Depression is the most common of all of the psychological problems people can struggle with. It is often referred to as “the common cold” of mental disorders. It is estimated that at any given time, 18-20 million Americans suffer from a depressive disorder and unfortunately, it is also one of the fastest growing diagnoses in America today.
Depression comes in various strengths, forms and hues. There are chronic depressions, severe “clinical” depressions, bipolar depressions, seasonal depressions and depressions related to life change events.
My view is that depression is a multi-dimensional disorder. Even though it is termed a mood disorder, depression involves more than our moods. It also involves physical health, body chemistry, behavior, thinking, relationships and spirituality. It is a whole person disorder. These various components of depression offer some clues for how you can manage your depression.
Physical Health: Depression affects our physical health by possibly contributing indirectly to a variety of health problems, including hypertension, overweight and diabetes to name just a few. In turn various medical conditions can contribute to depression. Depression is often triggered by childbirth, menopause, a thyroid condition or chronic fatigue syndrome. To manage your depression physically, first get a physical exam. If appropriate, stay active. Physical exercise helps relieve depression. The more regular and appropriately intense activity the better. If nothing else strenuous physical exercise will help you sleep better, a corrective to the inability to fall asleep and stay asleep that are often symptoms of depression. Exercise also helps you maintain a daily routine which works to overcome the passivity that accompanies depression.
Body Chemistry: Research now clearly shows when we are depressed, our brain chemistry changes. Various anti depressant medications relieve depression because they re-balance the brain chemistry. Particularly if your depression is severe or chronic, consider the use of medications to mitigate your depression. Consult with your physician or psychiatrist for details. However, do not forget the less effective but equally important element of nutrition. Depression is often accompanied by a lack of energy or fatigue. If you are over weight or eating excessive amounts of wheat, sugar and/or salt, you may be unintentionally contributing to your depression.
Emotions and the Will: Depression is typically labeled a mood disorder, a feeling of low mood, discouragement, lack of motivation and hopelessness. Depression has a way of paralyzing the will, your motivation. You may want to get better, but you cannot muster the motivation to take even your own advice. So it is that depressed people feel as if they have fallen in the dark hole, spiraling downward. Depression tends to feed on itself. Depressed people often feel helpless and powerless.
In particular pay attention to two emotions—grief and anger that are often associated with depression. Depression may be the result of some unresolved grief in your life, or even an anticipated loss that you are not facing up to. Depression may also be related to some unresolved anger or resentment, particularly self anger. Self criticism or self hate is one of the classic dynamics that underlies depression. What are you mad at your self for? What are you blaming yourself for? These kinds of emotional issues can run deep. If you are stuck here, contract with a therapist to do some work together around the emotional pieces of your depression.
Cognitions or Thoughts: Cognitive psychologists have learned that depressed people have distorted or negative thoughts. These “cognitive distortions” influence feelings or affect. Of particular interest is the “primary triad:” 1) pattern of interpreting events in negative way, 2) viewing yourself in negative way, 3) tendency to view the future in a negative way. If you have problems with depression, monitor your self talk. What are you thinking? What assumptions are you making about yourself and about life? Are those thoughts or assumptions accurate and truthful, or distorted by the depressed mood?
Sometimes it is not the bad things that happen to us that makes us depressed, but the meaning we conclude from these events that causes us to feel depressed. There are many self help books on the cognitive approach to depression, but you may also find a cognitive therapist or psycho-educational group on depression to be very useful to help you master the skills of self talk.
Relationships: Some family relationships can make us depressed. Indeed, sometimes it seems like depression runs in the family. For example, if you are in a dysfunctional or abusive marital relationship, you may be feeling depressed and helpless. If you are in an unproductive job, you may feel discouraged and trapped. If you are being discriminated against or oppressed in some fashion, you may feel depressed and resentful. Getting a handle on your depression may include getting into couple or family therapy, or even group therapy. You may feel a lot better when your relationship issues have been resolved.
Conversely, the loss of a valued relationship, through divorce or death, can also trigger a depression. Depression is a common component of most mourning processes. Sometimes depression occurs in response to any unwanted life changing event, such as a loss of job or a relocation or a health challenge.
Spirituality: Depression impacts our spiritual life. It may be harder to sense God’s presence in your life, or to feel grateful or joyful when you are chronically depressed. You may feel as if your life lacks the purpose or meaning that it had prior to the onset of depression. You may feel as if your prayers are not answered or even heard. You may pass through what the saints of old called the “Dark Night of the Soul,” a time when God seems distant or silent. For some people depression may be related to a lack of forgiveness in their lives, either they feel a lack of self-forgiveness or they are having trouble forgiving someone else. Realizing and embracing forgiveness may help release your depression. For others, hopelessness may be a major component in their depression. Depression makes people feel more hopeless, and in turn, hopelessness contributes to depression. When hopelessness and depression become their most intense, you may be vulnerable to ideas of suicide and/or self destructive behaviors. Attending to your spirituality, keeping it positive, being a part of a spiritual community will help you cope with depression.
To successfully cope with depression, you need to take a wholistic approach, tapping the resources of your body, your chemistry, your emotions, your thinking, your relationships and your spirituality.
R. Scott Sullender, Ph.D. Licensed Psychologist PSY 8931