MENTALLY THINKING

DEALING WITH MAJOR DEPRESSION

BY BONNIE FLOYD

We have all felt depressed from time to time. Everyday life is full of multiple opportunities to feel down. Perhaps our car repair bill exceeds what we expected it to be, or we step on the scales, only to discover that we have gained five pounds over the weekend.

Feeling down in response to negative life event is entirely normal. However, the development of clinical depression is an entirely different matter. Depression is a serious medical disorder. The lifetime risk of suicide for patients with untreated depression is 20%, whereas the risk for treated depression is only 0.141%.

Major depression affects every aspect of our well-being; it has motivational, cognitive, emotional, and physiological symptoms. Consequently, it is most accurate to define depression as a mindbody disorder, as opposed to a mental illness. Motivational symptoms are marked by reduced drive to engage in activities, including those that were previously enjoyed. Cognitive symptoms include the display of cognitive errors, such as engaging in “all or nothing” patterns of thinking; emotional symptoms include a deep sense of sadness or an inability to feel pleasure. Physiological symptoms include fatigue, increased/decreased appetite, and increased/decreased sleep.

There are many different types of depression. A major depressive episode is characterized by a period of two weeks or longer in which individual experience certain symptoms of major depression: feelings of sadness and hopelessness; angry outbursts, irritability, or frustration over minor events; increased fatigue, so that even minor take extra effort; weight gain or weight loss; changes in sleeping habits; slowed thinking, speaking, or body movements; feelings of worthlessness or guilt and rumination about past failures; difficulty with thinking, concentrating, making decisions, and remembering things; unexplained physical problems, such as back pain or headaches; loss of interest in previously enjoyed activities; or frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide.

Sometimes, an individual experiences a single instance of a major depressive episode. Other individuals may struggle with depression as a chronic illness, experiencing multiple episodes of depression during their lifetimes. It is important to remember that symptoms of having an isolated episode of major depression are just as serious as those experienced by individuals who have been diagnosed with recurrent major depression. In my experience as a clinical psychologist, individuals with recurrent major depression are more likely to experience the inability to experience pleasure, as opposed to feeling extremely sad.

Episodes of major depression are frequently triggered by a situational event, such as a death in the family, the loss of a job, the ending of a relationship, or some type of trauma, such as a physical assault. A leading theory of the development of mental illness is the diathesis-stress theory. This theory maintains that a biological vulnerability to the development of mental illness interacts with the experience of a stressful event to produce emotional distress. A biological predisposition is not sufficient in and of itself, to produce depression; similarly, a stressful event by itself is not sufficient to produce symptoms of a depressive episode.

There are well recognized gender differences in experiencing a major depressive episode. Women are twice as likely than men to experience depression. Depressed men are more likely to exhibit increased anger and irritability; they are also more prone to making risky choices. Women who are depressed are more likely to feel guilty, sad, and ashamed.

There are several important means of coping with a major depressive episode. Receiving psychotherapy is an important component of dealing with depression. Cognitive-behavioral therapists address how cognitive distortions lead to the development of depression. For example, those who are prone to the development of depression often engage in catastrophic thinking; they jump to the worst- case scenarios when faced with difficult circumstances.

Being consistent with taking antidepressant medication is another important component of treating depression. For those with recurrent depression, it is necessary to remain on antidepressant medication on a long-term basis, even when not feeling depressed. Finding the most

“Major depression affects every aspect of our well-being; it has motivational, cognitive, emotional, and physiological symptoms.”

effective antidepressant essentially involves trial and error. The best outcomes are associated with reception of psychotherapy, plus taking an antidepressant medication; this effect is synergistic.

Spending time with supportive individuals is of great benefit during periods of depression, despite most depressed individuals’ tendencies to withdraw from others. Practicing adequate self-care is critical when dealing with depression. Self-care may include attending therapy or support groups; practicing meditation or yoga; journaling thoughts and emotions; actively challenging negative thought patterns; and engaging in relaxing and enjoyable activities.

It is essential to practice good physical health habits in order to combat depression; eating a healthy diet, trying to obtain adequate sleep, getting plenty of exercise, and avoiding alcohol and drugs is extremely important. Finally, spending time outside is an important strategy to combat depression.

Depression is very challenging, but it is a manageable medical condition.