“Every man has his secret sorrows which the world knows not; and often times we call a man cold when he is only sad.”― Henry Wadsworth Longfellow
Depression is one of the most common and debilitating illnesses that a human can suffer from. It is subtle and cunning, making it hard for the victim to recognize, invisible enough so that others often don’t know, and is often misunderstood even by the medical community. It is the common cold of emotional problems, effecting 340 million people worldwide, 16 million Americans annually, and it is estimated that as many as 25% of American women and 10% of American men will meet its clinical diagnosis at any given point in time. 50% of all Americans will meet the criteria to such a degree that they would qualify for inpatient psychiatric care at least once during their lifetime. It would appear that many of us are quite sad a lot of the time.
Over half of all cases of depression go untreated, largely because those suffering with depression misinterpret the symptoms, attributing them to something else. Here is a short list of some of the more common symptoms:
⦁ a lack of energy, and more fatigued than usual
⦁ a sullen mood that differs from what’s normal
⦁ decreased ability to concentrate
⦁ decreased ability to tolerate normal, everyday frustrations
⦁ feelings of hopelessness, guilt, and anxiety
⦁ changes in sleep patterns and appetite
⦁ loss of interest in things that normally are sources of pleasure
Depression, like most mood disorders, will come and go during the course of a lifetime. Many who suffer from depression pass it off as something that they “just have to ride out for a while,” not seeking help because they are embarrassed, ashamed, or because they pass it off as part of their personality. “It’s just the way I am.” For those with mild to moderate depression, it will pass, usually within 6 to 8 weeks time. For those that are unaware of their own patterns, it will return, seemingly without warning, over and over again during the course of a lifetime, wreaking havoc on relationships, work, finances, and health. Untreated major depression can lead to major medical problems, substance abuse, chemical dependence, being incapable of routine functioning, or suicide.
Most suffering from depression who do seek help are first seen by their primary care physicians. Because physicians are schooled in a more medical model, victims are often diagnosed with a physical ailment and treated for that when mental health treatment is a more appropriate approach. Primary care physicians have limited time with patients, and many are prescribing psychiatric medications, including antidepressants, without having done a full psychiatric workup on the patient. Many insurance providers require all patients to be screened for specialty care by their primary care physician, with the PCP referring the patient as needed. This has resulted in primary care physicians becoming the front line providers for mental health care in the United States. The Journal of Mental Health and Family Medicine states that primary care physicians identify 33% of their patients as psychiatric, rather than medical, and that PCPs are prescribing approximately 75% of all psychiatric medications.
The combination of patient misunderstanding of depression, societal stigma, and primary care doctors’ time constraints usually leads to the PCP prescribing a medication and the depressed patient is out the door, on their merry way, changing nothing except the ingestion of a medication 1 to 3 times per day. Patients usually try the medication for a while, often discontinuing it because “it didn’t do anything,” or “I didn’t like the side effects.” The patient usually gives up on treatment because “I tried it and it didn’t work.” They believe that they have been treated for their depression, but this is not the case.
Treatment for depression, and most psychiatric issues, is best started with non-medical interventions focusing on thought processes, behavior, routines, and nutrition. For clients struggling with depression, it is also important that an assessment is done focusing on lifetime patterns of depression, seeking to identify common situational and internal triggers that can give insight into the patient’s unique relationship with their depressive symptoms. While a complete physical examination done by your primary care physician is necessary in order to rule out any physical causes, do not rely on your PCP to be your sole treatment. There are many steps that should be taken first, before medication is tried. Often, behavioral and lifestyle changes make medication unnecessary, and results are more permanent than those that could be obtained by medication alone.
Here are some action steps that can help you cope with and prevent depression:
⦁ Try some Cognitive Behavioral Therapy as self-help. CBT is perhaps the most immediate therapeutic intervention for many emotional disorders, but works particularly well for depression. It works to identify habitual, maladaptive thinking patterns that can lead to spiraling depression. While CBT is best done with a professional counselor, it is a great self-help tool that you can learn and practice regularly. Check the “Therapies” of this blog or the Amazon.com link to the right for access to my e-book “CBT Made Simple: A QuickStart Guide to Cognitive Behavioral Therapy” for some easy ways to implement CBT immediately.
⦁ Get into a well thought out, daily routine. Depression responds very well to structured activities. It is important that each day has a written plan, or a depressed person runs the risk of remaining in bed too long. Most suffering from depression will tell you that getting out of bed is perhaps the most challenging time of day. A pre-planned schedule of healthy activities and scheduled, positive, human interactions is vitally important to a wellness plan that is capable of keeping depression at bay.
⦁ Get adequate, but not excessive, amounts of sleep. I often tell my clients that there is no mental health or emotional issue that a lack of sleep will not imitate. Developing a system of solid sleep hygiene will improve your physical and emotional energy, making you more ready to combat the symptoms of depression. (Use the search links on this page to obtain more information and hints of how to maximize your sleep)
⦁ Exercise each day. While you don’t need to do a lot to obtain the mental health benefits of exercise, you do need to do something regularly. Yeah, it would be great if you had a formal structured routine that included resistance work, stretching, and cardiovascular activities, but that’s not necessary in order to reap depression fighting benefits. Brief, but frequent bursts of activity during the day of moderate to low intensity is all that it takes. It can be simple activities such as housework and household chores, a 5 to 10 minute stroll during your lunch break, parking your car farther from the entrances of places that you are going to, or taking brief stretch breaks during the day. When combating depression, the key is to make exercise sessions very brief, frequent, and interspersed them throughout your day. Do not run yourself down with this! The purpose is to create energy, not deplete it. This physical energy will soon carry over into emotional energy as well.
⦁ Be aware of your eating habits. Three or more small meals each day provide a steady source of nutrition, giving your brain the fuel that it needs to process emotions more positively. Food should be healthy, rather than quick and convenient. Adequate amounts of protein in your preferred form – lean meats, chicken, or fish, plus as many vegetable sources as you can take in – is your best bet. Avoid, or at least cut down drastically on caffeine, simple sugars, and carbohydrates. Processed foods may be unavoidable, but try to cut them down as much as possible. Many studies suggest nutritional supplementation can have a positive benefit in the treatment of depression. Don’t be too quick to jump on the latest fad with this. Stick to some form of Omega-3 fatty acid such as fish oil, a vitamin D3 supplement, and watch your diet. If you have any doubts about what other supplements you should consider, consult your PCP.
⦁ Get as much sunlight as you safely can. Try to get outside during the day as often as possible without over doing it. Modern man does not get enough vitamin D in the form of sunlight. Many are prone to seasonal affective disorder, a form of depression that results from seasonal climactic changes. If you can’t get outside as much as you would like, try to get natural light through things like opening the shades and opening the sun roof on your car. (See also http://mindbodycoach.org/reason-sad/ for more on seasonal affective disorder )
⦁ Develop some type of meditative practice. Learning to calm your mind enables you to think more clearly and rationally. Irrational thoughts are characteristic of both depression and anxiety, two emotions that go hand-in-hand in the thoughts of a depressed person. The Stress Management link on this page will give you some simple solutions and suggestions if you are one of those who believes that they cannot meditate. It’s not as complicated as you may think. Incorporate some form of meditation into your daily routine.
Make these suggestions a part of your overall wellness program. If you are prone to depression, or merely want to have a more aware and productive life, then these suggestions are for you. If your depression does not respond to these strategies within a month, or if you are experiencing suicidal thoughts, then contact your doctor immediately. For major depression it is sometimes necessary to combine appropriate medications along with the strategies that are suggested here. Research indicates that for major depression these activities plus medications work far better in combination. Don’t be so quick to have your primary care physician prescribe medication. Medication as the sole treatment for any type of depression is not enough. Depression responds better to a more comprehensive attack. If you suffer from depression, don’t delay getting treatment or creating a wellness program to fight it. Depression is one of the more treatable emotional issues that people face.
“You say you’re ‘depressed’ – all I see is resilience. You are allowed to feel messed up and inside out. It doesn’t mean you’re defective – it just means you’re human.” – David Mitchell
P. S. Contact me if interested in online mindbody coaching or cognitive behavioral therapy. Please check out my author’s page at amazon.com/author/johnsannicandro or using the Amazon link on this page. Follow me on Facebook, Twitter, and social media. Email me at email@example.com.