The Blues

The second-most topic I get emailed about is depression. Considering that most of the people who read this blog tend to be female, between ages 20-40, married, have at least one child, and do not have a family history of clinical depression or suicide, the majority of the focus in this blog will be on that demographic. However, because depression is a really broad-brush that affects people of all ages, I'll touch on some of the more common studies for others. I won't go into childhood or adolescent depression or geriatric depression here. If you're interested in any of those, there is a lot of research available.

Someone once told me, "It's normal to have bad days, bad weeks, sometimes bad years..." It was a friend, and she was talking about a marriage. However, this is so true for so many different aspects of our lives. There are actually studies that focus on this, called "Marital Satisfaction Across A Lifespan". It turns out that in pretty much every culture, in each society, we all have dips in our marriage satisfaction, and consequently our psyche right around the same time. Why? Because so often, as women, our marriage satisfaction and our life satisfaction are tied together....not always, but often. When we're a young couple, the satisfaction scale usually tends to be very high. It starts coming down as the first child is born, the lowest point is when the family has primary school-age children, starts coming back up as the children become adolescent, and is at it's highest once children leave the home and the couple retires. It's actually higher later in life than it was as a young couple. This is common, and there are jokes about having a "mid-life crisis", because as people feel low in their satisfaction with marriage, life, and themselves at around the same time. They may do things that they otherwise wouldn't do. Often people who go through this might feel a little depressed, irritable, or fearful. They might feel like their best years have gone by, and there's no way except downhill.

Usually depression is co-morbid with other things. What this means is that depression is often correlated with something else that is also present. There are numerous studies that support this about body image studies (depression co-morbid with obesity), abuse or neglect (depression co-morbid with abuse), neuropsychological disorders (depression co-morbid with schizophrenia or other neurological disorders), drug addiction (depression co-morbid with addiction), and the terminally ill (depression co-morbid with AIDS or cancer). Doctors (MD's) in all but 2 states in the US are the ones to prescribe anti-depressants. However, a family doctor is not a psychologist (Ph.D.), and therefore they'll often require the patient to see a psychologist to continue the medication. This is to work through whatever other issue may be present correlating with the depression, and also to develop coping skills so that the anti-depressant is used more as a band-aid until the person is able to cope effectively without it.

The most common prescription medication used for depression is called an SSRI (Seratonin Specific Reuptake Inhibitor). What this is designed to do is make the seratonin your body already produces go a little farther. Instead of it being reabsorbed in the neuron that released it, the SSRI blocks the neuron from reabsorbing it so that there is more seratonin available. Seratonin is our "feel-good" neurotransmitter. It is largely responsible for our mood along with some of our other basic drives.

There are some natural things that we can do to improve our seratonin levels - the first being exercise. Usually, the last thing someone with depression wants to do is exercise....but it's important. Why? When someone has exercised rigorously for 30 minutes or so, there is a rush in the brain of multiple neurotransmitters being released. Dopamine, norepinepherine, endorphins (endogenous morphine), and seratonin are all sprayed in multiple areas of the brain. That is why there are so many studies on exercise improving mood. For people with body-image problems, this is a two-pronged approach. Exercise can improve the body image, and it neurologically releases those feel-good neurotransmitters. A healthy diet, good deep sleep, and a feeling of balance are all also very important to make sure that our body is at it's highest functioning capacity.

Drug addiction is a tricky one. There are numerous studies on "Cross-Sensitization" meaning that people with former addiction develop depression or "manic depression" which is also known as bi-polar disorder. However, studies in rats show that rats who have been stressed are much more likely to develop drug addiction than non-stressed rats. So, it's a case of which came first....we may never know, what we do know is that it's a vicious cycle. Often, prolonged drug addiction to stimulant drugs causes nerve damage in the brain and changes the brain chemistry. Emotions may be difficult to handle, often because the drug was a coping mechanism to handle the emotion to begin with, so the individual may have never developed proper coping skills.

If someone has a terminal illness, chances are that they will be on the SSRI until they pass away. Usually, end-of-life psychotherapy is prescribed by the psychologist, which is very different than other types of psychotherapy.

There are also life's dips and twists that may cause bouts of depression. The loss of a spouse, child, parent, or close friend can definitely trigger this. Giving birth to a child can cause postpartum depression, most often attributed to rapidly changing hormones following the delivery of a child and the adjustment to being a parent. The loss of a job, children leaving home, going through bankruptcy or foreclosure, a divorce, or anything else that causes significant life-changing circumstances can also cause bouts of depression. Sometimes, we have the coping skills that we need already to handle the issue. Sometimes, we need a little help through it. Usually, it's a combination of our own psyche and the degree or severity of the circumstance that determines what amount of assistance we may need. Don't think that because you might need help you are weak, in fact it takes a really strong & brave person to ask for help.

In all cases, it's very important to be honest about any alcohol, drugs, or recreational drugs one may be using with their doctor. There are drug interactions when taking an SSRI, and there are side-effects as well. Alcohol should minimized or avoided altogether when taking an anti-depressant (if you think about it, it makes sense...alcohol is a depressant and an SSRI is an anti-depressant). This can affect the side-effects from the drug and also give the user a large amount of variance in the effects of the drug itself.

In all cases, if someone is feeling low, a little helpless, having issues with getting out of bed, irritable, anxious, having suicidal thoughts, or anything else....there are people highly trained to assist. Sometimes, all they need is a psychologist to talk to and work through some of the issues that may be causing these feelings. If a psychologist recommends that you speak to your family doctor about anti-depressants, then you've got a course of action. There are many types of psychotherapy, and not all types are equal. Cognitive-behavioral therapy is the most widely studied and practiced, and the most scientifically-validated...when seeing a therapist, ask them if they practice this type of therapy.