood, despair, sadness, anxiety and numbness are typical of depression. These feelings can result in reactive behaviours such as social withdrawal.
In some cases, self-medication with drugs or alcohol as individuals try to cope and manage symptoms on their own. As many as 40% of people with depression struggle with the over-use of alcohol or other substances. In extreme situations, people completely neglect their self-care (they don’t eat properly, don’t shower, and don’t take care of their living space).
Symptoms of Depression
Formally, a diagnosis of depression is warranted when you have been experiencing at least five of these symptoms for a period of two weeks or more.
Sleeping too little or sleeping too much
Gained or lost a significant amount of weight
Highly anxious and agitated or sluggish and inert
Have unexplained aches and pains
Extremely sad or very bad tempered - or both
A loss of interest in the pleasures of life, as well as work, family and friends
Unable to concentrate and make decisions
Negative, anxious, trapped, unable to act
Despairing, guilty and unworthy
Fatigue and an overall loss of energy
Suicidal – expressing thoughts and sometimes, making plans
Numb – an awful feeling of emptiness
Unexplained and ongoing aches and pains
Different types of depression
Major Depressive Disorder
Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.
This diagnosis is applied when you have experienced five or more of the symptoms discussed for two weeks or longer. In addition, your symptoms have resulted in significant changes in your ability to function at work or school, and socially.
Some people with major depressive disorder can experience psychosis where their thinking is disordered and out of touch with reality. Given the features of depression, their thoughts are most likely to be ones that are devaluing (I’m worth nothing. The world would be a better place without me). A major depressive disorder can occur once in a lifetime, never to return - or episodes can be recurrent.
Dysthymic Disorder
“Dysthymic” or persistent depressive disorder, is a medical term for a form of depression where people experience continuous low moods for a long time. They may still function, but struggle with lack of interest, poor appetite, insomnia, low self-esteem, limited concentration and feelings of hopelessness. Though persistent depressive disorder is not as severe as major depression, people find it hard to be upbeat even on happy occasions — or may be described as having a gloomy personality, constantly complaining or incapable of having fun. Without treatment, this type of depression can go on for years, leaving people thinking that this is “just the way I am”.
Postpartum Depression
Postpartum depression is different from the “baby blues,” which begin within the first three or four days of giving birth, require no treatment and lift within a few hours or days. PPD is a deeper depression that lasts much longer. It usually starts within the first month after childbirth (although it can occur any time within the first year) and can last weeks to months. In more serious cases, it can develop into chronic episodes of depression.
Seasonal Affective Disorder
SAD is a form of depression in which symptoms follow a recognizable pattern that coincides with a particular season rather than a separate condition. SAD is triggered by the low light and grey days of winter. It is not surprising that SAD is more common in northern countries, like Canada. Many people get the winter blues, but SAD is true depression with people withdrawing, missing work and social events due to their symptoms. Symptoms of SAD range from mild to severe and treatment for mild versions of SAD can be as simple as getting outdoors more often or, for those who can afford it, taking a vacation to the sun. For severe versions of SAD, people are prescribed antidepressants and undergo “light therapy,” which means daily exposure to light boxes that emit full spectrum light – just like sunlight.
Depression and Anxiety
It is not uncommon for people diagnosed with depression to also experience anxiety. According to Mood Disorder Canada, 50% of people with depression also have symptoms of anxiety.
The reverse is also true. People whose primary diagnosis is anxiety are found also to be experiencing depression. People with both depression and anxiety have more severe symptoms and respond more poorly to anti-depressants. Their lives are also more severely affected. Treatment is highly likely to involve medications for both depression and for anxiety. Finding the right combination can take time as each person is different and can respond differently.
Depression and Post-traumatic Stress Disorder
While PTSD is medically categorized as an anxiety disorder, it can also manifests itself as depression.
Post-traumatic stress disorder involves four areas of symptoms: intrusions (unbidden thoughts, feelings and likely flashbacks); avoidance (staying away from places, people, sounds – anything that constitutes a “trigger”); alterations in arousal (exaggerated startle response, quick to anger) and negative alterations to thoughts and emotions (blaming others and yourself for what happened, feeling guilty you survived while others did not, hopelessness, no sense of future). In other words, depression.
Depression and physical pain
Did you know, that people who are actually depressed often talk to their physicians only about their physical pain?
Through research, it is thought that depression may increase a person’s sensitivity to pain or may increase the suffering associated with pain. Studies have shown that, of those reporting nine or more physical pain symptoms, 60% had depression. When only one physical symptom was reported, only 2% were found to have depression. Why?
Researchers believe that there is a shared neural pathway for pain and depression with serotonin and norepinephrine involved in both mood and pain, and has shown that the higher the number of physical symptoms a person is experiencing, the more likely it is that they are to be suffering from depression. In fact, depression is strongly suspected when physicians cannot find a physical source for the pain patients report experiencing.
Further, people who experience chronic pain as part of their depression are more likely to also have suicidal thoughts. In addition, people with diagnosed physical illnesses such as stroke, diabetes, heart disease, dementia or cancer (to name only a few) suffer depression in disproportionately higher numbers than the general population.
Depression and substance abuse
Did you know that 1/3 of people with depression also have an alcohol problem?
People with depression are prone to alcohol and drug abuse, and the opposite is also true. People who abuse drugs and alcohol are also more likely to experience depression.
It is often the case that depression comes first, perhaps developing in adolescence. While people with depression begin drinking as a form of self medication for depression, the reality is that alcohol makes depression worse. People have more frequent and more severe episodes of depression. Alcohol abuse makes anti-depressants less effective.
Overcoming depression
Depression isn't a sign of weakness. It's not something you can just "snap out of." It's an illness that requires professional attention. Yet with the right care, people can feel better. As mentioned, depression is experienced differently and caused by a wide range of specific factors. The options available to overcome depression will depend on what works best for you, your symptoms, and your goals for recovery.
Therapy
Relational therapy says that life hits us with painful experiences that we just can't shake. Over time, this entrenches and affects our mood, behaviour, and desire to engage in the world. We enter a protective cycle, finding it difficult to find our place in the world. Awareness of this cycle helps us to interrupt it — with mindful thoughts and actions — which can lift our mood and help us to develop a connection with ourselves that allow us to live a life lived more with meaning and fulfillment.
It can be helpful to talk with someone who’s “been there”. Someone who knows about the steps to recovery, the possible set-backs you may encounter and what it is like to believe that the darkness will never lift – until, one day, it does. Engaging in the process of communicating and getting to understand your depression will gradually make you more active in the decision-making about what is and is not working for you to move you forward in a more positive way.
Medication
Medication for depression is a complex topic. Depression is often described as a “chemical imbalance” in the brain, where certain neurotransmitters (your brain chemicals) are not at the levels they should be to maintain a “positive” mood. The most common medications for depression are designed to increase the levels of these neurotransmitters and thus, improve your mood. However, there are many brands with different chemical formulas, each designed to act somewhat differently in the brain. Medications do not act immediately to lift mood and can take anywhere from two to eight weeks to begin to work – a frustrating experience if, you don’t have the right medication on the first try and must now turn to something else. One thing to consider, from certain humanistic perspectives only using medication without therapy can sometimes end up supporting an experience where people feel trapped and helpless against the possibility that they can actually go beyond “coping” and changing their lives for the better. That’s why often doctors will recommend therapy alongside medication.
Alternative Therapies
Many people with depression include a variety of treatments in their recovery regime, in addition to medication and therapy. Complementary therapies can include massage, dietary supplements, yoga, meditation, art therapy and many other non-medical approaches.
Self-Education/Management
Seeking therapy, educating yourself about your illness, and if it is for you, participating in a self-help group are all ingredients in recovery – as are other choices that may be particular to your individual needs and circumstances. It is central to your empowerment and recovery. It means that you begin to take personal responsibility for learning all you can about your illness and actively search out and try coping mechanisms that improve your self-management skills.
For family, caregivers and friends…
While there is no doubt that the person who is experiencing depression is suffering, those who care for them are also in pain. Here are some things you should know…
Educate Yourself
Families and friends need to know all about depression too, its symptoms and treatments.
This Is an Illness
Stigma is not only hurtful, it is dangerous. People with depression can’t pull themselves up by their boot straps. Fear of cruel judgments can prevent people from getting help in the first place or interfere with their treatment and recovery when they do enter treatment. Self-stigma is particularly insidious, as it robs people of hope and they begin to feel that they deserve to suffer. As a result, those suffering from depression can hold exactly the same devaluing attitudes and blame themselves for their illness.
Avoid Trying to Reason People Out of Their Negative Feelings and Beliefs
People in the depths of depression do not respond to reason. Many of the most overwhelming symptoms of depression are thoughts of worthlessness, hopelessness and suicide. The pain is so great, people can view death as a relief. In fact, 15% of people with chronic depression die by suicide. Thoughts of suicide must be taken very seriously and if your loved one is openly expressing a wish to die, do not hesitate to take them immediately to an emergency room or call 911 for help – it’s that urgent!
Take Care of Yourself
Families and friends suffer too. They need their own circle of supports and possible treatment for their mental health. There are self-help groups, especially for families and friends, where they can get advice, receive support from others who are going through what they are and exchange tips on coping mechanisms.
We’re here if you need help.
Therapy is a valuable tool that can help you to solve problems, set and achieve goals, or teach you new ways to track your emotions and keep your fears in check. It can help you to build the life, career, and relationship that you want. Does everybody need it? No. But if you are curious about working with a therapist, that curiosity is worth pursuing.
We know it takes a great amount of courage to examine your life and to decide that there are things you would like to change. And, it takes more courage to do something about it. We can help. We offer free consultations for anyone in Ontario considering individual or couples counselling, online at The Dot. We will go through any of your questions and concerns to help you decide whether online counselling is the right choice for you.