Categorized | Depression

Living With Depression

“Depression is the sadness that informs as it leads an animal to pursue that course of action which is most beneficial.”  Charles Darwin

Today, I’m revisiting a post that I wrote in September of 2011 called the Beneficial Face of Depression. Undeniably, there is an upside to depression, as I talked about in this post. But, for the most part, clinical depression is a dark curtain that closes you off from the world.

Many people do not understand clinical depression. They see it as a weakness of strength, faith, will or personality. This may be true of even some of you who may have it. It’s not easy to wrap our minds around depression, as it seems like something basic to one’s nature, rather than the biophysical disease that it is. There’s still a social stigma attached to clinical depression. It’s easier to share with people that you are diabetic than you are being treated for clinical depression, although both are medical disorders.

Thus, I understand your resistance to accepting that you or a loved one may have a depressive disorder that needs treatment. Nonetheless, if you want to live well, despite depression, you need to accept its causes and treatments. By any measure, living with depression is one of the toughest mental health diseases to endure. So many of you have shared stories of how depression has affected your life. Some of you have been living with depression for most of your life and worked hard to manage it. Others of you have lost children, siblings, parents, relatives and friends to it, through suicide and drug and alcohol addiction. Although depression can open you to psychological and spiritual reflections, understandings, creative self-expression and wisdom of inner spirit, for the most part, it feels like a hell that you, alone, must suffer.

But, you are not alone. Depression affects 121 million people worldwide and is responsible for 850,000 deaths per year, through suicide. 1 out of 6 (17%) Americans have a depressive episode, in his or her lifetime (New Worldwide Statistics for Depression). And, like alcohol and drug addiction, clinical depression does not discriminate. It affects every country, culture, and race, rich and the poor. Some of culture’s most beloved writers, musicians, poets, painters, producers, directors, celebrities, and royalty have struggled with clinical depression. (Famous People Living With Depression).

What is clinical depression?

Clinical depression is a persistent sadness and loss of interest in living. It is more than transient blues or a bad mood; it is a severe, unrelenting state of physical, mental, and behavioral symptoms that affect how you think, feel, and act, and the will to live.

The clinical depressive disorders include Major Depression Disorder (MDD) and Depressive Disorder, unspecified. But, I’m also including the Bipolar I and II Disorders that are predominantly of the depressive type and Dysthymic Disorder, which is a lower grade, long term depression that may also require clinical intervention. Clinical depression can stand alone as in MDD or be part of a larger psychiatric disorder as in narcissistic and borderline personality disorders. But, whatever form of it you have, for sure:

Clinical depression is a huge, unwieldy ship that must be steered properly, so as to avoid personal destruction. If steered well, it can enrich existence as much as threaten it.

What causes depression?

Clinical depression is the result of biological, genetic, environmental and personality influences that alter the brain’s chemistry. The character and intensity of these influences can create a stress load that depletes the body’s nerve chemicals and hormones implemented in mood, problem solving and behavior. This can lead to a clinical depression. Remember, your brain chemistry is to you, like a fancy computer system is to a car. If it breaks down, you stop running.

Also, no two depressions are exactly alike, because of these varying influences. Take, for example, the death of a child. This loss would cause all of us to be depressed. But, it is your state of physical and mental health, past experience, and beliefs and value system that can move you from the sadness of normal grieving into a full-blown depressive episode. It is the complexity of these influences that makes it challenging to accurately diagnose and treat a depressive disorder.

Rule of Thumb: Psychiatrists and Psychologists have the most education and training to diagnose and prescribe treatments. The treatment plan for a first-time Major Depressive Episode can be quite different than prescribed treatments for the more recalcitrant types of depression that have a strong biological contribution to them, like Dysthymic Disorder, and Bipolar I and II Disorders. Also, there are many accompanying mood and behavior features, like anxiety, anger, or impulsivity that also dictate the recommended treatment.

Five-Step Treatment Plan

You can live well, despite your depression. I know this, personally. Indeed, I’m more than an arm-chair philosopher. I have lived with depression for most of my life and have learned to manage it very well. Today, you would never know that I have a strong biological tendency toward depression. My education and training has helped me to steer this unwieldy disease quite well. But, even more than this, it is my dedication to living life well that has seen me through periods of depression.

Thus, in the words of Charles Darwin, let your depression inform and lead you to a beneficial course of action. The five-step treatment plan that follows is beneficial to your physical and mental health. It’s grounded in research and practice, and also in personal experience.

  1. Consider Medication. You may resist this idea (many people do), but please consider the need for antidepressant medication. Clinical depression is a disruption in the brain’s chemistry. If you don’t get the brain chemistry right, you lessen your chance for getting better. Also, give your Psychiatrist a chance to help you. Although he or she knows how to treat you, prescribing medication is not an exact science, because of so many individual differences in clinical depression.
  2. Get psychotherapy. Psychotherapy in conjunction with medication can help you to understand better the circumstances and events, thought patterns, and learned behaviors that worsen depression. It also provides you with information and resources for understanding its treatments. Also, psychotherapists give you the support you need to come to grips with your depression, to see that you have choices in managing it, and to regain control of your life.
  3. Examine Choices. Even if your depression has a strong genetic contribution, the choices that you make in life can send you into a depressive episode or worsen one that you already have. For example, if you keep repeating past mistakes of relationship, job choice, or whatever else it is that is keeping you unhappy, you need to choose differently, so that your choices do not worsen your depression. If you do not, no medication or psychotherapy will be enough to keep depression at bay for you.
  4. Keep up your health habits. Sleep, nutrition and exercise are vital to good physical and mental health.  There is a lot of research that shows the benefits of good health habits on depression. Eating nutrient-deficient foods, not getting enough carbohydrates, protein or fat in your diet, or not eating enough in the day can fluctuate blood-sugar levels that worsen depression. In particular, however, the omega-three fatty acids have been shown to be quite helpful in treating depressive disorders. Also, exercise has been shown to extend the positive effects of psychotherapy treatment (USA Today, Exercise and Depression).
  5. Live authentically. Depression does inform; it can cause you to question much of what you once believed to be true and purposeful to your life. It’s a time of great self-doubt, dismantling your normal way of being. The confusion that depression often brings with it opens a space within you for examining and clarifying what you want. This is the beneficial face of depression. It is a blessing in disguise, if you make it so. You may be taken out of life temporarily, but if you use the passage well—you’ll come out on the other side more authentic and whole, healthy and wise.

Thus, do not let the social stigma that comes with depression stop you from getting help for it. Have courage. Do what you need to live well, despite depression. You deserve it.

If you Liked my post today, please let me know by selecting the Like icon that immediately follows. You can also Tweet or Google+1 about it, if you feel it may be helpful to other people. Be Well, warmly, Deborah.

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23 Responses to “Living With Depression”

  1. avatar Gina Rilke says:

    What a wonderful article! Thank you for talking about this debilitating illness in a way that offers hope and concrete steps for realizing a better life. I have suffered terribly with depression, but you are so right when you say it can actually be a means toward personal growth and, eventually, more freedom to live authentically. For me, medication was (still is) a big part of what helped me get to a place where I could begin to move through the darkness to a better place. A therapist and a good support system have also been invaluable. I couldn’t agree more with ALL the steps you offer. Thank you for helping to destigmatize depression ~ it’s nothing to be ashamed of. : )

    • avatar Dr. Deborah Khoshaba says:

      Hello Gina, I’m so glad you liked this article. You are welcome. It is a debilitating disease, but there are many people, like you, and me, who have found a healthier way to live with depression. Thank you for sharing that you too have struggled with deep depression. I see the ways creative, sensitive, insightful and authentic ways in which your suffering has also enriched you. You truly have let it inform you to the most beneficial action. Blessings to you dear Gina. Love Deborah.

  2. avatar Mahesh says:

    Like it

  3. avatar Pratik says:

    Dear Doc,
    Couple of weeks back, I started reading your articles on this website.I have found the link in a facebook page.I’m sure I’ve become a fan of your candid writing style to discuss the pertinent psychological issues in our everyday life.
    I’m a marketer and I love dealing things with psychology, NLP, latest research on mind, cognitive behavioral issues, hypnosis and so on.
    People around me perceive me as a ‘think-deep’ kind of a guy.I had depression and I went to a psychiatrist as well.Had taken antidepressant for some months and finally gave up!
    Anyway, this is just an attempt to let you about my type.My question is: People who read,think, interact and spend fair share of time with psychology or psychological stuffs (i.e. the psychologists, the psychiatrists, the counseling experts…) are they prone to caught depression? What’s the remedy for them? When you know the magic, you may not be surprised by it. Doesn’t this have a connection with depression as you have such an analytical mind that you are seeing through things and finally there’s nothing to be surprised.
    I hope, you are understandable.
    Keep this journey go on and on.

    Warm regards.

    • avatar Dr. Deborah Khoshaba says:

      Hello, thank you for being a dedicated reader of my articles and friend. This means a lot to me. Marketing and psychology go hand-in-hand, as you know. I like NLP also Pratik.

      You ask an excellent question. I don’t have research statistics on this subject, but I can tell you from experience, and knowing many therapists, that many of them have struggled with depression. Your hypothesis is correct. It’s interesting to think which came first, right? Does deep analytical thought stimulate depressive processes or do depressive processes make one more analytical? I think it is a two-way phenomenon. There’s probably, already, an analytical propensity but this in combination with certain personal experiences can certainly higher one’s tendency to reflect deeply upon experience. Also, you say something else that is very interesting and I have thought about much, myself. It is true that the more you think things through and the more that your reflections reduce fantasy and denial as to what life is all about–there certainly maybe a tendency toward some depression. It takes courage to see Life for what it is and us for who we really are (without denial and fantasy) because, then, we have to find joy and meaning in life from within ourselves. This is a good thing and psychologically healthy, but a challenge for people who need a lot of excitement and stimulation to stay engaged in living. I hope I’m saying things clearly here. You ask very deep questions.

      I’m sure you are a deep-think guy; you like psychology. Pratik, the remedy for depression depends upon the type of depression. If the depression is severe, medication is really needed to get the body and mind to run properly again. But, psychological understanding definitely positively affects the brain and nervous system. Just being able to think through, reflect upon and gain insight into the things that have happened to us in life can heal us emotionally, but also biochemically.

      Well, thank you again. I appreciate your friendship. Warmly, Deborah.

      • avatar Pratik says:

        Dear Doc,
        My happiness knows no bound after getting such a wonderful feedback from a knowledgeable person like you.I don’t really know who’s right or wrong and that’s not my concern.I liked what you said- “Does deep analytical thought stimulate depressive processes or do depressive processes make one more analytical? I think it is a two-way phenomenon.”
        I also think it is indeed a two way phenomenon and not mutually exclusive.
        What I think about the psychologists is: For giving a lot of people some comfort, some assurance about life, some caring, some clarification this particular professionals are willing to accept pain and discomfort about life.There is a philosophical question, I once wrote in my personal diary-‘ Who is the psychologist of the psychologist?’.
        Things are getting deeper.I better stop here.Let me wish something for you:
        ‘Have a warm, happy, healthy life with/without depression.’
        Reading something about extended mind.Quite interesting.Would love to share with you someday!.
        Till then, break a leg, Doc!

        Lukewarm regards,

  4. avatar deanna solodko says:

    I enjoy your posts so much, dear Dr. Debbie, please keep your good work going!

    • avatar Dr. Deborah Khoshaba says:

      Hello Dr. Deanna, what a pleasure to get to say hello to you from time to time now. I’m so glad you like my posts. Again, I see you so clearly in my mind Deanna. Your way of being and warm spirit has stayed with me. Warmly, Dr. Debbie 🙂

      • avatar amjad says:

        what s self analysis can u tell us from this site.what s ego and super ego .can any body exist without ego we sindhi people have overloaded with super ego any treatment of jealousy superiorty complem and other complex in life thanks i am doctor general physician but in there s not so much medics for general condition how we can treat psychic pt many drs specially big chairs r psychic how can we deal them pl explain i pray for u thanks so kind of u thaks

        • avatar Dr. Deborah Khoshaba says:

          Hello Dr Amjad, i like your question very much. If the super ego and ego is too strong so that it does not permit for healthy self expression, then the body and mind can suffer. As you already know, too much tension creates a number of different health problems and psychiatric problems like anxiety and depression. Thus if we have too many rules for our behavior, too many ideas about what is right or wrong, good or bad, we can creat too much stress on the body and mind. Freeing ourselves of what we should do can reduce. Lot of physical tension and make one happier and healthier.

          Also i think you are also saying that these patients are difficult to handle sometimes because they have their own way, rather than listening to their medical doctors. People who have very strong egos may not listen to medical advice too well. I have had patients like this too, sometimes, Amjad. I give them options in treatment, so they know the psychiatric option, or medical with regard to you, so that they feel that they have some choice. As you know, these type of people are very controlling and want to control the treatment. I think it is important to give them some control, with reason. I also give them the facts of the treatment so that they understand. These type of people need to know why so that they can feel like they have control.

          I know this is a challenging situation Amjad. Many patients want relief from their physical or mental troubles but are unwilling to take the treatments they need. I always tell people candidly but also with understanding that they will not get better without this treatment, but of course, in the end, it is up to them. War regards to you. And i am so pleased that you read this article today. Hope to see you here agIn. Deborah.

  5. avatar dr nowshad says:

    Its a great article.of course to treat underlying medical condition if any,like diabetes ,hypothyroidism,chronic liver disease.

    • avatar Dr. Deborah Khoshaba says:

      Hello Dr. Nowshad, thank you for your comment. You are so right. It is very important to rule out underlying medical conditions that may cause or exacerbate depression. I’m glad you stopped by to read this post today. Look forward to hearing from you again. Warmly, Deborah.

  6. avatar nabba says:

    A very informative post . Good piece of work.. Appriciated!!

    • avatar Dr. Deborah Khoshaba says:

      Thank you. I’m pleased that you find the post informative. There’s nothing more I love than giving people information to live their lives better. Warm regards to you Nabba. I hope to see you here again soon. Warmly Deborah.

  7. avatar Brandilynn V. says:

    This is a wonderful article, Dr. K! Thank you.

    • avatar Dr. Deborah Khoshaba says:

      Hi Brandilynn. Thank you. So good to say hello. I hope all is going very well. And, thank you for your support and friendship to me and Dr. Maddi. Warmly Deborah — Happy Holidays.

  8. avatar hameed says:

    Dear doc
    Im a medical student as student ur articles wil be benifitail for is my 1st time to read ur best article about most common but unrecognized disorder…

    • avatar Dr. Deborah Khoshaba says:

      I am very happy that you find my articles helpful to you as a medical student. Also congratulations on your studies in becoming a doctor. Yes, you are right it is a very common disorder that is often so unrecognized. Well said. I look forward to talking with you again. Warm regards to you Deborah.

  9. avatar Qasim Ahmad Ilyas says:

    Charles Darwin is clever enough to explain the importance of depression. Well, to the point this article certainly contains useful information and Mr Amjad’s comment about my dear country fellas.
    It is true that too many principles and social roles cause intra-psychic conflict, and resultantly within a person an anomie condition grows up. Consequently, provoking anxiety and heightened level of depression invades in. I believe this intra-psychic conflict is learnt and how other people look at their lives give us a crucial learning vantage. But importantly, by coping stressful events in an optimistic manner we can lessen the level of depression.
    My question to Dr. Deborah is; how can we treat people in a diverse culture such as In Pakistan, and what would be cross-cultural impacts of five step treatment plan?

    • avatar Dr. Deborah Khoshaba says:

      I like what you say about Darwin, Dr. Quasim. I agree very much. Yes, it is true that too many principles and social roles can restrict our personal freedom so much that it becomes difficult to initiate action, which causes depression. Depression does have many influences and social roles and restrictive principles is one of them.

      I very much like your question, and it’s a complex one to answer, as you know. Just the other day, for example, a young woman from India wrote me expressing exactly the subject that you and I are talking about, here. She has been withdrawn and has become depressed because her parents do not value what she wants to do for a career. I don’t want to disclose personal information, so I will stop here. Just to say that I was thinking very deeply about how to help her in the context of considering her parents’ wishes. Giving guidance in such situation requires a lot of thought. Cultural background and the family has to be considered when thinking about depression and a treatment plan.

      The very first line of treatment is to help family members to understand what depression is and that the depression is not the fault of the parents, or something deeply, mentally wrong about their depressed family member. As you know, what happens to the family member in diverse cultures is much like it is actually happening to the entire family. This really has to be understood by the treating clinician. That being said, enlisting the family into the treatment process can be vital to the treatment’s success. In cultures other than America, the family or group is much more important than individual freedom. Clinicians who exclude the family are making a mistake. I think therapy with more diverse cultures is an art. The clinician really has to appreciate how the culture feels about mental health problems. Balancing individual needs and concerns with the family is vital to treatment success.

      Additionally, the topic of medication and other treatments must be addressed with greater sensitivity to the cultural biases and beliefs about taking medication for a personal problem. In America, as you know, medication is discussed freely, it’s aired on television in ads throughout the day, and it’s become part of popular culture for many people to exchange with friends and family the medications that they take for various mental health issues. There’s little shame about taking medication here for a mental health condition. But, my experience with other cultures is that medication is a sign of weakness and that the depressed member is not strong enough in faith, will and belief to recover on his or her own. Mental health problems can make a family feel ashamed.

      Well, Quasim, I haven’t really given you a five step treatment plan, but I hope I talked about some of the main considerations when treating more diverse cultures for mental health issues. I hope this helps, for now. It’s a great question Quasim and something clinicians are always trying to learn more about and get better at doing. Thank you so much for stopping by Dr. Quasim and taking the time to comment. Warm regards to you Deborah.

  10. avatar Qasim Ahmad Ilyas says:

    I am not Dr.
    I acknowledge it is difficult to sum up with a unique solution. You said family needs to entertain with regarding the problems that a depressive person is suffering from. That’s the most difficult part of the assignment. People here too believe that individuals are free but not entirely as it is considered in America. Usually, in most cases families admit that their beloved ones are having mental problems. But when we talk about locus of control, the way a person feels about his or her surroundings, it becomes a hectic phenomena. You know, South Asian people believe that their fate or third party like God is responsible for their lives, and they try to hire spiritual healers who always put their lives in danger.
    What I have seen here in my country that people believe in medication then psychotherapy. Well, I think by educating people more we can prevent people getting into this disruptive health problem.
    Well, thank you for considering my comment valuable.


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